tag:theconversation.com,2011:/ca/topics/weekend-deaths-22541/articlesweekend deaths – The Conversation2016-01-11T14:37:13Ztag:theconversation.com,2011:article/525082016-01-11T14:37:13Z2016-01-11T14:37:13ZRevealed: link between NHS staffing levels and higher weekend death rates<figure><img src="https://images.theconversation.com/files/106521/original/image-20151217-8081-16n1458.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Better staffing linked to better odds of surviving emergency surgery</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?lang=en&language=en&ref_site=photo&search_source=search_form&version=llv1&anyorall=all&safesearch=1&use_local_boost=1&autocomplete_id=&searchterm=operating%20theatre&show_color_wheel=1&orient=&commercial_ok=&media_type=images&search_cat=&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=168767780">www.shutterstock.com</a></span></figcaption></figure><p>In recent months there has been a focus from the Department for Health towards delivering seven-day services within the NHS. This has been based, in part, on a number of studies that have demonstrated links between weekend admissions to hospitals and higher death rates compared with weekday admissions. It has been assumed that reduced staffing levels at the weekend is to blame, but there’s <a href="http://www.bmj.com/content/351/bmj.h4596/rr-5">not much reliable data</a> on which to base this assumption. We believe that our <a href="http://bja.oxfordjournals.org/content/116/1/54.full">latest study</a> could help inform the debate. </p>
<p>We examined the death rates of nearly 300,000 patients undergoing emergency abdominal surgery over a five-year period. The conditions covered included emergency bowel surgery, appendix removals, hernia repairs, and acute pancreatitis, rather than planned surgery. </p>
<p>The study investigated whether death rates varied among hospitals in the English NHS, and whether any factors could be identified that were linked to higher or lower death rates. If so, these might provide targets for quality improvements and reduce the number of deaths overall.</p>
<h2>Significant differences</h2>
<p>We found that death rates differed significantly among NHS hospitals. The hospitals with the best outcomes (lowest death rates) tended to have a greater access to diagnostic services, more critical care beds, and more operating theatres. Lower death rates also appeared to be related to higher staffing levels of all grades of clinicians, including consultants, and nurses. Finally, the study suggested that there was a lower death rate for patients admitted between Monday and Friday than on the weekend.</p>
<p>The best performing hospitals in the study had 60% fewer deaths relative to lower performing hospitals, although the absolute difference was small (3.5% versus 5.5% dying in the 30 days after surgery). The difference was attributed to 40% more surgeons per bed, 38% more junior doctors per patient admitted and 24% more nurses per bed. </p>
<p>The relationship existed despite the better performing hospitals treating a higher number of patients with more significant pre-existing medical problems, who would be expected to do worse from their surgery.</p>
<h2>More unwell on weekends?</h2>
<p>We suggest that patients admitted on the weekend might be more unwell, and so could be expected to have a slightly higher death rate. But this needs further investigation.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/107313/original/image-20160105-28988-14i6lex.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/107313/original/image-20160105-28988-14i6lex.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/107313/original/image-20160105-28988-14i6lex.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/107313/original/image-20160105-28988-14i6lex.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/107313/original/image-20160105-28988-14i6lex.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/107313/original/image-20160105-28988-14i6lex.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/107313/original/image-20160105-28988-14i6lex.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Better performing hospitals are better equipped.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?lang=en&language=en&ref_site=photo&search_source=search_form&version=llv1&anyorall=all&safesearch=1&use_local_boost=1&autocomplete_id=&searchterm=diagnostic%20lab&show_color_wheel=1&orient=&commercial_ok=&media_type=images&search_cat=&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=228495076">www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>This is the first analysis on this scale for emergency general surgical admissions, examining associations between the numbers of senior doctors, junior doctors, nurses and death rates. And it showed that hospitals with higher staffing levels had the best patient survival rates.</p>
