Time to Change

• Increasing evidence of poor outcomes for patients admitted at weekends.

• 5 day service model not meeting patient needs or expectations.

“This change will be difficult - but it is the right thing to do.”

Sir Bruce Keogh, National Medical Director

Mortality rates

Medical Royal Colleges and the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) research demonstrates a significantly greater risk of dying within 30 days of admission (up to 16%) for weekend compared to weekday admissions

Higher mortality rate is multi-factorial and likely to be a consequence of:• Variable staffing levels in hospitals at the weekend• Absence of senior decision-makers of consultant level skill and

experience• Lack of consistent specialist services, such as diagnostic and

scientific services at weekends• Lack of availability of specialist community and primary care

services, which might otherwise support patients to die at home

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…

• Forum scope widened - consideration of a fully integrated seven day service

• 5 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 10 Clinical Standards

Patient Experience

Time to first consultant

review

MDTReview

Shift Handovers

Transfer to community and Primary

and social care

MentalHealth

Quality Improvement Diagnostics

On-going review

Intervention/Key services

Standard 5 DiagnosticsHospital 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 for whom

Adapted from SourceRCP (2007): Acute medical care: The right person, in the right setting – first time RCS (2011): Emergency Surgery, Standards for unscheduled surgical care AOMRC (2012): Seven day consultant present care RCR (2009): Standards for providing a 24-hour radiology diagnostic service NICE (2008): Metastatic spinal cord compression

Standard 6- Intervention/key servicesHospital inpatients must have timely 24 hour access, seven days a week, to consultant-directed interventions that meet the relevant specialty guidelines, either on-site or through formally agreed networked arrangements with clear protocols, such as:

• Critical care • Interventional radiology • Interventional endoscopy • Emergency general surgery

Supporting information: Standards are not sequential; if an intervention is required it may precede the thorough clinical assessment by a suitable consultant in standard 2. • Other interventions may also be required. For example, this may include: • Renal replacement therapy

Adapted from SourceNCEPOD (1997): Who operates when? NCEPOD (2007): Emergency admissions: A journey in the right direction? RCP (2007): Acute medical care: The right person, in the right setting – first time RCS (2011): Emergency Surgery, Standards for unscheduled surgical care British Society of Gastroenterology AoMRC (2008): Managing urgent mental health needs in the acute trust

The Timescale

• Standard contract to include action plan for delivering the clinical standardsDeadline - March 2015

Year 1

2014/15

• The standards which will have the greatest impact should move into the national quality requirements section of the NHS standard contract.

• 50% implementation by March 2016

Year 2

2015/16

• All clinical standards incorporated into the national quality requirements section of the NHS standard contract with appropriate contractual sanctions in place for non-compliance.

• Full Implementation by March 2017

Year 3

2016/17

Seven Day Services Partners

Seven Day Services ProgrammeImprovement Priorities

1. Diagnostics – targeted improvement spreading evidence-based models

2. Start the drive for spread by identifying the top 5 interventions which make a difference through working with healthcare communities

3. Designing new models of seven day services for whole systems change

Early Adopters

LevelsLevel 0 - Five days a week, Monday to Friday 9am to 5pm.

Level 1 - Services limited to one department or a service that is beginning to deliver some services beyond the 8am to 6pm Monday to Friday service.

Level 2 - Services that are delivered seven 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 seven 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 seven day service delivery by integrating the requirements for elements of seven day services across more than one specialty.

NHS Improving Quality’s role

• Support and facilitate the ‘how to’:- spreading learning and knowledge

- advice and support

- resources to support assessment and delivery

- connecting people

• Spread change, foster collaboration and build momentum

• Build capacity and capability - service improvement

• Champion patient & public involvement

• Shape future policy - identifying barriers/challenges

National Seven Day Service Self Assessment Tool

www.7daysat.nhs.uk

• Enables self assessment of current level of service provision against the National Clinical Standards for Seven Day Services and the planning guidance

• Plans for expanding services

• How patient and public views are used in service design

• Barriers and drivers to achieving extended services around areas such as workforce and finance?

• What benefits the organisation seen / would like to see as a result of extending services?

HEALTHCARE SCIENTISTSEVEN DAY SERVICES SURVEY FINDINGS

25th September 2013

356 Responses- Majority of staff believe they should offer 7DS

Consultation with service users regarding needs ; less than 50%, compared to 95% in pathology services

Services currently implement 7DS

- Pathology (Haematology, Biochemstry, Microbiology)

- Medical Physics

- Cardiac physiology (primarily interventional cardiology, pacemaker/defibrillation services, echo)

Service delivery models - half using predominantly on call systems for specific diagnostic tests rather than deliver a full 7DS

Top 3 drivers for 7DS delivery

-Clinical demand

-Urgent/emergency care demand

-Waiting time and elective work – primary driver for neurophsyiology

Top 3 barriers to implementing 7DS

-Financial constraints

-Recruitment /staff shortages

-Staff rota preference

Healthcare Scientists conference feedback12 November 2014Services which

should be provided 7/7

Services which don’t need to be

7/7

Enablers Barriers

Remote cardiac monitoring Cardiac echoBiochemistryHaematologyHistopathology (6/7)Microbiology Radiotherapy

Immunology Genetics

• Technology and innovation with access to interpretation and clinical action

• A networked approach

• Workforce- Investment in more staff - Alternative and extended roles - Expansion of point of care testing

• Leadership and engagement are needed

• Workforce availability, numbers and capability

• 7/7 Access to medical team

• 7/7 Access to patient information

• New registration system • Scientist Training

Programme (STP) make workforce planning difficult

• Potential for demand increase if primary care-is 7/7

• Entrenched staff who want to work 5/7