Birmingham Better Care
Improving Quality: 7 Day Service Team visit
Agenda
10:00
Arrival & refreshments
10:15
Welcome & introductions
Judith Davis: Programme Director, Birmingham Better Care
10:30
A patient & professional perspective
Perminder Paul: PM, Birmingham Better Care
10:45
7 day service: discharge hub
Pauline Mugridge: Group Manager, Acute Hospitals
Mary Ring: General Manager, Out of Hospital Care, HoEFT
11:00
Trusted Assessor, Trusted Assessment &
Trusted Organisation
Lorraine Thomas: Service Transformation Director, BCHC
Dawn Lowe: Senior Manager, System Integration LA
11:15
Comfort break
11:30
Community standards
11:45
Photographs
12:00
Networking lunch
All delegates and invited guests
1:05
7 day services: the acute perspective
Matthew Cook: Deputy Medical Director, Strategy & Transformation, HoEFT
1:25
7 day services: the staff perspective
David Byrne: Discharge Hub Clinical Team Leader
1:40
Supported Integrated Discharge Team (SID)
Julie Blake: Clinical Lead Promoting Independence
Karen Lewis: Solihull hospital Therapy and Intermediate Care lead
2:00
7 day forward view
Barbara King: Accountable Officer, Birmingham CrossCity CCG
2:35
Open Q & A
Barbara King: Accountable Officer, Birmingham CrossCity CCG
2:50
Closing remarks
Judith Davis: Programme Director, Birmingham Better Care
3:00
Close
Perminder Paul: 7 Days Project Manager, Birmingham Better Care
Lorraine Thomas: Director of Service Transformation, BCHC
Welcome and introduction
Judith Davis: Programme Director, Birmingham Better Care
About the 7 day services collaborative
• The early adopter application was based on delivery of the Better Care
programme.
• It has always been about changing the whole non-elective health and
social care system rather than a focus on specific elements.
• 7 day services runs as a common thread through all of the schemes in
the programme.
What is Birmingham Better Care
NHS and social care services in Birmingham are now caring for people with
increasingly complex needs and multiple conditions. We need to do things
differently to make sure we can provide the best care both now and in the
future.
Birmingham Better Care is one of the most concrete steps ever towards
making this change happen.
Estimated savings
What we will achieve: integration
• A more joined-up system which is easier to navigate
• An anticipatory system that focuses on prevention and keeping people
well where they live
• A culture of trust where professionals work together and understand
patient outcomes across an entire care journey
• A system fit for the future challenges it will face
Birmingham Better Care priorities
1.
Keeping people well where they live
2.
Making help easier to get
3.
Better Care at times of crisis
4.
Making the right decisions when people can no longer cope
Schemes within the programme
• Scheme 1: Developing and agreeing the case for change
• Scheme 2: Creating the impetus for change
• Scheme 3: Accountable community professional and defining new
Primary Care Service delivery models
• Scheme 4: Equipment and technology
• Scheme 5: Discharge from acute setting and step up/ down care
• Scheme 6: Instigate 7 day health and social care services
• Scheme 7: Establish Combined point of access
• Scheme 8: Improve data sharing between health and social care
• Scheme 9: Dementia strategy
The aims of the collaborative
• Developing Acute standards
• Working at interface between hospitals and community health and social
care services
• Working with NHSIQ to develop community standards
A patient and professional perspective
Perminder Paul: Project Manager, Birmingham Better Care
https://www.youtube.com/watch?v=O_Qw3tDEzUo
Good Hope Discharge Hub: one year on
Improving Discharges 7 Days a week
Pauline Mugridge: Group Manager, Acute Hospitals
Mary Ring: General Manager, Out of Hospital Care, HoEFT
WHERE ARE WE UP TO?
Joint Planning & Collaboration
Discharge hub open 7 days , mixed staff presence
Enhanced awareness of roles within & across the interfaces of health,
social care and independent/3rd sector services
Central point for complex discharge referrals & multiagency planning.
