Nigel Beasley, co- Chair East Midlands Clinical Senate. Nigel's slides from his presentation at the East Midlands #7dayservices event on 12th June 2014

1. 7 Day Services Programme
East Midland Acute Trust Collaborative
Nigel Beasley
co- Chair
East Midlands Clinical Senate
12th June 2014

2. Background
• Initiated by East Midlands Chief Executives Group working
with East Midlands SCNs and Clinical Senate
• Agreed set of principles and enabling behaviours to aid
clinical collaboration across organisational boundaries
• Seven day services
– National policy… and a moral imperative
– Increasingly part of business as usual
– Not just about hospitals; it is about the whole system
– Seven day services are within units of planning draft strategic plans
but concepts are still to be defined
2 NHS | East Midlands - Seven Day Services Programme | 12/06/2014

3. Background – King’s Fund
• https://www.youtube.com/watch?v=l6iKZ_SOKCY
• http://www.kingsfund.org.uk/projects/urgent-emergency-
care/alternative-guide-urgent-and-emergency-care-system-
england
NHS | Presentation to [XXXX Company] | [Type Date]3

4. 10 Acute Trusts Involved
• Chesterfield Royal Hospital
• Derby Hospitals
• Kettering General Hospital
• North Lincolnshire & Goole
• Northampton General
Hospital
4
• Nottingham University Hospitals
• Peterborough & Stamford
Hospitals
• Sherwood Forest Hospitals
• United Lincolnshire Hospitals
• University Hospitals of
Leicester
NHS | East Midlands - Seven Day Services Programme | 12/06/2014

5. 10 clinical
standards
Clinical outcomes
Workforce /
staffing
Demand,
capacity and
flow
Finance
Availability of
non- clinical
services
Availability of
clinical services
Phase 1 – Urgent/ Emergency
5
BaselineAssessment
&GapAnalysis
Site/ Trust
Unit of Planning
East Midlands
OptionsDevelopment
Care
Pathways
Financial
Workforce
NHS | East Midlands - Seven Day Services Programme | 12/06/2014

6. Clinical Standards – Urgent and Emergency
6
Assessment
Referral
Treatment
Referral
Type Emergency Department
Urgent /
Short stay In patient
EMU, AMU,
SAU,
Ambulatory
Care, AFU, EFU,
EDU, UCC,
Elderly Acute,
CDU
Community
Specialty
(Ward)
T&O
Paeds
Urology
Cardio
Stroke
Ophth’y
ICU / CCU
/HDU
ENT
?
?
?
Clinical Standard 1 – Patient Experience
Clinical Standard 2 – Time to first Consultant Review
Clinical Standard 3 – MDT Review
Clinical Standard 4 – Shift Handovers
Clinical Standard 5 - Diagnostics
Clinical Standard 6 –
Intervention / Key Services
Clinical Standard 7 – Mental Health
Clinical Standard 8 – Ongoing review
Clinical Standard 9 – Transfer to Community Primary Care
Clinical Standard 10 – Quality Improvement
Community
Note: All standards apply to all admissions

7. Milestones
7
April June August October
Agree design of
baseline
assessment
approach
Baseline assessment and gap
analysis
Develop,
prioritise and
refine options
Finalise options and
produce
recommendations
NHS | East Midlands - Seven Day Services Programme | 12/06/2014

8. Whole System View
8
Emergency
Department
GP Referrals
Self- Referrals
Hospital
Transfers
Other Health
Care Provider
Usual Place of
Residence
Community
Hospital
Nursing/
Residential Home
Primary/
Community Care
Social Care
Packages
Urgent and Emergency
Care Pathway
&
Supporting Diagnostics
Admission
Sources
Discharge
Sources
Third Party Resources e.g. radiology
NHS | East Midlands - Seven Day Services Programme | 12/06/2014
Acute Trust

9. NHS | Presentation to [XXXX Company] | [Type Date]9
Initial Findings

10. Initial Findings (Cont’d)...
NHS | East Midlands - Seven Day Services Programme | 12/06/201410
Clinical Standard Findings
1. Patient Experience
 Variable depending on medical staff and specialty
 Lack of/ inconsistent evidence for pro-active
engagement of patients/ family and relatives
2. Time to First
Consultant Review
 Inconsistent recording of activity in medical notes
 Lack of data available to evidence first consultant
review within 14 hours
3. MDT Review
 Not all specialties have a daily MDT review, even less
at weekends
 MDTs are not compliant across most sites and
specialties, i.e. not all MDTs include Nursing,
Medicine, Pharmacy, Physiotherapy representatives
 MDT currently include junior doctors and nurses

11. Initial Findings (Cont’d)…
Clinical Standard Findings
4. Shift Handovers
 Nursing shift handovers occur at similar times across
sites and specialties.
 No consistent guideline/ policy used to conduct shift
handovers. They range from specialty developed
operating procedures to local ‘way of working’.
 Use of locally developed shift handover forms, with
very little information transferred electronically.
 High variability with medical shift handovers
NHS | East Midlands - Seven Day Services Programme | 12/06/201411

12. Initial Findings (cont’d)…
Clinical Standard Findings
5. Diagnostics
 Generally across East Midlands there is a significant
shortfall in diagnostics resources, e.g. 28%
sonographer vacancies in Lincolnshire in the last 2
years
6. Intervention/ Key
Services
 Not all interventions are accessible out of hours or at
weekends
7. Mental Health
 High degree in variability from Trusts’ staff views on
Mental Health Liaison Services (MHLS) response time
 Variation in service provision across specialties, e.g.
MHLS refusing to assess patients in areas other than
Emergency Department
NHS | East Midlands - Seven Day Services Programme | 12/06/201412

13. Initial Findings (cont’d)…
Clinical Standard Findings
8. On-going Review  No issues identified in this area to date
9. Transfer to
Community, Primary
and Social Care
 Big challenges in accessing new packages of care
during weekend
 New placements in residential/nursing homes require
full re-assessment and 48hours notice, delaying
transfer
 Nursing home and community hospitals are unable to
provide level of specialist nursing care
 Lack of night visits capacity in community services
10. Improving Quality  No issues identified in this area to date
NHS | East Midlands - Seven Day Services Programme | 12/06/201413

14. 10 clinical
standards
Clinical outcomes
Workforce /
staffing
Demand,
capacity and
flow
Finance
Availability of
non- clinical
services
Availability of
clinical services
Phase 1 – Urgent/ Emergency
14
BaselineAssessment
&GapAnalysis
Site/ Trust
Unit of Planning
East Midlands
OptionsDevelopment
Care
Pathways
Financial
Workforce
NHS | East Midlands - Seven Day Services Programme | 12/06/2014