Seven-day NHS 'unaffordable' says BMA At a time we are doing that, I don't see that it's possible to move towards a consumerist seven-day-a-week service. He argued: "What resources we have should be put into caring for those who really need it most: emergency and acute patients." Earlier this month Dr Porter himself raised the issue of increased seven-day working by consultants. Addressing the BMA's annual conference of consultants, he told colleagues they needed "to embrace" recommendations by the royal colleges that there should be more senior doctors present at weekends and nights, to improve emergency care. "It's inescapable that this will in some cases mean increasing investment in order to increase the quality of care," he said. His speech followed numerous reports which found patients benefited from having a "consultant-present" service. Last autumn, Dr Foster Intelligence, a healthcare information service, found patients admitted as emergencies at weekends were almost 10 per cent more likely to die than those admitted during the rest of the week. The report, highlighted in The Daily Telegraph, also found hospitals with the fewest consultants working outside normal hours had worse performance. But while Dr Porter supported having more consultants working at nights and weekends to improve acute care, he criticised moves to expand weekend working further. Advocates argue it will make the NHS more efficient because it will mean expensive equipment does not lie idle two days a week, and will mean hospitals are less crowded with staff and patients between Mondays and Fridays. Demand is increasing, with more people using NHS hospital services every year, and many see weekend working as one way of coping better. Last night, Sir Bruce said providing more routine services at weekends "could provide long term savings for the NHS and the wider economy." But Dr Porter argued that weekend working could reduce efficiency between Monday and Friday, because rotas would have to be altered which made staff less available. Increasing the supply of appointments and operations could also have the unintended consequence of driving demand still higher, he said. "I'm not sure this analogy to retail experience is appropriate," he said. One of the things I've said to Sir Bruce is that while weekend retail opening was driven by demand, it has resulted in further increases in demand. Salary costs remained his main concern, however. Last month the Centre for Workforce Intelligence published a report calculating that "potentially, there could be a 60 per cent increase in the consultant salary costs" if the NHS adopted a "consultant-present" service. That would cost the NHS another £2.2 billion a year in consultants' wages, up from £3.8 billion in 2010, it estimated. Currently the NHS budget is about £104 billion and there are no plans to increase it. Health economists argue this amounts to a real-terms cut because more people are using the service, and costs are increasing rapidly. Dr Porter said that the cost of expanding consultant services to seven days a week would "undoubtedly" exceed £2.2 billion a year, as the CfWI's estimates were largely based on having more senior doctors available for acute care. Consultants were already paid a third more per hour for working at weekends, to provide emergency care, he noted. He went on: "When you are talking about doing things purely for convenience, rather than patient safety, we have found that hospitals have been paying a lot more in excess of that, sometimes embarrassingly so. It's in excess of the standard overtime rate because it's not essential. The Royal College of Physicians, of which many hospital consultants are members, is minded to agree with Dr Porter, said a spokesman. She said: "Our priority would be to address acute care issues and having doctors at the hospital 12 hours a day, seven days a week to cover acute care. Consultants covering the acure medical unit should have no other duties during this time. In response, Prof Sir Bruce Keogh said: "I agree with Mark Porter about the need to improve emergency services, but we also need to be more ambitious for patients with less urgent complaints. They need convenient and compassionate services too. Well designed, convenient weekend services could provide long term savings for the NHS and the wider economy by providing more rapid diagnosis, quicker treatment and advice, reduce time in hospital for some patients and time off work for others. This is why I am starting a wide-ranging debate on this issue.