↓Duplication with TOC. More accurate reporting of delays/reasons
Escalation arrangements slicker and more effective
ADAT – multiagency planning for complex discharges – solution
focused, enhanced working together, weekend plans discussed
Front door REACT update: Capacity info available 7 days , having
access to additional OOH services, close working with BCHC & being
able to liaise and refer the more complex cases, access to hub &
service info weekends
Dedicated front door social worker & priority access to CU27 and
rehab units from the front door
Current ANP in reach service from BCHC
Partnership working & commitment to D2A model 7 days week
13
WHERE ARE WE UP TO contd..
Trusted/joint assessment
New broker model for access to EAB beds 7 days week with
trusted assessor service
Future D2A model to be underpinned by trusted assessor
support.
Trusted assessor status extended to social workers in the
Enhanced Assessment Units
TA competency framework (in progress)
Enablement / care available 7 days a week.
Enhanced assessment beds available 7 days a week.
14
Going Forward
• Agree vision for 7 day working across the whole economy – staffing
complement at weekend not equal to weekdays
• Joint assessments/trusted assessors
• REACT: - access to Carefirst; social workers 7 days per week;
expansion of coverage, being able to assess for reablement
packages
• BCHC – developing the Trusted Assessor Role/implementing and
developing the community standards
• Development of early supported discharge.
• Use of Just Checking for assessment and care planning.
15
TOTAL NUMBER OF WEEKEND DISCHARGES
FOLLOWING SOCIAL WORK ASSESSMENT
DISCHARGES:
JANUARY – DECEMBER 2014
CITY
GOOD HOPE
HEARTLANDS
MOSELEY HALL
SANDWELL
SOLIHULL
UNIVERSITY
WEST HEATH
TOTAL:
26
64
80
6
3
5
60
4
248
PLANNED DISCHARGES
WITHIN 2 WORKING DAYS
CITY
GOOD HOPE
HEARTLANDS
MOSELEY HALL
SANDWELL
SOLIHULL
UNIVERSITY
WEST HEATH
Main Presenting Reasons:
1. Awaiting Treatment 3. Awaiting CHC Assessment
2. O.T. Assessment
4. Physiotherapy Assessment
TOTAL:
52
97
131
87
5
5
144
59
580
5. TTO’s
Trusted Assessor, Trusted Assessment & Trusted Organisation
Judith Davis: Programme Manager, Birmingham Better Care
Comfort break
Community standards
Perminder Paul: 7 Days Project Manager, Birmingham Better Care
Lorraine Thomas: Director of Service Transformation, BCHC
Approach
• Action from the Birmingham Collaborative to promote whole
systems work around 7 day services
• Developed from Dudley CCG
• Collaboration with commissioners, providers and quality leads
• SDIP developed (service development implementation
programme) self assessment and developing progression
• Achieved, Achievable, Aspirational
• Will form a suite of Out of hospital standards for all providers
Standards
•
•
•
•
People referred for or requiring a review must be assessed for complex or on-going
needs with 48 hours by members of a multi-disciplinary team (MDT) with the
appropriate skills, 7 days a week.
Where a palliative care or an end of life carer need is identified following an
assessment, there needs to be a prioritised care management plan in place. For
end of life care: within 4 hours. Palliative care: (non-urgent within 24 hours).
People who require access to Assessments for an acute condition should be seen
within 2 hours, by appropriate community care professionals, provided by
integrated community services 7 days a week, through formal agreed networked
protocols to meet people’s health needs
Seven-day access to diagnostic services such as scans, x-ray and pathology.
Completed reporting will be available seven days a week.
Domains
•
•
•
•
•
Multi-disciplinary team
Personalised Care Plan
Shift handover
Access to advice from senior doctors
Access to urgent and non urgent diagnostics
Getting it right
• Do the standard compliment and support the
delivery standard 9 of the Acute contract
standards
• Diagnostics requirements to keep people out
of hospital at weekends
• Bridging services
• Workforce
Photographs
Networking lunch
7 day services: acute perspective
Matthew Cook: Deputy Medical Director, Strategy & Transformation, HoEFT
Patients need the NHS every day!
Evidence shows that the limited availability of some
hospital services at weekends can have a detrimental
impact on outcomes for patients, including raising the
risk of mortality.
If you were a patient
wouldn’t you want the same
treatment every day of the
week? A limited service can
mean delays to diagnostics,
interventions and
support…..your treatment.
