Oversight and Governance Committee
Michael Rawlins (chairperson), Jennifer Dixon, Peter Lees, Paddy Storrie, Alastair Henderson, Matt Sutton and Naomi Fulop.
Local project leads from participating NHS trusts
Dr Tim Felton and Dr Tim Cooksley, Manchester University NHS Foundation Trust; Dr Victor Lawrence, Isle of Wight NHS Trust; Dr Michelle Gallagher, Royal Surrey NHS Foundation Trust; Dr Rebecca Thorpe, University Hospitals Bristol NHS Foundation Trust; Dr Andrew Griffiths, Torbay and South Devon NHS Foundation Trust; Professor John Kinnear, Southend University Hospital NHS Foundation Trust; Dr Rupert Negus, Royal Free London NHS Foundation Trust; Dr Achim Schwenk and Dr Cathy Cale, North Middlesex University Hospital NHS Trust; Dr Fiona Wisniacki, The Hillingdon Hospitals NHS Foundation Trust; Miss Jane Wilson, Kingston Hospital NHS Foundation Trust; Dr Matthew Hayman, Taunton and Somerset NHS Foundation Trust; Dr Richard Jee, Dorset County Hospital NHS Foundation Trust; Dr Mark Lipton, Wirral University Teaching Hospital NHS Foundation Trust; Dr Shirley Hammersley, Mid Cheshire Hospitals NHS Foundation Trust; Dr Roope Manhas, Northern Devon Healthcare NHS Trust; Dr Shwe Zin Chit Pan, Bedford Hospitals NHS Foundation Trust; Dr Peter Albert, Bedfordshire Hospitals NHS Foundation Trust; Dr Andrew Alldred, Dr Peter Hammond and Dr David Scullion, Harrogate and District NHS Foundation Trust; Dr Franco Guarasci, Airedale NHS Foundation Trust; Dr Mark Blunt, The Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust; Dr Tina Tamm, Heatherwood and Wexham Park Hospitals NHS Foundation Trust; Dr Ian Reckless, Milton Keynes University Hospital NHS Foundation Trust; Dr Marcus Pittman, Basildon and Thurrock University Hospitals NHS Foundation Trust; Dr Allan Harkness, Colchester Hospital University NHS Foundation Trust; Dr Earl Williams, The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust; Dr Mark Daly and Dr David Friedericksen, Royal Cornwall Hospitals NHS Trust; Dr John Hollingsworth, Aintree University Hospital NHS Foundation Trust; Dr Magda Smith, Barking, Havering and Redbridge University Hospitals NHS Trust; Professor Anil Hormis and Dr David Harling, The Rotherham NHS Foundation Trust; Dr Anitha Mathews, Dr Suzanne Hamilton and Dr Callum Gardner, North West Anglia NHS Foundation Trust; Dr Paul Molyneux, West Suffolk NHS Foundation Trust; Dr Chris Adcock, Cambridge University Hospitals NHS Foundation Trust; Mr James Hobbs and Mr Martin Cooper, Royal Devon and Exeter NHS Foundation Trust; Dr Mike Clancy, University Hospital Southampton NHS Foundation Trust; Dr Andrew Gibson, Sheffield Teaching Hospitals NHS Foundation Trust; Dr Phil Young, Portsmouth Hospitals University NHS Trust; Dr Emma Vaux, Royal Berkshire NHS Foundation Trust; Dr David Wood, Guy’s and St Thomas’ NHS Foundation Trust; Dr Mehool Patel and Dr David Sulch, Lewisham and Greenwich NHS Trust; Dr Nnenna Osuji, Croydon Health Services NHS Trust; Dr Jane Evans, St George’s University Hospitals NHS Foundation Trust; Dr Viviana Elliott and Dr Jyothi Nippani, South Warwickshire NHS Foundation Trust; Dr Nick Coleman, University Hospitals of North Midlands NHS Trust; Mrs