<p>Although we have still not demonstrated causation, the findings are an important part of the debate over disparities in staffing and resource levels between NHS trusts. The results of this research suggest that recruiting, training and retaining the medical and nursing workforce is critical to delivering the best results for emergency surgery.</p><img src="https://counter.theconversation.com/content/52508/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Peter Holt receives funding from NIHR & British Heart Foundation. </span></em></p>A new study on death rates following emergency procedures shows that higher staffing levels are associated with better odds of surviving.Peter Holt, Senior lecturer, St George's, University of LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/508012015-12-09T11:12:48Z2015-12-09T11:12:48ZHow to build a better NHS with a beefed up front line of empowered GPs<figure><img src="https://images.theconversation.com/files/104840/original/image-20151208-32365-1v07py2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Pressure point. Smarter GP surgeries can lighten the burden on the rest of the NHS.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/worldbank/9345886598/in/photolist-feS7tQ-8rJnn8-hdNo5K-hfKw2m-3BTUfe-ekcbCY-arjhua-hfLDF4-xaGohs-53LXw5-hFGqqf-hFGt5o-7LJmVd-qS7PSb-71vE2L-bf51mv-hxbo5-bk8Yk4-mdHCSP-brnWyk-gp14PF-38oNBx-jbsecw-j9fnw-pQSGhF-8vqs8s-daApsn-5PQ8fV-64465-phhDQb-qh1Mi8-umFpG-7Lejnw-q3U8ZA-6d9EHD-pRB4j5-5HAzkZ-6nE1h6-7Sy3VX-e6G7DK-i657S-cXT6K7-uq5qJ-brnSPZ-2AMiw-2b2HTV-nHWq5z-sckRGx-G7GW8-hFG4z9">World Bank Photo Collection</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span></figcaption></figure><p>Britain’s National Health Service has spent much of its lifetime <a href="http://www.rcgp.org.uk/policy/rcgp-policy-areas/general-practice-2022.aspx">trying to get GP services right</a>. The answer lies in a simple combination of scale and specialisation that could bring efficiency as well as improved care. As the NHS hunts even more savings during a <a href="http://www.kingsfund.org.uk/blog/2015/10/nhs-spending-squeezed-never">spending squeeze</a>, the need has rarely been greater.</p>
<p>The local doctor’s surgery is most people’s point of first contact with the NHS and is all important in the modern world of health care. It is where demand and need management meet and where flaws in the system can be solved at source. Expanding what is available by building networks of surgeries would make that easier. Once someone enters the more <a href="https://www.routledge.com/products/9780415739269">complex health systems</a> up the chain, costs rise rapidly if they are misdiagnosed or sent for inappropriate treatments.</p>
<h2>Building scale</h2>
<p>There are some easy wins to be had. Building a better and beefed up GP system would help to address the anxieties that many people have around contacting medical services. And anxiety delivers dysfunctional results. Some go too often, <a href="http://gpaccess.uk/evidence/gp-consultation-how-long/">but never get enough time to explain themselves</a> and end up feeling more anxious and guilty each time they return. Others might put off going and <a href="http://www.nhs.uk/Livewell/men1839/Pages/Menshealthweek.aspx">ignore dangerous symptoms</a>. Late diagnosis is one of the biggest causes of escalating costs; earlier diagnoses <a href="http://www.incisivehealth.com/uploads/Saving%20lives%20averting%20costs.pdf">could save the NHS billions</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/104846/original/image-20151208-32365-1b909fe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/104846/original/image-20151208-32365-1b909fe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/104846/original/image-20151208-32365-1b909fe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=425&fit=crop&dpr=1 600w, https://images.theconversation.com/files/104846/original/image-20151208-32365-1b909fe.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=425&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/104846/original/image-20151208-32365-1b909fe.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=425&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/104846/original/image-20151208-32365-1b909fe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=534&fit=crop&dpr=1 754w, https://images.theconversation.com/files/104846/original/image-20151208-32365-1b909fe.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=534&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/104846/original/image-20151208-32365-1b909fe.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=534&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Building healthier lives.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/hammersmithandfulham/3146751485/in/photolist-piAwYE-5N66oa-eqEES3-5N4VzX">https://www.flickr.com/photos/hammersmithandfulham/3146751485/in/photolist-piAwYE-5N66oa-eqEES3-5N4VzX</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