7 day services is now a main focus in the NHS
‘The Academy of Medical Royal Colleges’ have agreed a number of
principles and Sir Bruce Keogh, NHS England's National Medical
Director has set out a plan to drive 7 day services across the NHS over
the next three years, starting with urgent care services and
supporting diagnostics.
Ten clinical standards have been identified:
1.Patient Experience
2.Time to first consultant review
3. Multi-Disciplinary Team (MDT) review
4.Shift Handovers
5.Diagnostics
6.Intervention/Key Services
7.Mental Health
8.On-going review
9.Transfer to community, Primary & Social care
10.Quality Improvement
What's happening at HEFT right now?
HEFT is an ‘Early adopter’!
‘NHS Improving Quality (NHS IQ)’ is working in partnership with
‘NHS England’ to drive improvement and change expertise in the
NHS and have developed a 7 day services improvement
programme which includes a cohort of early adopter
organisations.
HEFT is part of the Birmingham, Solihull & Sandwell Collaborative
which consists of a number of acute trusts (S&WB, HEFT and
UHB), Birmingham and Solihull City Council and community and
social care providers. With momentum from the Birmingham
Better Care board the collaborative is developing a system wide
approach across Birmingham, Sandwell and Solihull.
Produced by: Claire Jones – Project Analyst and 7 Day Services Support
•
Two questions regarding 7 day services have been posted on the
intranet to get your opinion.
•
We have been working with colleagues to complete the information
needed in the 7 day assessment toolkit. BHH and GHH is now
complete and SOL is soon to follow.
•
We will be working with colleagues to gather further information to
help further evidence whole system models of delivery
•
A one page summary diagram and quarterly dashboard is in
development to monitor our performance internally against the
clinical standards currently and going forward.
•
2 clinical leads have now been appointed to drive 7 day services
forward
January 2015
Patients need the NHS every day!
day services is now a main focus in the NHS
Expectations from Early Adopters
Within five years early adopters are expected to:
• Be regarded as experts in delivering seven day services;
- Delivering improved outcomes, including better experiences for patients, carers and the public
- Tackling local cultural and organisational barriers
- Realising savings and efficiencies
• Have demonstrated a range of approaches and models involving whole system approaches to the delivery of seven day
services;
• Have demonstrated the scope to make rapid progress at scale and pace;
• Have overcome the barriers to delivering coordinated care and support across pathways – testing radical options for
delivering care differently;
• Have accelerated learning locally, regionally and nationally; and
• Have improved the robustness of the evidence base to support and build the value of the case for seven day services across
the health and social care system.
Time Lines
•2014/15 – High level action plans with service development and improvement plans
•2015/16 – Clinical standards which have the greatest impact into National standard contract
•2016/17 – All clinical standards incorporated
Produced by: Claire Jones – Project Analyst and 7 Day Services Support
January 2015
Patients need the NHS every day!
day services is now a main focus in the NHS
Current 7 day services
• Nursing staff 24/7
• Therapy 7 day working: Physiotherapists, Occupational Therapists,
Speech and Language, Therapists and Support Workers across all
grades and specialties work their contracted hours over 7 days instead
of 5
• 24/7 RAID service at BHH and GHH 12/17 at SOL
• SPA – Single Point of Access for patients with a Bham GP (BCHC) and
Solihull GP (Solihull Community Services)
• SAFER care bundle: S - Senior Review, all patients should have a Daily
Consultant Review (sick and identified discharge patients prioritised
before 10am) A - All patients should have a Planned Discharge Date
<= 24Hrs F - Flow , every ward should have a min. of 1 bed available
from 9am to enable emergency assessment and theatre services to
flow safely E – Early discharge, 50% of our patients should be
discharged from base inpatient wards before midday, R – Review, a
weekly systematic review of patients with extended lengths of stay ( >
14 days)
• Medicines Reconciliation by admitting Doctor should be done within
24Hrs of admission (however pharmacy is not available at weekends).
• Integrated care 7 days a week *- A collaborative approach with
GHH, BCC and BCHC to achieve optimal patient flow through the
hospital including the following:
• Hospital based social workers 7 days per week*.
• Community Convalescent Unit *: At GHH for medically fit
patients requiring convalescence.
