East Midland Clinical Senate
7 Day Services Programme
Chesterfield Royal Hospital NHS
Foundation Trust and East Midlands
Clinical Senate
Improving health outcomes across England by providing improvement and change expertise
Local Context
 Successful pilots Winter 2012/13 ‘improving patient flow
and outcomes’
 1 of 8 trusts involved in HFMA led Finance workstream of
7 Day Service Forum
 Fieldwork Summer 2013 (Emergency and Urgent
Services + Supporting Diagnostics)
 Report released December 2013
 NHS IQ ‘early adopter Site’ successful application –
December 2013
Improving health outcomes across England by providing improvement and change expertise
CRH Costing Summary

Main cost driving standards

Standard 2 - Consultant Time to Review

Standard 3 – MDT Review

Standard 5 – Diagnostics

Standard 6 - Interventions

Standard 8 – On-going Review (daily consultant
ward rounds)
Improving health outcomes across England by providing improvement and change expertise
CRH Costing Summary
Gross investment of c£3.8m



2.9% of our pay bill
Or 2.0% of patient care income
£4.0
70
£3.5
60
£3.0
Other
£2.5
Therapies
£2.0
50
Other
Therapies
40
Nursing
Radiology
£1.5
Medical Staff
£1.0
Nursing
30
Radiology
Medical Staff
20
10
£0.5
£0.0
0
Investment £ms
wte's
Improving health outcomes across England by providing improvement and change expertise
Vision
 Convinced morally ‘the right thing to do’
 Applied for early adopter - Health Community Supported
 Determined must be strategic Health Community approach
 Driven and overseen by our 21st Century Healthcare group
 Multi-Disciplinary / Multi Agency Project Board
Improving health outcomes across England by providing improvement and change expertise
Current Position
 Part of East Midland Acute Provider baseline assessment
 Continuing to build on approach from earlier pilots
 Submitted first cut data through NHSIQ tool
 Working across East Midlands to understand opportunities
 Launching live (health comm.) Project Board for delivery
 Working collaboratively with SYMYND on early challenges
as well as East Midlands providers
 (ENT/Max Fax/Ophthalmology/Diagnostics/Paediatrics)
Improving health outcomes across England by providing improvement and change expertise
EM Collaborative Project
 Agreed principles and enabling behaviours for clinical
collaboration - test on delivery of seven day services
 Phase 1 - 10 acute trusts:
 common understanding of the challenge – community
of practice
 platform for organisational development and change
 inform future commissioning and provision
 Providers as a key gear in the system; responsible for
engaging with local health and care community partners
 Workforce as a key enabler: Health Education East
Midlands
Improving health outcomes across England by providing improvement and change expertise
10 clinical
standards
Availability of
non- clinical
services
Clinical
outcomes
Workforce /
staffing
Finance
Gap Analysis &
Implications
Availability of
clinical
services
Options Development
Overarching Approach
Care
Pathways
Financial
Workforce
Demand,
capacity and
flow
1. Site/ Trust
2. Unit of Planning
3. East Midlands
Improving health outcomes across England by providing improvement and change expertise
Whole System View
Admission
Sources
Acute Trust
Discharge
Sources
Emergency
Department
Usual Place of
Residence
GP Referrals
Community Hospital
Self- Referrals
Urgent and Emergency Care
Pathway
&
Supporting Diagnostics
Nursing/ Residential
Home
Hospital Transfers
Primary/ Community
Care
Other Health Care
Provider
Social Care Packages
Interfaces
Third Party Resources e.g. Interventional Radiology
NHS | East Midlands - Seven Day Services Programme | 12/06/2014
9
Emerging Issues and
opportunities
1.
2.
3.
4.
5.
6.
7.
8.
9.
Patient Experience: inconsistent pro-active engagement
Time to First Consultant Review: lack of monitoring
MDT review: involvement of therapies
Shift Handovers: inconsistent guidelines and approach
Diagnostics: workforce and technology - radiology
Interventions: accessibility out of hours/weekends
Mental health: liaison services, input to A&E
On-going review: lack of consultant led daily ward rounds
Transfers: access new packages of care at weekends,
requirement to reassess
10. Improving quality:. inconsistent supervision of trainees
Improving health outcomes across England by providing improvement and change expertise
Next Steps
 Identification of options for future improvement
 Trust / Site level:
 Operational improvements / transactional change
 Organisation-specific transformation
 System level:
 Local health and care community / units of planning /
Urgent and Emergency Care Networks
 East Midlands – and beyond
 Data improvements and ongoing monitoring
 Potential to align priorities and delivery plans - Phase 2?
Improving health outcomes across England by providing improvement and change expertise
Questions
Improving health outcomes across England by providing improvement and change expertise
12