</figcaption>
</figure>
<p>And those who do go when they should don’t always get the right help, and keep going back around the system. This reduces its capacity to do other things. Not everyone contacting their GP needs expensive medical help. But a GP visit should be an opportunity to provide them with what they need and to prevent other major health problems escalating later in their lives.</p>
<p>So how do we address this? First, build clusters by creating networks of smaller surgeries. This would make good creative use of generalists who can also develop their own part time specialities. With good management and leadership, GP surgeries could pool resources and each provide a different but complementary specialist diagnosis and treatment element to the cluster. There would also be a flow of specialists and treatment visits from area hospitals, and investment in higher quality diagnostic equipment in each cluster.</p>
<p>So, instead of having one local surgery, you might have access to three or four which were set up to tackle more effectively a wider range of medical complaints. Add in the excellent community relations with patient and charity groups that an efficient cluster of surgeries would pursue and the offering looks even stronger. It would also help smooth out inequalities around the country in terms of patient to staff ratios. There would be issues with this model in more dispersed parts of the countryside, of course, but this looks entirely workable in urban areas.</p>
<h2>Regular visitors</h2>
<p>Such a system would help tackle some key issues for the NHS. A broader offering which pulled in <a href="http://www.kingsfund.org.uk/sites/files/kf/Shaping-PCT-Provider-Services-the-future-of-community-health-Candace-Imison-The-Kings-Fund-April-2009.pdf">community health services</a>, charities and counselling services would help particularly to address the high proportion of visits to the GP which are for psychological problems, or for long term chronic conditions. Standards can only go up if these organisations are sharing how they do things in a cluster and learning from each other.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/104848/original/image-20151208-32388-1383d3y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/104848/original/image-20151208-32388-1383d3y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/104848/original/image-20151208-32388-1383d3y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/104848/original/image-20151208-32388-1383d3y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/104848/original/image-20151208-32388-1383d3y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/104848/original/image-20151208-32388-1383d3y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/104848/original/image-20151208-32388-1383d3y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/104848/original/image-20151208-32388-1383d3y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Signs of the times. Round the clock care.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/mwichary/2132378428/in/photolist-fJfNg2-tbdiA2-8RLNw8-5hAo4m-dBaRgW-4NLScW-8SAgd-WSYP-5XqPt5-pBorxs-anXQpP-4qZvBG-ck9id5-sn4Qm-oxiBzp-khTj51-9uV2Q-uaS85X-9QzawX-ehp7Bv-y9xGfG-51TX7U-5THb6Q-HgPKw-4fqZPj-2Mr3x-rRC4Jo-3oYcW8-3oYcDp-q5K2J-7HgRSM-8s1Rjx-HWPYw-u1d7N-83T28y-54oJc2-7jF2dB-3dBGC-dBve4-7x4LPS-c2ePFu-diQBE4-9UAso6-5pw5Zd-ffWUYV-ffWV5r-fhPwad-fhA1Sv">Marcin Wichary</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>These clusters of GP services could also form part of ambitions for a 24-hour NHS, plans which have seen strike action threatened by junior doctors <a href="http://www.bbc.co.uk/news/health-34965603">recently</a>. The <a href="https://www.nao.org.uk/report/stocktake-of-access-to-general-practice-in-england/">National Audit Office </a> has described the difficulty young people and the employed sometimes face when trying to make local doctor appointments. This can be all the excuse people need to put off necessary visits, which leads to more costly treatments down the line. Simply put, weekend GP services are almost as important as round-the-clock hospital care.</p>
<p>And the costs won’t be as onerous as you think. Prevention – early diagnoses and changing behaviour to make people healthier – is what primary and community health care is best at and this saves secondary hospital costs in later years. Total primary health costs are currently a relatively small proportion of <a href="http://www.health.org.uk/sites/default/files/FundingOverview_CurrentNHSSpendingInEngland.pdf">health care costs</a> compared to hospital care. </p>