• Quick Discharge*: A bridging service for up to 5 days before the
full enablement package begins; providing home based
domiciliary care that commences within 4 hours of referral.
• Recovery at home*: a form of virtual ward for patients that do
not need an acute bed. These patients are cared for at home,
with nursing and domiciliary services, they are also under the
care of a hospital consultant.
• Re-ablement facility*: Cedarwood is located at Good Hope
Hospital and developed in partnership with housing care
provider Midland Heart, this purpose built re-ablement facility
provides accommodation and domiciliary support for patients
who are medically fit for discharge but need additional help for
example with mobility aids, diet, nutrition or personal
care before they can return home independently
Key:* = This information has been taken from the ‘Collaborative approach to providing integrated care 7 days a week …’ case study by Dawn Lowe (Senior Manager, System
Integration, Birmingham City Council) and Julia Hughes (Team Manager Good hope and Solihull, Birmingham City Council ) and NHSIQ
Produced by: Claire Jones – Project Analyst and 7 Day Services Support
January 2015
Patients need the NHS every day!
Gap Analysis and Potential
areas of focus
The newly appointed Clinical Leads: David Byrne - Discharge Hub
Clinical Team Leader and Rifat Rashid - Consultant Respiratory
Medicine will be driving forward 7 days services both internally and
system wide. Gap Analysis is underway and the Clinical leads will be
meeting with each directorate to identify where their services are at
in regards to 7 day services. This information along with the base lining
that has already been carried out will provide the ‘Action Plans and
service development and improvement plans’ due at the end of
2014/15.
day services is now a main focus in the NHS
Clinical Standard
Monitoring
A quarterly dashboard is in development to monitor our
performance internally against the clinical standards currently
and going forward; this is a one page summary for each site to
give a high level overview. This will be will be further developed
into a directorate level Dashboard.
Issues: During development of the dashboard it has become
apparent that not all standards can be easily measured due to the
limited data available and IT constraints.
Some potential areas of focus at HEFT have already been identified
which will be discussed in the clinical standards section.
Clinical Dashboard - Snap shot View
Produced by: Claire Jones – Project Analyst and 7 Day Services Support
January 2015
Patients need the NHS every day!
day services is now a main focus in the NHS
Clinical Standards
Please find below the Ten Acute Hospital Clinical standards. All standards will be worked towards however those which are presumed
to have the greatest impact into the national standard contract will be implemented in 2015/16 and are priority focus areas.
Comments
Focus Area in 2015/16
1 Standard: Patient Experience
We do not currently capture the views of
Patients, and where appropriate families and carers, must be actively involved in shared decision making and supported by
clear information from health and social care professionals to make fully informed choices about investigations, treatment and 7 day services in our standard surveys
however specific 7 day surveys within
on-going care that reflect what is important to them. This should happen consistently, seven days a week.
individual directorates may have been
Supporting information:
carried out.
• Patients must be treated with dignity, kindness, compassion, courtesy, respect, understanding and honesty at all times.
Action
• The format of information provided must be appropriate to the patient’s needs and include acute conditions.
• With the increasing collection of real-time feedback, it is expected that hospitals are able to compare feedback from weekday - 7DS experience implemented into
standard survey
and weekend admissions and display publically in ward areas.
- 7DS experience survey in those areas for
which the standard is a focus
Specialty
Focus Area in 2015/16
Patients admitted as an emergency
All emergency admissions must be seen and have a thorough clinical assessment by a suitable consultant as soon as possible
receive a consultant clinical assessment 7
but at the latest within 14 hours from the time of arrival at hospital.
days per week however this is at varying
Supporting information:
times.
1) All patients to have a National Early Warning Score (NEWS) established at the time of admission.
There also appear to be gaps in bullet
2) Consultant involvement for patients considered ‘high risk’ (defined as where the risk of mortality is greater than 10%, or
point ‘3’. Also relevant medicines surgical
where a patient is unstable and not responding to treatment as expected) should be within one hour.
expertise may not be delivered within the
3) All patients admitted during the period of consultant presence on the acute ward (normally at least 08.00-20.00) should be appropriate time frame for patients on
seen and assessed by a doctor, or advanced non-medical practitioner with a similar level of skill promptly, and seen and
outlying wards.
assessed by a consultant within six hours.
