Editorial: Doctors must join the world of 24/7

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When the new NHS Commissioning Board publishes its first planning guidance on Tuesday, a central proposal will be that hospitals and GP surgeries should move towards a seven-day working week. Such a change is long overdue. It is 15 years since the reform of Sunday trading laws allowed shops to open every day of the week. Yet hospitals remain stuck in a culture of nine to five, Monday to Friday.

This is a perversity that does not just affect the NHS. While many workers in the private sector accept flexible hours and seven-day rotas as part of the job, the emergency services generally, local authorities and public transport often depend on goodwill and generous overtime payments to operate "out of hours". Indeed, the very sectors that need to work 24/7 are the ones that have been slowest to adapt.

In the NHS, however, this hostility to change can mean the difference between life and death. Several studies have shown that patients admitted at weekends are more likely to die than those admitted on other days of the week. People cannot arrange to fall ill or suffer their accidents during standard working hours.

Yet this is how many hospitals still work, with consultants guarding their regular hours as a reward for their long years of training. The result is that hospitals may be staffed entirely by junior doctors and trainees at night and weekends – and, no, having a consultant "on call" is not enough – while expensive facilities, such as scanners and operating theatres, lie idle.

The head of the Commissioning Board, Professor Sir Bruce Keogh, is a forceful advocate of change, but the British Medical Association in particular has resisted. It may be that contracts will have to be revised, but we urge Sir Bruce to stand firm. The country can no longer tolerate a situation where medical services, whether hospitals or GP surgeries, are so out of kilter with the way the rest of the country works.

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