7 day working a practical perspective
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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 . - PowerPoint PPT PresentationTRANSCRIPT
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7 Day WorkingA Practical Perspective
Dr Janet Williamson,
National Director, NHS Improvement
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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
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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
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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
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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
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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
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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
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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
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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!
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Financial• The need to save money – high cost of “on call”• New business opportunities – provider of choice• Reduce LOS• Enhanced tariff
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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
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Emerging Learning1. Admission prevention 2. Early diagnosis / intervention 3. Early supported discharge
Impact of 7 day examples
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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
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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
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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
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Barriers to ChangeWhat do you think the main barriers are to implementing/
extending 7 day working?
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
Financialconstraints
Recruitmentshortages
Patients will notwant to attend
Lack of staffwillingness
Other
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Stakeholder Views Do you believe we should be delivering more healthcare
services 7 days per week?
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
Yes No No View
Less than 20% have implemented
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“ 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?”