Deborah Price and Dr Andrew Willis, Burton Hospitals NHS Foundation Trust; Dr Sanjeev Srivastava, East Cheshire NHS Trust; Dr Frank Joseph, Countess of Chester Hospital NHS Foundation Trust; Dr William Bernal, King’s College Hospital NHS Foundation Trust; Dr Andrew Haynes, Sherwood Forest Hospitals NHS Foundation Trust; Dr Sam Waddy, University Hospitals Plymouth NHS Trust; Dr Richard de Boer and Dr Mike Iredale, University Hospitals Coventry and Warwickshire NHS Trust; Dr Clarissa Murdoch, The Whittington Hospital NHS Trust; Dr Lee Dowson, The Royal Wolverhampton NHS Trust; Dr Martyn Farrer, City Hospitals Sunderland NHS Foundation Trust; Ms Jo Sampson and Dr Rupert Ransford, Wye Valley NHS Trust; Dr Catherine Free and Dr Gordon Wood, George Eliot Hospital NHS Trust; Professor Erika Denton, Dr Neil Burgess and Mr Peter Chapman, Norfolk and Norwich University Hospitals NHS Foundation Trust; Dr Richard Warner, Salford Royal NHS Foundation Trust; Dr Natalie Walker and Dr Leonidas Zaccharides, Bolton NHS Foundation Trust; Dr Martin Pattrick, Tameside and Glossop Integrated Care NHS Foundation Trust; Dr Debesh Mukherjee, Great Western Hospitals NHS Foundation Trust; Mr Ben Cresswell, Hampshire Hospitals NHS Foundation Trust; Dr Aref Rastegar and Dr Lanitha Srikugan, Dartford and Gravesham NHS Trust; Dr Hassan Paraiso, The Dudley Group NHS Foundation Trust; Dr Rod Harpin, North Cumbria University Hospitals NHS Trust; Dr Raja Reddy, Kettering General Hospital NHS Foundation Trust; Dr Raghu Govindan and Dr Amanda Bisset, Northampton General Hospital NHS Trust; Dr Stuart Henderson, Salisbury NHS Foundation Trust; Dr Timothy Noble, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust; Dr Graeme Sanders, Medway NHS Foundation Trust; Dr Peter Burnham and Dr Kathryn Clark, Royal Liverpool and Broadgreen University Hospitals NHS Trust; Dr Jayachandran Radhakrishnan, Mid and South Essex Hospital Services NHS Trust; Dr Emma Rowlandson, Chelsea and Westminster Hospital NHS Foundation Trust; Dr Andy Morris, The Princess Alexandra Hospital NHS Trust; Dr Emma Rowland, Homerton University Hospital NHS Foundation Trust; Dr Rifat Rashid and Professor Matthew Cooke, Heart of England NHS Foundation Trust; Dr Kilimangalam Narayanan and Dr Christopher Scott, Gateshead Health NHS Foundation Trust; Dr Graham Johnson, Leeds Teaching Hospitals NHS Trust; Dr Catherine Snelson and Dr Mike Berry, University Hospitals Birmingham NHS Foundation Trust; Dr Samer Elkhodair, Dr Nicoletta Gaston, Dr Breid O’Brien and Ms Simone Akuffo-Akoto, University College London Hospitals NHS Foundation Trust; Dr Sean Elyan, Gloucestershire Hospitals NHS Foundation Trust; Dr Eliot Sykes, Northumbria Healthcare NHS Foundation Trust; Professor Richard Donnelly, Derby Teaching Hospitals NHS Foundation Trust; Dr James Price, Oxford University Hospitals NHS Foundation Trust; Mr Pasha Nisar, Ashford and St Peter’s Hospitals NHS Foundation Trust; Dr Sath Nag, South Tees Hospitals NHS Foundation Trust; Dr Andrew Higham, University Hospitals of Morecambe Bay NHS Foundation Trust; Dr Kiaran Flanagan, North Bristol NHS Trust; Dr Pauline Swift, Dr Aik Guam Lim and Dr Steve Hyer, Epsom