<h2>Economies for the economy</h2>
<p>And if we want another way to improve primary health care, perhaps we could look to a new form of partnership between employers and the NHS. Employers lose billions of pounds <a href="http://www.hrmagazine.co.uk/article-details/sick-leave-costs-uk-employers-29-billion-a-year-says-pwc">when their staff go off sick</a> and this is made worse if employees have problems accessing primary care. Getting the right early help can be a big part of enabling reductions in sick leave. There may be something in it for employers to provide more primary health care support and advice? For example, providing flu immunisations to a large firm will most likely reduce winter absences. If the government provided incentives, it might even save the NHS money in the longer run.</p>
<p>The NHS is such a complex beast that it can only work with integrated and efficient services, helped along by a spark of quality leadership that aims to get the whole machine working to support common values. At the moment we’re not making the most of the part of the system most likely to set the tone for the entire enterprise. A successful NHS will be about collaboration above competition and should be creating local primary services that are large enough, broad enough and funded enough to make GPs not just gatekeepers to a strained hospital system, but powerful providers of first resort.</p><img src="https://counter.theconversation.com/content/50801/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Philip Haynes has previously received research funding from the ESRC and several charitable bodies.</span></em></p>Britain’s local healthcare system of small time gatekeepers should become stronger networks of powerful providers.Philip Haynes, Professor of Public Policy, University of BrightonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/505462015-11-12T11:56:57Z2015-11-12T11:56:57ZCutting hospital death rate at weekends is achievable – but keep a close eye on the number of admissions<figure><img src="https://images.theconversation.com/files/101572/original/image-20151111-9374-orv1h5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">More patients die at weekends</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-205406395/stock-photo-intensive-care-unit.html?src=dt_last_search-1">www.shutterstock.com</a></span></figcaption></figure><p>In a recent letter to junior doctors, secretary of state Jeremy Hunt again argued that “tackling higher mortality rates at weekends” was of <a href="http://www.telegraph.co.uk/news/health/11968014/Jeremy-Hunt-Junior-doctors-have-been-misled-by-the-BMA.html">utmost priority</a> and that he would be pushing pay reform through to tackle the “link between higher weekend death rates and reduced weekend services”. </p>
<p><a href="https://www.gov.uk/government/publications/research-into-the-weekend-effect-on-hospital-mortality/research-into-the-weekend-effect-on-patient-outcomes-and-mortality">Six studies</a> have found a link between higher weekend death rates and a reduced weekend service, the most <a href="http://www.bmj.com/content/351/bmj.h4596">recent</a> of which found that 11,000 more people die each year if admitted over the extended weekend, from Friday to Monday, compared with those admitted on midweek days. </p>
<p>Hunt’s solution is to increase weekend cover, with more senior consultants on hand to back up junior doctors, together with a full range of diagnostic and support services. His plan will work. By increasing weekend staffing levels, in time there will be a smaller difference between midweek and weekend mortality rates. But the gap may not close for the reason Hunt intends. </p>
<h2>Closing the gap</h2>
<p>The figure of 11,000 excess deaths was calculated by comparing the rate of deaths to admissions over the weekend with the midweek rate. There are two ways by which a rate can be reduced. One is to reduce the number of deaths of those admitted over the weekend. This is what Hunt wants. It may be that people are dying unnecessarily because there aren’t enough staff to care for them. If so, making more staff available at the weekend should help save lives. </p>
<p>But the weekend mortality rate can also be reduced by increasing the number of weekend admissions. If more people are admitted, then the weekend mortality rate would fall, even if the same number of people were still to die.</p>
<p>At the moment, simply because fewer staff are available, the chance of being admitted over the weekend is lower than <a href="https://www.nao.org.uk/wp-content/uploads/2013/10/10288-001-Emergency-admissions.pdf">during midweek</a>. And because the chance of admission is lower, those people that are admitted at the weekend <a href="http://www.bmj.com/content/351/bmj.h4596">tend to be sicker</a> than those admitted during the week. And, of course, sicker people are more likely to die. </p>