Action
4) Standards are not sequential; clinical assessment may require the results of diagnostic investigation.
- Explore the existing systems in place to
5) A ‘suitable’ consultant is one who is familiar with the type of emergency presentations in the relevant specialty and is able to ensure they are adequate.
initiate a diagnostic and treatment plan.
- extend dialogue with consultants and
6) The standard applies to emergency admissions via any route, not just the Emergency Department.
explore how input at weekends could be
7) For emergency care settings without consultant leadership, review is undertaken by appropriate senior clinician e.g. GP-led increased to improve discharge rates
inpatient units.
2 Standard: Time to first consultant review
January 2015
Patients need the NHS every day!
day services is now a main focus in the NHS
Clinical Standards
Emergency
Focus Area in 2016/17
3 Standard: Multi-disciplinary Team (MDT) review
MDT board rounds take place with the
All emergency inpatients must be assessed for complex or on-going needs within 14 hours by a multi-professional team, use of JONAH boards, however the MDT
attending the board round varies and do
overseen by a competent decision-maker, unless deemed unnecessary by the responsible consultant. An integrated
management plan with estimated discharge date and physiological and functional criteria for discharge must be in place not always meet the minimum for the
specialty
along with completed medicines reconciliation within 24 hours.
Action
Supporting information:
- Reinforce MDT board rounds with
• The MDT will vary by specialty but as a minimum will include Nursing, Medicine, Pharmacy, Physiotherapy and for
appropriate
teams.
medical patients, Occupational Therapy.
Specialty
• Other professionals that may be required include but are not limited to: dieticians, podiatrists, speech and language
therapy and psychologists and consultants in other specialist areas such as geriatrics.
• Reviews should be informed by patients existing primary and community care records.
• Appropriate staff must be available for the treatment/management plan to be carried out.
Focus Area in 2015/16
The shift handover process will vary
Handovers must be led by a competent senior decision maker and take place at a designated time and place, with multi- between departments . In some areas
professional participation from the relevant in-coming and out-going shifts. Handover processes, including
there appear to be gaps with evening
communication and documentation, must be reflected in hospital policy and standardised across seven days of the week. provision by consultants (until the night
Supporting information:
shift begins), designated places and
• Shift handovers should be kept to a minimum (recommended twice daily) and take place in or adjacent to the ward or times for handovers overseen by a
unit.
competent decision maker and keeping
• Clinical data should be recorded electronically, according to national standards for structure and content and include shift handovers to the minimum
the NHS number.
recommended.
Action
- Explore current practice within
individual departments with a view to
standardising handovers.
4 Standard: Shift handovers
January 2015
Patients need the NHS every day!
day services is now a main focus in the NHS
Clinical Standards
Specialty
5 Standard: Diagnostics
Emergency
Focus Area in 2016/17
There is a good provision of
imaging at weekends and
the imaging team are
developing a programme of
work in this area.
Hospital inpatients must have scheduled seven-day access to diagnostic services such as x-ray, ultrasound, computerised tomography
(CT), magnetic resonance imaging (MRI), echocardiography, endoscopy, bronchoscopy and pathology. Consultant-directed diagnostic
tests and completed reporting will be available seven days a week:
• Within 1 hour for critical patients • Within 12 hours for urgent patients • Within 24 hours for non-urgent patients
Supporting information:
• It is expected that all hospitals have access to radiology, haematology, biochemistry, microbiology and histopathology
• Critical patients are considered those for whom the test will alter their management at the time; urgent patients are considered those Actions will be developed
later in 2015/16
for whom the test will alter their management but not necessarily that day.
• Standards are not sequential; if critical diagnostics are required they may precede the thorough clinical assessment by a suitable
consultant in standard 2.
• Investigation of diagnostic results should be seen and acted on promptly by the MDT, led by a competent decision maker.
• Where a service is not available on-site (e.g. interventional radiology/endoscopy or MRI), clear patient pathways must be in place
between providers.
• Seven-day consultant presence in the radiology department is envisaged.
• Non-ionizing procedures may be undertaken by independent practitioners and not under consultant direction.
