Seven Day Services
Transformational
Programme
Ann Driver
Head of Programmes
NHS IQ
The Challenge
NHS Director promises
seven-day service by
2017
‘unstoppable movement’
Sir Bruce Keogh
The Sunday Times
July 20th 2014
So what are we to do?
“How can we take on
the extraordinary
challenge of
integrating services
into a seamless,
consistent, high
quality seven
day service?”
Fiona Carey,
Cancer & Patient Representative
Spread what we know works
Develop models to take us further
Enroll every provider &
commissioner
Build a momentum for change
Engage the public & patients
Commission the best
See local change happen at scale
& pace.
NHS Improving Quality
7 Day Services Improvement Programme
• The next 3 to 5 years, dedicated support, dedicated investment
• Signpost evidence from the diagnostic service reviews for 24/7 provisions across
England including Interventional Radiology, Endoscopy and Scientific services to
ensure providers and networks have plans in place to implement evidence
based seven day diagnostics services and models.
• Start the drive for spread: engaging every commissioner and provider in moving
towards the provision of services that are delivered in a way that meets NHS
England’s Seven Day Services clinical standards.
NHS Improving Quality
7 Day Services Improvement Programme
• Support organisations to understand their baseline position – self assessment
tool, build on the evidence, measure outcomes.
• Start to identify the top interventions which will make the biggest difference to
supporting delivery of local seven day services across the whole system.
• Supporting learning networks, communities of interest, building capability and
capacity, communication & engagement.
– CCG Development, Service Improvement & large scale change programmes
• Share the learning widely across the health and care communities
The next three to five years improvement programme
- dedicated support, dedicated investment
Self Assessment: Early Signs
1. Patient Experience – Lack of active
social care across 7 days.
2. Consultant review – NEWS score
widely used upon admission. A shortfall
in clinical assessments, consultation
involvement.
3. MDT – Significant variation, in terms of
access to timely complex needs
assessment and medicines reconciliation.
No area reports having access to
patients’ primary and community care
records.
4. Shift Handovers – Little electronic
recording of clinical data, the standard is
achievable across the country
Self Assessment: Early Signs
5. Diagnostics – Lack of weekend access to Bronchoscopy, Histopathology and MRI
6. Intervention / key services – The majority of inventions / key services are
available across 7 days across the country, variation in urgent radiology
7. Mental Health – One area of the country has excellent access to mental health
assessments, variation in access across the rest of the country
8. On-going review – Lack of an electronic record is hindering achievement
9. Transfer to care – Lack of weekend access to equipment provision, occupational
therapy, social services, senior clinical expertise & access to an integrated care
record
10. Quality improvement – Good involvement of those who deliver care in the
review of patient outcomes, majority of sites give training that is consistent with
General Medical Council and Health Education England recommendations
Taking on the challenge
•
Clinical & managerial engagement and leadership
– Strong senior clinical champions with a clear responsibility for 7 days
– Involvement of Workforce Lead , HR and Finance at the start
•
Organisational leadership and sponsorship
– Standing item on executive team meetings , keen interest on how things are progressing
and intervene when obstacles present
•
Collaborative/partnership working
– Senior representatives from all stakeholder organisations meet regularly and work in
partnership to achieve outcomes. Shared ownership of constraints and difficulties
– Some see transformation and working together as the only way forward and are making
efforts to engage with others
– Sharing the financial risks & benefits
•
Patient focus and a “Can do” attitude
– Patients as partners in service redesign and reconfiguration and a belief in what they
are trying to achieve
•
Dedicated management and capacity
– Recognition of the workload to achieve significant change across organisational
boundaries and at scale and pace
Taking on the challenge
“Stakeholders are finding it
difficult to ‘see outside their
own front door’ due to
operational pressures and
cost reduction”
“Competition between
Trusts and lack of trust
between us is one hurdle”.
“There are numerous plans
and strategies in place but
little positive action and
achievement”
“We were slow to realise that
it not about additional
funding or simply adding to
acute workforce, we were not
thinking laterally across the
whole health economy”
“Patients want 7 day
services but react when
we need to close, relocate
services to offer a 7 day
service"
“Everyone thinks that the CCG’s should be
driving the agenda as they have the legitimate
power but in some areas leaders are questioning
whether they have the courage to be radical”
Partnerships
Care Quality Commission
• The CQC and the Chief Inspector of Hospitals have agreed
to routinely assess the availability of seven day services as
part of the assessment of safety within a hospital. For
acute services to be judged safe they have to be safe seven
days a week.
Health Education England
• Has agreed that education contracts should include
consultant availability to provide adequate supervision of
doctors in training, seven days a week.
HS&DR Programme
Aim: to determine the cause(s) of increased weekend
hospital admission mortality
Website: www.hislac.org
Twitter: @HISLACProject
Hypothesis: reduced specialist input at weekends
Supported/endorsed by:
Phase 1: Develop metrics, measure specialist intensity
• 16,000 consultant and associate specialists across 119
acute Trusts recently completed the HiSLAC point
prevalence survey
Phase 2: Link intensity to HES data, local PAS data, quality of
care (4000 case record reviews) and ethnography; create
health economics model; measure changes over time.
Contacts:
•
•
•
Prof Julian Bion, Chief Investigator: c.s.price@bham.ac.uk
Dr Cassie Aldridge, Project Manager: c.p.aldridge@bham.ac.uk
Ms Amunpreet Boyal, Research Fellow: a.r.k.boyal@bham.ac.uk
Our work is focused on understanding the clinical, financial and workforce impact of
Seven Day Services across the health and care system
Across all settings of care
UEC
OOH
Define relevant standards and
services
Workforce impacts and
wider impacts
• Pathway- and issue-based
analysis
• Review of UK and international
evidence base
• Interviews with providers for
each of the two local health
economies
• Workshops with leads
• Challenge with Deloitte and
NHS England clinicians
• Refine
• Interviews with providers
• Data request
• Challenge with Deloitte
and NHS England
clinicians
• Benchmark with
information (including
data from Monitor,
London 7DS team, HFMA,
and early adopters)
Planned
Social
Services
Cost / benefit analysis
• Define costs / benefits
• Develop framework
• Estimate overall NPV
• Challenge findings
Minimise cost / maximise
benefit
• Define a plan for each
cost / benefit
• Use a workshop to refine
• Develop implementation
recommendations
• High level implications
for wider landscape (e.g.
impact on providers,
access etc).
Identify case study
providers
Our deliverable for NHS England will be a report outlining service definitions as well as impacts. This will include a technical
appendix with our modelling approach
13
Delivering 7 Day Services
Our role in Engagement:
Connect
- share, learn &
debate
•
Inform
- to expand
knowledge
National
Engagement
Service
- Enabler
- Building Trust
Connecting HRDs/Workforce
Leaders on 7 day services
work-stream
Influence
-practice & Policy
• Influencing
national policy
- Responsive
Challenge
'thinking to
innovate'
• Support and share –
enabling function
Seven Top Tips
1. Use a
systematic
Approach
2. Understand your baseline position
– “Don’t jump to solutions before you
understand the real problem “
3. Engage, communicate, partner, network ,
align with the whole system - “You cannot
achieve this alone”
4. Keep the focus on patients , safety, quality
of care & outcomes
5. Don’t ignore the big challenges
6. If your not measuring– your not improving If you are only measuring you’re not improving,
but measure & improve the right thing that
adds value
7. Get the messages right - services not
working. Share the learning. Think scale & pace