<p>To some extent, the higher likelihood of dying is taken into account in the calculation of mortality rates. But the calculation is imperfect because there is limited information about how sick patients are. Taking account of this missing information has been shown to be critical in the analysis of <a href="http://www.sciencedirect.com/science/article/pii/S0167629613000908">hospital readmission rates</a>, and efforts are being made to do something similar in analysing admission from <a href="http://www.nets.nihr.ac.uk/projects/hsdr/1212848">accident and emergency departments.</a> </p>
<p>Probably both the number of deaths and the number of admissions will change as a result of more staff being available at the weekend. So Hunt is likely to achieve his goal. By making more staff available, the weekend mortality rate is likely to fall. But the reduction is likely to be driven not so much by a fall in the number of deaths but mainly by an increase in weekend admissions. </p>
<h2>Saving lives</h2>
<p>This wouldn’t be an altogether desirable achievement. For one thing, reductions in the weekend mortality rate will come at the expense of efforts to <a href="https://www.england.nhs.uk/wp-content/uploads/2014/03/red-acsc-em-admissions.pdf">reduce emergency admissions</a>. For another, it may detract from more <a href="http://onlinelibrary.wiley.com/doi/10.1002/hec.3207/abstract">cost-effective</a> ways to save lives. </p>
<p>It turns out that hospitals have been getting better at keeping people alive over the past decade. This can be seen from data about hospital death rates published by the <a href="https://indicators.ic.nhs.uk/webview/">Health and Social Care Information Centre</a>, the latest release covering 2003-13. </p>
<p>There have been significant improvements in survival in the 30 days following coronary artery bypass graft, elective surgery and treatment for heart attack and leg fracture. But the most dramatic improvement has been in stroke survival, especially following the launch of the <a href="https://www.nao.org.uk/wp-content/uploads/2010/02/0910291.pdf">national stroke strategy</a> in December 2007.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/101688/original/image-20151112-9388-10nbpm3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/101688/original/image-20151112-9388-10nbpm3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=482&fit=crop&dpr=1 600w, https://images.theconversation.com/files/101688/original/image-20151112-9388-10nbpm3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=482&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/101688/original/image-20151112-9388-10nbpm3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=482&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/101688/original/image-20151112-9388-10nbpm3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=606&fit=crop&dpr=1 754w, https://images.theconversation.com/files/101688/original/image-20151112-9388-10nbpm3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=606&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/101688/original/image-20151112-9388-10nbpm3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=606&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Age standardised deaths per 100,000 within 30 days of a hospital procedure.</span>
<span class="attribution"><span class="source">derived from HSCIC https://indicators.ic.nhs.uk/webview/</span></span>
</figcaption>
</figure>
<p>The trends in survival are cause for celebration. When it comes to keeping people alive, the NHS has been making big improvements for quite some time. These improvements have not happened by chance, but reflect the success of efforts such as the national stroke strategy to improve prevention, diagnosis and treatment. A similar strategy is needed to address higher weekend mortality, underpinned by a better understanding of its causes and a review of how these might be addressed. Without this, the weekend mortality rate might well fall, but we’ll be no better off as a consequence.</p><img src="https://counter.theconversation.com/content/50546/count.gif" alt="The Conversation" width="1" height="1" />
<h4 class="border">Disclosure</h4><p class="fine-print"><em><span>Andrew Street receives funding from the National Institute of Health Research and the Department of Health's Policy Research Programme but the views expressed are his own.</span></em></p>Jeremy Hunt’s solution to cutting deaths in hospitals at the weekend is to increase staff levels. But is it just a fudge?Andrew Street, Professor, Centre for Health Economics, University of YorkLicensed as Creative Commons – attribution, no derivatives.