Focus Area in 2015/16
Most interventions are in
Hospital inpatients must have scheduled seven-day access to diagnostic services such as x-ray, ultrasound, computerised tomography
place however scheduled
(CT), magnetic resonance imaging (MRI), echocardiography, endoscopy, bronchoscopy and pathology. Consultant-directed diagnostic
lists do not take place on a
tests and completed reporting will be available seven days a week:
weekend.
• Within 1 hour for critical patients • Within 12 hours for urgent patients • Within 24 hours for non-urgent patients
Action
Supporting information:
- Check if new endoscopy
• It is expected that all hospitals have access to radiology, haematology, biochemistry, microbiology and histopathology
suite plans will help to
• Critical patients are considered those for whom the test will alter their management at the time; urgent patients are considered those address the issue.
for whom the test will alter their management but not necessarily that day.
- If endoscopy suite will not
• Standards are not sequential; if critical diagnostics are required they may precede the thorough clinical assessment by a suitable
address the issue, identify
consultant in standard 2.
the volume of activity
• Investigation of diagnostic results should be seen and acted on promptly by the MDT, led by a competent decision maker.
affected and create a
• Where a service is not available on-site (e.g. interventional radiology/endoscopy or MRI), clear patient pathways must be in place
business plan to achieve this
between providers.
standard.
• Seven-day consultant presence in the radiology department is envisaged.
• Non-ionizing procedures may be undertaken by independent practitioners and not under consultant direction.
6 Standard: Intervention / key services
January 2015
Patients need the NHS every day!
day services is now a main focus in the NHS
Clinical Standards
Emergency
Focus Area in 2016/17
7 Standard: Mental health
RAID (Rapid, Assessment, Interface and
Where a mental health need is identified following an acute admission the patient must be assessed by psychiatric liaison
Discharge) for people aged over 16 years
within the appropriate timescales 24 hours a day, seven days a week:
with mental health or substance misuse
• Within 1 hour for emergency* care needs • Within 14 hours for urgent** care needs
needs who access A&E departments in
Supporting information:
hospitals 24/7 in Birmingham and 12/7 in
• Unless the liaison team provides 24 hour cover, there must be effective collaboration between the liaison team and out-of- Solihull . Further work will be developed
hours services (e.g. Crisis Resolution Home Treatment Teams, on-call staff, etc.)
later in 2015/16
* An acute disturbance of mental state and/or behaviour which poses a significant, imminent risk to the patient or others.
** A disturbance of mental state and/or behaviour which poses a risk to the patient or others, but does not require
Actions will be developed later in 2015/16
immediate mental health involvement.
The trust has already made good progress in
8 Standard: On-going review
All patients on the AMU, SAU, ICU and other high dependency areas must be seen and reviewed by a consultant twice daily, this area and so further development is not
including all acutely ill patients directly transferred, or others who deteriorate. To maximise continuity of care consultants a priority however it is important to
maintain existing levels of service at
should be working multiple day blocks.
weekends.
Once transferred from the acute area of the hospital to a general ward patients should be reviewed during a consultantSpecialty
delivered ward round at least once every 24 hours, seven days a week, unless it has been determined that this would not
Continuous monitoring to ensure the clinical
affect the patient’s care pathway.
standard is maintained.
Supporting information:
• Patients, and where appropriate carers and families, must be made aware of reviews. Where a review results in a change
to the patient’s management plan, they should be made aware of the outcome and provided with relevant verbal, and
where appropriate written, information.
• Inpatient specialist referral should be made on the same day as the decision to refer and patients should be seen by the
specialist within 24 hours or one hour for high risk patients (defined as where the risk of mortality is greater than 10%, or
where a patient is unstable and not responding to treatment as expected).
• Consultants ‘multiple day blocks’ should be between two and four continuous days.
• Ward rounds are defined as a face-to-face review of all patients and include members of the nursing team to ensure
proactive management and transfer of information.
• Once admitted to hospital, patients should not be transferred between wards unless their clinical needs demand it.
• The number of handovers between teams should be kept to a minimum to maximise patient continuity of care.
• Where patients are required to transfer between wards or teams, this is prioritised by staff and supported by an electronic
record of the patient’s clinical and care needs.
• Inpatients not in high dependency areas must still have daily review by a competent decision-maker. This can be delegated
by consultants on a named patient basis. The responsible consultant should be made aware of any decision and available for
support if required.
