Carole Smee NHSIQ 2 nd Dec 2014 Seven Day Services Improvement Programme
Time to Change Five day service model not meeting patient needs or expectations. Increasing evidence of poor outcomes for patients admitted at weekends - mortality rates - re-admission rates - length of stay - patient experience This change will be difficult - but it is the right thing to do. Sir Bruce Keogh, National Medical Director
Mortality rates Significantly greater risk of dying (up to 16%) for weekend admissions Multi-factorial, likely to be result of: Variable staffing levels Absence of senior decision-makers / consultant level skill and experience Lack of specialist services (eg diagnostics) Lack of specialist community and primary care services to support patients to die at home
Other outcomes Length of stay Factors contributing to unnecessarily longer stays more pronounced at weekends Waiting for senior assessment equates to longer LoS Readmission rates Working between different parts of system more difficult, impacting on readmissions Patient Experience Lack of senior decision makers hinders communication
The journey so far.. Everyone Counts: Planning for Patients 2013/14 - The NHS will move towards routine services being available seven days a week. Seven Day Services Forum established - urgent and emergency services, supporting diagnostics. Forum s recommendations approved by NHS England including adoption of 10 clinical standards.
The journey so far (cont d) Forum scope widened - consideration of a fully integrated seven day service. Five Year Forward View: key part of system transformation we will develop a framework for how seven day services can be implemented affordably and sustainably
The clinical standards Patient Patient Experience Experience Shift Shift Handovers Mental Health Intervention /Key services Time to first consultant review MDT Review Transfer to community and Primary and social care On-going review Quality Improvement Diagnostics
The timescale Year one 2014/15 Local contracts to include action plan for delivering the clinical standards. Year two 2015/16 Year three 2016/17 The standards which will have the greatest impact should move into the national quality requirements section of the NHS standard contract. All clinical standards incorporated into the national quality requirements section of the NHS standard contract with appropriate contractual sanctions in place for non-compliance.
Seven Day Services Partners
NHS Improving Quality s role Spread change, foster collaboration and build momentum Help with the how to : - spreading learning and knowledge - advice and support - resources to support delivery - connecting people Build capacity and capability - service improvement. Champion patient and public involvement. Evaluation and measurement of impact. Shape future policy - identify barriers/challenges.
Seven Day Services Improvement Programme 1. Diagnostics - spreading evidence-based models 2. Engaging all healthcare communities in moving towards services that meet the clinical standards and identifying the top interventions 3. Designing new models of seven day services
Early Adopters
Challenges There are numerous plans and strategies in place but little positive action and achievement. Stakeholders are finding it difficult to see outside their own front door due to operational pressures and cost reduction. Patients want 7 day services but react when we need to relocate services to offer a 7 day service." We were slow to realise that it not about additional funding or simply adding to our workforce, we were not thinking laterally across the whole health economy. Competition between Trusts and lack of trust between us is one hurdle. Everyone thinks that the CCGs should be driving the agenda but in some areas leaders are questioning whether they have the courage to be radical.
Success examples Epsom Hospital Co-located social care on the acute medical unit seven days a week consultant reviews every day, new MDT approach to manage discharge, social care team take lead role. Delayed discharges fallen by 50%. Seven day therapy services, Heart of England Foundation Trust Introduced seven day therapy service across its three sites in April 2011 staff work max of one weekend in five as part of contracted hours. Earlier discharges, improved access to rehab, high level of patient satisfaction, staff satisfaction increased.
Success examples cont d. Out-of-Hospital health and social care team, Great Yarmouth and Waveney Developed 24/7 co-located community (service) providing care at home for patients who would otherwise need admission - works alongside patient s GP to provide intensive, short term care, includes community nurses, OTs, physio, rehab support workers, social workers. Early indications of reduced hospital admissions and improved patient experience.
Key learning Get the message right: services not working. Needs to be a collaborative/system-wide approach. Think differently. Maintain patient focus. Staff engagement key.
Getting started Get leadership in place. Allocate dedicated capacity. Develop baseline (NHS Improving Quality selfassessment tool). Identify links with other work and local priorities. Get partners round table. Get in touch with NHS Improving Quality!
How we can help Help develop system-wide approach, including coproduction of local events. Knowledge and learning sharing connecting to others. Quality improvement and service redesign advice and support. Support with baseline, gap analysis and planning.
Self-assessment tool Developed to help plan for seven day services and national clinical standards. Provides baseline against standards, helps identify gaps and local needs. Considers patient involvement, barriers and drivers, and potential benefits. Use to stimulate discussion across local health community. Register at www.7daysat.nhs.uk
Contact us 7DayServices@NHSIQ.nhs.uk @NHSIQ #7dayservices carole.smee@nhsiq.nhs.uk