A whole system challenge -in a
challenged system !
South East Essex Health and Social Care
Improving health outcomes across England by providing improvement and change expertise
South East Essex seven day services
A whole system challenge – in a challenged system !
Improving health outcomes across England by providing improvement and change expertise
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Improving health outcomes across England by providing improvement and change expertise
Population 360,000
Peninsula location
2 CCGs
Southend Unitary
Council
• Essex CC
Local context
• Elderly population > than average at 17%, rising 20% by
2020
• Most densely populated area in East of England
• Low GP numbers plus high number of single handed GPs
• Southend Hospital has c650 beds, Cancer Centre,
Ophthalmology hub,
– bidding to be a Vascular hub and Hyperacute Stroke unit
• A whole system approach, Acute, Community, CCGs and
Council
Improving health outcomes across England by providing improvement and change expertise
Competing priorities & challenges
• Southend Council, CCG and Hospital are also partners in
the Integrating Health and Social Care programme as a
Pioneer site
• Year of Care pilot with D0H
• In March, poor A&E performance led to a Risk Summit with
Monitor
– Emergency Care Action plan
– Involving all partners, CCGs, CSU, LAT, NHS England
etc
• Other usual performance challenges, RTT, Cancer
Improving health outcomes across England by providing improvement and change expertise
A lot going on !
Improving health outcomes across England by providing improvement and change expertise
Where are we now ?
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Gap analysis done using the NHSIQ tool and ‘Perfect Week’
Linking strongly with the Pioneer programme
Embedding the clinical standards in the Emergency Care Action plan
Working with CCGs to address the A&E ‘open door’ issue
Length of stay (LOS) review - very few patients at > 7 days
– But a high number of <2 day stays
– Address with Standard 2 – Senior reviews
Started to resolve clinical engagement issues
‘Perfect Week’ completed
Realisation that 7 day services is not a project – it’s a set of standards to
be adopted across the system
Governance through Joint Executive Group (CEOs of partners)
Improving health outcomes across England by providing improvement and change expertise
Successes
• ‘Perfect Week’ highlighting 7 day services issues
• Consultant engagement following on from ‘Perfect Week’
• Experienced medical outreach team to address the ‘Deteriorating
patient’ out of hours
• Implementing NEWS (National early warning scores) in hospital
• LOS review highlighted quality of matrons and discharge team
• Discharge coordinator 7 days a week supported by rehab teams
• Frail Elderly assessment unit
• GP Federation in Castle Point CCG - 80% of GPs signed up, will
provide closer support to patients in Care Homes
• Creation of energy and commitment in the whole system
Improving health outcomes across England by providing improvement and change expertise
We’ve come a long way……
Improving health outcomes across England by providing improvement and change expertise
But it’s a long journey !
Improving health outcomes across England by providing improvement and change expertise
What next ?
• Implementing learning from the Perfect Week
– 7 day Frail Elderly Assessment Unit
– 24 hour ward clerk cover in AMUs 7 days a week
– Standardising nurse staffing levels across the 7 days
– Increase weekend Rehab/OT support
• Focus on increasing availability of Diagnostics at weekends
• Embed the SAFER bundle
– Twice daily senior reviews
• 7 day single point of referral for community care & services
• Social worker in A&E
• GP hub with integrated MDT working 7 days
• Review of 7 day services in community by Pioneer programme
Improving health outcomes across England by providing improvement and change expertise
But not necessarily a long walk !
Improving health outcomes across England by providing improvement and change expertise
Improving health outcomes across England by providing improvement and change expertise
Improving health outcomes across England by providing improvement and change expertise