January 2015
Patients need the NHS every day!
day services is now a main focus in the NHS
Clinical Standards
Specialty
9 Standard: Transfer to community, primary and social care
Support services, both in the hospital and in primary ,community and mental health settings must be available seven days a week to
ensure that the next steps in the patient’s care pathway, as determined by the daily consultant-led review, can be taken.
Supporting information:
• Primary and community care services should have access to appropriate senior clinical expertise (e.g. via phone call), and where
available, an integrated care record, to mitigate the risk of emergency readmission.
• Services include pharmacy, physiotherapy, occupational therapy, social services, equipment provision, district nursing and timely and
effective communication of on-going care plan from hospital to primary, community and social care.
• Transport services must be available to transfer, seven days a week.
• There should be effective relationships between medical and other health and social care teams.
Emergency
Focus Area in 2016/17
This standard is under
development with the
community.
Actions will be developed
later in 2015/16
Focus Area in 2015/16
All those involved in the delivery of acute care must participate in the review of patient outcomes to drive care quality improvement. The Actions
- Dialogue with Junior
duties, working hours and supervision of trainees in all healthcare professions must be consistent with the delivery of high-quality, safe
Doctors
and consultants to
patient care, seven days a week.
ensure
current
training is
Supporting information:
in
line
with
the
standard of
• The review of patient outcomes should focus on the three pillars of quality care: patient experience, patient safety and clinical
7
days
services.
effectiveness.
- Keep up to date with
• Attention should be paid to ensure the delivery of seven day services supports training that is consistent with General Medical Council
contract
negotiations
and Health Education England recommendations and that trainees learn how to assess, treat and care for patients in emergency as well as
regarding
staff training
elective settings.
and
working
patterns in
• All clinicians should be involved in the review of outcomes to facilitate learning and drive quality improvements.
relation to seven day
services.
10 Standard: Quality improvement
January 2015
7 day therapy services: a staff perspective
David Byrne: Discharge Hub Clinical Team Leader and 7 day services clinical lead
Therapies Directorate
•
•
•
•
•
•
•
150 Physiotherapists
100 Occupational Therapists
70 Dietitians
15 Speech and Language
50 Support Workers
3 Site
1,200 beds
The Journey
• Scoping: Jan 2010
• Staff Consultation Informal then Formal: AugDec 2010
• Phased Implementation: Jan- April 2011
• Formal Review: March 2012 and March 2014
• Whole System- next step
The Aims- Patients
• Reduce length of stay
• Achieve more discharges at the weekends
• Achieve timescales for assessment of patients
who had suffered a stroke
• Improve patient safety
The Aims- Staff
• Harmonise the reimbursements in line with
Agenda for Change
• Define when therapists are carrying out
routine work, on call or emergency duty
• Harmonise core hours
• Improve the rota’s for staff
• Equity across all sites
The Challenges
•
•
•
•
•
•
Cost- restructure rather than additional
Staffing- 5 days over 7
Managing complex rota’s
Staff Engagement
Changing the Culture
Time
Weekend Culture
• Only urgent patients seen
• Only minimum input to patients to “get
through to Monday”
• Too many junior staff on duty without access
to enough support
• On call support of seniors is rarely accessed so
of little value
• Sense of helplessness with those staff who are
on duty
Staff Concerns
•
•
•
•
Work life balance
Ability to manage week day caseload
Complexity of rota’s
“Not what we signed up for”
Staff Story- Ward Based OT
• Initial: “I was reluctant to change. I enjoyed
my weekends and was concerned about child
care”
• The change: “The process felt uncomfortable
but I understood that 7 day working was best
for the patient”
• Now: “I am happy with my work life balance. I
would not want to change back. Patients get a
much better service”
Staff Story- Ward Based Physio
• Initial: “I was concerned about how we would
staff the week days”
• Change: “After some teething problems we
were able to adapt the rota to ensure we had
adequate staffing 7 days a week…the therapy
bank really helped”
• Now: “The patients get much better care”
How The Staff Were Supported
•
•
•
•
•
•
•
Use Change Management Policy
Discussion and engagement- different type
Audit and feedback
Adapt solutions to individual areas
Give teams autonomy- particularly rotas
Separate the personal problems from the clinical hurdles
Personal issues can be overcome with; consultation, time,
Human Resource (HR) support
• Involve HR, Staffside and Staff Reps
• Identify training and ensure skill mix
The Outcome
• Level 3 Service
• Admissions avoided by 7 day REACT services is
between 40 and 50 each weekend across sites.
