7 Day Working

'Physiotherapy has demonstrated it is an essential healthcare service and this makes it difficult to sustain workforce based arguments that limit access to most physiotherapy services to a week day during office hours. Improvement to equity of access of physiotherapy care for patients and evidence based research has indicated a need to improve patient access to physiotherapy at weekends. Wide service re-organisation, the introduction of competitive pressures in the NHS and a drive to increase productivity are also increasing demand for a review of on call provision of physiotherapy services during the weekend.'                                                                                                                                                                       (CSP, 2008)

What is 7 Day Respiratory Working?

-    A new rota that provides physiotherapy access seven days a week, without increasing staffing levels or working hours (37.5 hours a week).

-    Physiotherapists work 3 to 4 days a week on longer shifts with increased breaks resulting in more days off a week

-    Physiotherapists will receive the timetable of working shifts 1 year in advance to aid the planning annual leave. (Guys and St Thomas's 2010)

Advantages to Patient

 -   Same care available throughout the week
 -   Reduced likelihood of readmission
 -   Return to function sooner with treatment available over 7 days
 -   Responsive and reactive service that allows assessment and treatment much sooner and more  often
 -   Continuity of same physiotherapist throughout the day
 -   Doubled provision of respiratory physiotherapy from 45 to 84 hours a week
 -   Integration of ITU team as a whole     

                                                                                                                                 (CSP, 2011) 

Disadvantages to Patient

 -   Lack of continuity with staff from day to day for patient and family
 -   Not increasing staffing levels, but spreading over longer hours, may impact on patient care

Advantages to Physiotherapist

 -   Flexibility over the year - willingness to work more weekends over certain times of the year
 -   Work over bank holidays - time in lieu
 -   Increased days off
 -   Better pay for same overall hours                 

                                                                                                                               (CSP, 2008)

 -   Improved work-life balance (for some)
 -   Discharges possible over the weekend
 -   Same shift patterns as doctors and nurses resulting in unification
 -   Further integration into team
 -   Work in same ward more often
 -   Reduced on-call shifts
 -   Self-rota system allows for staff to choose what days they would like to work
 -   During week complements MDT provision         

                                                                                                                                (CSP, 2011)

Disadvantages to Physiotherapist

-    Long working day

-    Unsocial hours

-    Lack of continuity between staff from day to day

-    Staff meetings and in service training more difficult to organise

-    Supervision of students and Band 5s becomes more difficult

-    Decreased work-life balance (for others)

-    Could feel that it is being 'forced upon' them

-    Worried about contract termination if not compliant (current staff)

-    Worried about standard of service offered to patients

-    OTs and SALTs not available over weekend

-    Continuity of information to the family becomes more difficult on a day to day basis 

-    Staff availability at times suited to surgical team and other working patterns

                                                                                                                                   (CSP, 2008)

                                                                                                                             (CSP, 2011)

Other Considerations

-    Predictability of shifts required to maintain job satisfaction 

-    CSP recommends minimum roster period of 13 weeks with not less than two months notice

                                                                                                                             (CSP, 2008)

-    Development of online resources and a summary of session 

-    Availability of meeting minutes

-    Requires appropriate funding and research for an effective system

-    Use of pilots

-    Joint decision to implement system to benefit of trust and staff (CSP, 2008)             

                                                                                                                                           (CSP, 2011)

Cost

-    The Average cost of critical care beds is 1.3 billion annually in England (Department of Health, 2011)

-    In 2010, almost 15,000 people were admitted to an ITU bed with a further 590,000 occupying an HDU bed. (Department of Health, 2011)

-    Approximately 110,000 people spend time in intensive care units after critical illness in England and Wales each year  (National Institute for Health and Clinical Excellence, 2009)

Cost Efficiency

-    Reduced likelihood of readmission --> Lowered costs

-    £500,000 investment cost is required including, short term set up costs, possible additional staffing and change of system 

-    Long term reduction in costs with shorter ITU and HDU stays

-    £52,000 reduction annually in temporary staffing cost

-    £45,000 reduction annually in staff sickness rates

-    £45,000 reduction annually in on-call payments for out-of-hours working. 

-    Efficiency savings of £20,000 annually

 Investment to be recouped over a 3 year period.                                                                

(Guys and St Thomas', 2010)

Conclusion   

7 day respiratory working has many advantages and disadvantage both to the patient and to the staff alike, however: 

-    Patients are more likely to benefit but lack of continuity and staff availability does put them at a disadvantage.  

-    Staff, despite increased financial benefits, are worst off in moral related to job dissatisfaction, job insecurities, familial as well as social discontentment. 

-    Setting up of the program, as well as limited number of   staff being sparsely distributed to cover new shifts might subsequently increase their workload and may result in negative psychological effects in the long term.     

-    Costs for setting up the program are positive according to figures from St. Thomas where the program has been in practice since 2010.  Here financial benefits to the NHS appear to far outweigh disadvantages as well as initial set-up costs, which according to the figures will be re-couped over a mere 3 years period.

References

CSP (2008) Seven Day Working, Shift Working and Extended Hours Working

CSP (2011) Seven days a week

CSP (2011) Seven-day workers win excellence award

CSP ( 2011) Intensive care

CSP (2011) Downside of seven-day working

Guys and St Thomas's Hospital NHS Foundation Trust (2010) 7 Day Working, Examples of Innovation and Good Practice