and St Helier University Hospitals NHS Trust; Dr Paul Stevens, East Kent Hospitals University NHS Foundation Trust; Dr Nick Roper, North Tees and Hartlepool Hospitals NHS Foundation Trust; Dr Patrick McDonald, Southport and Ormskirk Hospital NHS Trust; Dr Nick Tierney, Pennine Acute Hospitals NHS Trust; Dr Sanjiv Jain, United Lincolnshire Hospitals NHS Trust; Dr Mark Ardron, University Hospitals of Leicester NHS Trust; Dr Vinay Bhatia and Dr Clive Lawson, Maidstone and Tunbridge Wells NHS Trust; Dr Michael Van Der Watt, West Hertfordshire Hospitals NHS Trust; Professor Phillip Smith, Miss Jane McCue and Mr Neil Harris, East and North Hertfordshire NHS Trust; Dr Colin Wasson and Dr James Catania, Stockport NHS Foundation Trust; Ms Anna Walker, Worcestershire Acute Hospitals NHS Trust; Dr Rehan Naseer, Calderdale and Huddersfield NHS Foundation Trust; Dr Keith Girling, Nottingham University Hospitals NHS Trust; Dr James Wilkinson, East Sussex Healthcare NHS Trust; Mr Ian Carr, The Mid Yorkshire Hospitals NHS Trust; Dr Heather Brown and Dr Wendy Munro, Brighton and Sussex University Hospitals NHS Trust; Dr David Carruthers, Sandwell and West Birmingham Hospitals NHS Trust; Professor Mark O’Donnell, Blackpool Teaching Hospitals NHS Foundation Trust; Dr Paul Peter and Dr Mike Jones, County Durham and Darlington NHS Foundation Trust; Dr Andrew Huang; Buckinghamshire Healthcare NHS Trust; Mr Charles Thomson, East Lancashire Hospitals NHS Trust; Dr Richard Heinink, Shrewsbury and Telford Hospital NHS Trust; Professor Julian Redhead and Dr William Oldfield, Imperial College Healthcare NHS Trust; Dr Tim Taylor and Dr Rob Haigh, Western Sussex Hospitals NHS Foundation Trust; and Dr Faris Al-Sultan, Weston Area Health NHS Trust.
Case note reviewers
Randeep Mullhi, Jonathon Coates, Neil Patel, Emma Carver, Zoe Kimbley, Nicholas Price, Akshay Nair, Sheena Sikka, Navinee Gilliat, Greg Packer, Anna Blackwell, Emma Christmas, Adebola Adebowale, Sebastien Ellis, Rebecca Mallinson, Farhad Peerally, Daniel Forster, Simmi Krishnan, Vishal Patil, Richard Hopkins, Ruth Todd, Sofia Cavill, James Murray, Imran Ghafoor, Katey Flowers, Paul Dean, Christopher Wright, Shreena Shah, Jonarthan Thevanayagam, Richard Hunt, Karwai Tsang, Mohammed Yusuf, Mark Whitsey, Brian Hogan, Amina Jaffer, Emma Bryden, Rebecca Powell, William Wareing, Yasir Elhassan, Parijat De, Manoj Viegas, Christopher Wharton, Michael Duffy, Richard Heinink, Chris Beet, Elin Roddy, Anna Szczerbinska, Annabel Makan, Manohasandra Majuran Manohasandra, Neel Patel, Behrad Baharlo, James Brown, Jun Jack Wong, Salmaan Mughal, Musarat Hussain, Nick Murch, Georgina Barrows, Ryan Boyle, Syed Habib Zaidi, Ivan Collin, Caroline Kibbler, Monica Bowa-Nkhoma, Clare Hughes, Muniswamy Hemavathi, Thomas Cozens, Khin Nyo, Debbie Beck, Claire Peplow, Devasena Subramayam, Tom McLellan, Gautam Bagchi, David Hartin, Stewart McMorran, Chung Thong Lim, Hiba Mohamed, John Ong, Hoi-Ping Mok, Ayesha Khaliq, Abigail Ford and Alison McInerney.
Additional acknowledgements
Felicity Evison for statistical support with Chapter 5.
Professor Nick Black and Dr Helen Hogan for access to their case record review methodology.