• Weekend discharges enabled due to therapy
presence in excess of 60 each weekend across
sites
• 2013/14 New in-patients assessed over weekends
totals 5,030
• 2013/14 Follow up in-patients seen over
weekends totals 21,037
Changing Staff Attitudes
1st year
• 72% Good for patients
• 75% happy with frequency
and availability of rota
• 58% happy with work life
balance
2nd Year
• 87% Good for Patients
• 80%happy with frequency
and availability of rota
• 67% happy with work life
balance
Therapy Comments- Patient
• “We are now meeting guidelines of
assessment of strokes”
• “New patients picked up quicker, gives a head
start for week”
• “We have been able to commence diet and
fluids earlier, rather than having to wait till the
following week”
• “Good to see patient’s relatives at the
weekend”
Therapy Comments- Staff
• “Nice to have days off in week to spend with
children”
• “It gives me the opportunity to do things
during the weeks, e.g. going to the bank etc”
• Majority of comments supported weekend
working either for personal reasons or for the
benefit of the patient even if they personally
did not like working them.
My Journey- Clinical Lead
•
•
•
•
•
•
Seen varying levels of 7 day services
Patients deserve 7 day services
Whole systems approach
Flow and capacity
Utilise learning from Therapies experience
Excited to be able to make a difference
Any Questions?
Supporting Integrated Discharge Team (SID)
Julie Blake: Clinical Lead Promoting Independence
Karen Lewis: Solihull hospital Therapy and Intermediate Care lead
Heart of England NHS Foundation Trust
Birmingham City Council
Solihull Metropolitan Borough Council
Our Drivers for Change
Service Experience pre–SID
https://vimeo.com/nhsmediahub/review/108456278/6c80b4163b
What did we do?
Partnership Steering Group
• Shared vision, objectives and values
• Prepared to take a risk
• Challenged traditional organisational and
professional boundaries
Developed integrated pathway
• Co-ordination of therapy (acute) and
personal care (social) services
Workforce redesign and development
•
•
Therapists trusted assessors for social care
Role enhancement
What does it mean for our patients?
https://vimeo.com/nhsmediahub/review/108456278/6c80b4163b
What does it mean for our workforce?
https://vimeo.com/nhsmediahub/review/108456278/6c80b4163b
What was important for success?
“Think like a patient, act like a tax payer”
Simon Stevens – NHS CEO
•
•
•
•
Right thing to do for patients – not finance driven
Commitment to deliver change for our people
Willingness to take organisational risks and trust each other
True Partnership Working – integrated model
7 Day Services Considerations
• Aim of the Service, hours that service is required for effective
delivery
• Staffing resource. Is there enough in all professions and roles?
• What can be done to start 7 day working on a voluntary basis for a
trial;
• How is on call used?
• Management cover;
• Absence cover, lone working
• HR support;
• Requires resilience; fortitude; vision; commitment; energy and
leading by example.
Seven day SID
Health
• Established SID rota through additional staffing and
redesign of traditional weekend rotas in hospital
and community.
• Training and utilisation of flexible working patterns
to expand number of therapists experienced in SID
model
• 1 qualified therapist and 1 support worker each
weekend with rest days in week
Seven day SID
Social care
Do you want to add something in here Julie
about what you provide and plans to
expand/difficulties with taking this forward?
Why is the SID Service an HSJ Award Winner?
“Its improved outcomes
for the whole system”
“Its what our
patients want”
“Its how our staff want
to work”
Questions?
7 day forward view
Barbara King: Accountable Officer, Birmingham CrossCity CCG
Open Q & A
Barbara King: Accountable Officer, Birmingham CrossCity CCG
Closing remarks
Judith Davis: Programme Director, Birmingham Better Care
Thank you
www.birminghambettercare.com
birminghambettercare@nhs.net
@bettercarebrum