7 Day Working
A Practical Perspective
Dr Janet Williamson,
National Director, NHS Improvement
Casting the net wide
•
•
•
•
•
•
•
•
SHA Medical Directors
NCD’s – Professional networks
Presidents & ex presidents
Clinical networks
E-bulletins – heart, pathology,etc.
Contacts - Trusts, primary care and community
Conference speakers
Site vists
30 Practical examples
•
•
•
•
•
•
•
•
Mental Health
Orthopaedics
Pharmacy
Respiratory care
Stroke care
Telemedicine
Therapy services
Cancer Care
• Cardiac care
• Integrated older
peoples service
• Community health
care
• Diagnostics
• General medicine
• Integrated systems
• Women's services
4 Level Model
• Level 1 –
Services limited to one department or a service that is
beginning to deliver some services beyond the 8am - 6pm Monday to Friday
service.
• Level 2 -
Services that are delivered 7 days per week, but not always
offering the full range of services that are delivered on week days.
• Level 3 -
A whole service approach to 7 day service delivery that
requires several elements to work together in order to facilitate clinical
decision making or treatment, often covering more than one work force
group
• Level 4 -
A whole system approach to 7 day service delivery by
integrating the requirements for elements of 7 day services across
more than one specialty area
6 Key Drivers for Change
• Personal desire to make the service more
equitable
• Policy and professional guidance
• Commissioning
• Improving access / increase in demand
• Financial
• Operational
Personal desire to make the service more
equitable, “it feels wrong as a professional”
• Less than optimum service
• Patient safety (real & perceived)
• Difficult carrying on delivering the service,
once you recognise the impact on your
patients
Policy drivers and professional guidance
• Policy (Stroke strategy & indicators)
• Recommendations from professional
organisations / royal colleges – RCP statement
( can also lead to different models e.g. NCEPOD)
• Compliance with clinical targets
• Safety & performance targets
Commissioning drivers
• To be a provider of choice, offering something
competitors don’t, but clinically justifiable
• Commissioners holding patient events /
consultations to shape the services they want
to commission
• Enhanced tariffs
• Access standards
Improving access / increase in demand
• No more capacity in “office hours”
• Increasing demand / or rising waits
(often having tried WLI’s)
• New service demand – servicing other
departments who now need your service
• New demand can be policy driven, clinically
driven, access driven, commissioner driven!
Financial
• The need to save money – high cost of “on call”
• New business opportunities – provider of choice
• Reduce LOS
• Enhanced tariff
Operational
• “Monday morning chaos” – backlogs, delayed
discharge, can’t do anything else for catching
up (elective capacity lost)
• Risk / safety – chaos leads to error, pts not
being managed appropriately, not treated
• Mergers – different conditions (inequity)
• Excellent Leadership & a “can do” attitude
Impact of 7 day examples
Emerging Learning
1. Admission prevention
2. Early diagnosis / intervention
3. Early supported discharge
Admission Prevention
• Services that are designed to care for patients
in their usual place of residence during times
of poor health or mental illness
– Birmingham Rapid response service
– Pan Gwent Frailty Programme
– Lancaster Intensive support team
Early Diagnosis / intervention
• No delays in assessment, diagnostics and
treatment leading to an earlier diagnosis and
intervention.
– Golden Jubilee National Hospital – enhanced
recovery
– Royal free Hampstead Trust -7 day
microbiology service
– Heart of England Hospital -7 day consultant
ward rounds
Early Supported Discharge
•
Patients returning home once they are able
to be supported in their own home by
services
– Lancaster Intermediate support team
– Birmingham community rapid response
Team
Barriers to Change
W ha t d o y o u think the ma in b a rrie rs a re to imp le me nting /
e xte nd ing 7 d a y wo rk ing ?
90.0%
80.0%
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
Financial
constraints
Recruitment
shortages
Patients will not
want to attend
Lack of staff
willingness
Other
Stakeholder Views
Do you believe we should be delivering more healthcare
services 7 days per week?
100.0%
80.0%
60.0%
40.0%
20.0%
0.0%
Yes
No
No View
Less than 20% have implemented
“ I was lucky. Shouldn’t
everyone of us have the
best chance possible,
no matter what time of
the day or day of the
week it is?”