Emma Lancashire, Kam Gareja, Claire Price and Olivia Brookes for project support.
Elisa Liberati, David Kocman, Sarah Chew, Jen Jones and Emma Angell for conducting qualitative research visits to hospital sites (particular thanks go to Emma Angell for her role supporting project management).
Liz Shaw for her contribution to the analysis of qualitative data.
Xavier Armoiry, Caroline Higenbottam, Nicholas Cowley, Ranjna Basra, Chia-Wei Wu and Amy Gosling for their contribution to the systematic review.
Sue Pargeter, Manager, NIHR HSDR programme.
In memoriam
Professor Tim Evans: an outstanding researcher, collaborator, leader, clinician and good friend.
Contributions of authors
Julian Bion (https://orcid.org/0000-0003-0344-5403) (Professor of Intensive Care Medicine) was the HiSLAC project chief investigator. He developed the original design and contributed to methodology development, analysis of data and writing of the manuscript.
Cassie Aldridge (https://orcid.org/0000-0002-9162-3478) (HiSLAC Project Manager) contributed to data collection, methodology development, analysis of data and writing of the manuscript.
Chris Beet (https://orcid.org/0000-0002-9259-9852) (Specialty Registrar in Intensive Care Medicine) contributed to methodology development, development of the case record review and reviewer training materials, and the writing of the manuscript.
Amunpreet Boyal (https://orcid.org/0000-0002-5156-2869) (Research Associate) contributed to data collection, methodology development and writing of the manuscript.
Yen-Fu Chen (https://orcid.org/0000-0002-9446-2761) (Associate Professor, Population Evidence and Technologies) contributed to the systematic review, methodology development and the writing of the manuscript.
Michael Clancy (https://orcid.org/0000-0001-8669-5226) (Consultant Emergency Physician) contributed to methodology development and the writing of the manuscript.
Alan Girling (https://orcid.org/0000-0003-2022-045X) (Honorary Reader in Medical Statistics) contributed to data collection, methodology development, analysis of HES data, statistical analysis and the writing of the manuscript.
Timothy Hofer (https://orcid.org/0000-0003-0434-8787) (Professor of General Medicine) contributed to methodology development and the writing of the manuscript.
Joanne Lord (https://orcid.org/0000-0003-1086-1624) (Director and Professorial Fellow in Health Economics) conducted the health economics analysis and contributed to the writing of the manuscript.
Russell Mannion (https://orcid.org/0000-0002-0680-8049) (Professor of Health Systems) contributed to methodology development and the writing of the manuscript.
Peter Rees (https://orcid.org/0000-0001-5654-6254) (Patient and Public Involvement Lead) contributed to methodology development and the writing of the manuscript.
Chris Roseveare (https://orcid.org/0000-0002-9767-7725) [Consultant in Acute and General (Internal) Medicine] contributed to methodology development and the writing of the manuscript.
Louise Rowan (https://orcid.org/0000-0001-6211-3869) (Communications Fellow) contributed to collaborator engagement, dissemination of findings and the writing of the manuscript.
Gavin Rudge (https://orcid.org/0000-0002-9857-6547) (Research Fellow, Applied Health Research) contributed to data collection, methodology development, analysis of HES data, statistical analysis and the writing of the manuscript.
Jianxia Sun (https://orcid.org/0000-0003-4029-6515) (Statistical Intelligence Analyst) contributed to data collection, methodology development, analysis of HES data, statistical analysis and the writing of the manuscript.
Elizabeth Sutton (https://orcid.org/0000-0002-6691-6287) (Research Associate, Health Sciences) was involved in the qualitative research design and contributed to organising and facilitating the focus groups and interviews, analysis of data and the writing of the manuscript.
Carolyn Tarrant (https://orcid.org/0000-0001-7356-5342) [Professor and Research Group Lead of the Social Science Applied to Healthcare Improvement Research (SAPPHIRE) Group] devised and led on the qualitative research design, and contributed to analysis of data and the writing of the manuscript.
