Eleven Thousand Excess Deaths Due to 'Weekend Effect'

in Special Feature 15 September 2015

Eleven Thousand Excess Deaths Due to 'Weekend Effect'

New figures on hospital deaths underline the urgent need for improving care at weekends in England. Medical chiefs say the case is "simply unassailable."

NHS England medical director Sir Bruce Keogh has called for action, as research he carried out with other doctors linked the so-called weekend effect to 11,000 excess deaths. How many of these could have been avoided is unknown.

The study is reported in the British Medical Journal, which says the findings raise "challenging questions" about weekends. It comes as the government tries to implement a policy of extending the services available to seven days a week.

'Weekend effect'

Similar research was conducted three years ago, but the latest report has examined hospital records covering 2013-2014. Seven senior doctors and statisticians, including Sir Bruce, took part.

15.9 million patients were admitted to hospital during the period, with 1.8 per cent - just over 290,000 - dying within 30 days. The weekend effect was identified after the data was analysed by day of admission. The study concluded that:

  • Friday admission = 2 per cent increased risk of death
  • Saturday admission = 10 per cent increased risk of death
  • Sunday admission = 15 per cent increased risk of death
  • Monday admission = 5 per cent increased risk of death
  • This gives a total of 11,000 excess deaths per year.

    Compelling Case

    The data was adjusted for variables including patients' age and severity of illness. Weekend admissions are usually for patients who are in greatest need, because routine operations such as knee and hip replacements are less likely to be carried out, and fewer community services are available.

    The researchers made clear that it was not possible to be certain that all variable factors had been taken into account, so it would be "misleading" to state categorically that all excess deaths were avoidable.

    However, Sir Bruce said he believed it presented a compelling case for action:

    "Doctors up and down the country routinely go the extra mile, well beyond any contractual duty, to save and improve lives. But the idea that patients are being harmed because of the way we organise our services is quite simply beyond what any of us can regard as acceptable.

    "The moral and social case for action is simply unassailable and there is widespread clinical consensus about that. Change always brings practical difficulties that must be tackled but we cannot duck the facts."


    Dr Mark Porter, Council Chair of the British Medical Association said: "Given the current funding squeeze on NHS Trusts, the only way for many hospitals to increase the number of doctors over the weekend would be to reduce the number providing care during the week.

    "If the government really want to deliver more seven-day services then they need to show patients, the public and NHS staff their plan for how this will be delivered at a time of enormous financial strain on the NHS and when existing services and staff are under extreme pressure."

    Health Secretary Jeremy Hunt said the findings should act as a "wake-up call".

    The BBC has a really useful guide, NHS weekend: 7-day services explained.

    More on this story:

    The BMJ

    BBC News

    The British Wheel of Yoga