Mark Temple (https://orcid.org/0000-0003-1600-851X) (Consultant Nephrologist) contributed to methodology development and the writing of the manuscript.
Sam Watson (https://orcid.org/0000-0002-8972-769X) (Senior Research Fellow, Population Evidence and Technologies) contributed to the statistical methodology development for the cost–benefit analysis, conducted the health economics analysis and contributed to writing of the manuscript.
Janet Willars (https://orcid.org/0000-0002-7886-3223) (Honorary Visiting Fellow, Health Sciences) contributed to organising and facilitating the focus groups and interviews, analysis and writing of the manuscript.
Richard Lilford (https://orcid.org/0000-0002-0634-984X) (Director of NIHR Applied Research Centre West Midlands, and Research Methodology Lead for HiSLAC) contributed to the writing of the application, design of the project, health economics analysis and the writing of the manuscript.
Publications
Aldridge C, Bion J, Boyal A, Chen YF, Clancy M, Evans T, et al. Weekend specialist intensity and admission mortality in acute hospital trusts in England: a cross-sectional study. Lancet 2016;388:178–86.
Chen YF, Boyal A, Sutton E, Armoiry X, Watson S, Bion J, et al. The magnitude and mechanisms of the weekend effect in hospital admissions: a protocol for a mixed methods review incorporating a systematic review and framework synthesis. Syst Rev 2016;5:84.
Bion J, Aldridge CP, Girling A, Rudge G, Beet C, Evans T, et al. Two-epoch cross-sectional case record review protocol comparing quality of care of hospital emergency admissions at weekends versus weekdays. BMJ Open 2017;7:e018747.
Tarrant C, Sutton E, Angell E, Aldridge CP, Boyal A, Bion J, et al. The ‘weekend effect’ in acute medicine: a protocol for a team-based ethnography of weekend care for medical patients in acute hospital settings. BMJ Open 2017;7:e016755.
Sutton E, Bion J, Aldridge C, Boyal A, Willars J, Tarrant C. Quality and safety of in-hospital care for acute medical patients at weekends: a qualitative study. BMC Health Serv Res 2018;18:1015.
Watson SI, Chen YF, Bion JF, Aldridge CP, Girling A, Lilford RJ, et al. Protocol for the health economic evaluation of increasing the weekend specialist to patient ratio in hospitals in England. BMJ Open 2018;8:e015561.
Chen YF, Armoiry X, Higenbottam C, Cowley N, Basra R, Watson SI, et al. Magnitude and modifiers of the weekend effect in hospital admissions: a systematic review and meta-analysis. BMJ Open 2019;9:e025764.
Sun J, Girling AJ, Aldridge C, Evison F, Beet C, Boyal A, et al. Sicker patients account for the weekend mortality effect among adult emergency admissions to a large hospital trust. BMJ Qual Saf 2019;28:223–30.
Bion J, Aldridge C, Girling AJ, Rudge G, Sun J, Tarrant C, et al. Changes in weekend and weekday care quality of emergency medical admissions to 20 hospitals in England during implementation of the 7-day services national health policy [published online ahead of print October 28 2020]. BMJ Qual Saf 2020.
Data-sharing statement
All data requests should be submitted to the corresponding author for consideration. Access to available anonymised data may be granted following review.
Patient data
This work uses data provided by patients and collected by the NHS as part of their care and support. Using patient data is vital to improve health and care for everyone. There is huge potential to make better use of information from people’s patient records, to understand more about disease, develop new treatments, monitor safety, and plan NHS services. Patient data should be kept safe and secure, to protect everyone’s privacy, and it’s important that there are safeguards to make sure that it is stored and used responsibly. Everyone should be able to find out about how patient data are used. #datasaveslives You can find out more about the background to this citation here: https://understandingpatientdata.org.uk/data-citation.
Disclaimers
This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the HS&DR programme or the Department of Health and Social Care. If there are verbatim quotations included in this publication the views and opinions expressed by the interviewees are those of the interviewees and do not necessarily reflect those of the authors, those of the NHS, the NIHR, NETSCC, the HS&DR programme or the Department of Health and Social Care.
