The document discusses delivering 7-day healthcare services in the UK. It notes that current regulation requires sufficient staffing at all times. It then outlines what constitutes 7-day versus 24/7 services using various examples. The document also presents data showing variation in hospital admissions and discharges by day of the week. It discusses potential benefits of 7-day services but also barriers to implementation, and quotes recommendations from organizations like the Royal College of Physicians calling for increased consultant presence on weekends.

1. Delivering a 7-Day Service
in Health & Social Care
Dr Nick Bishop 4 March 2013
National Professional Advisor

2. CQC’s Role
We make sure that the
care people receive
meets essential
standards of quality and
safety.
We encourage ongoing
improvements by those
who provide or
commission care

3. What does the law say?
Regulation 22 of the Health and Social care Act 2008 states:
In order to safeguard the health, safety and welfare
of service users, the registered person must take
appropriate steps to ensure that, at all times, there
are sufficient numbers of suitably qualified, skilled
and experienced persons employed for the
purposes of carrying out the regulated activity

4. http://www.youtube.com/watch?v=zhfpBW-nUWk

5. The Dowager Countess’ view
“What is a weekend…?”

6. Question….
What does “out of hours” mean
in the context of healthcare?

7. One step at a time…..
7 days versus 24/7

8. 7-Day services
Many Shops
Holiday booking
Insurance booking
Fuel stations
Car servicing

9. 24/7 services
AA/RAC
Ambulances
Police
Fire
Coastguard
RNLI
A&E
Midwifery
Hospital Radiology maintenance*
Drain clearance
…..and some branches of Tesco, Asda etc

10. “If I had to reduce my message for management to
just a few words, I’d say it all had to do with
reducing variation.” – W Edwards Deming

11. Admissions and Discharges by day of
week for 1 year
Trust A
7,000
6,000
5,000
Number
4,000
3,000
2,000
1,000
0
y
y
y
ay
y
y
ay
da
da
a
da
da
id
sd
sd
on
ur
n
es
Fr
ne
ur
Su
t
M
Tu
Sa
Th
ed
W
Admissions Discharges

12. Admissions and Discharges by day of
week for 1 year
5000 Trust A 6000 2000
7,000
3800
6,000
5,000
Number
4,000
3,000
2,000
1,000
0
y
y
y
ay
y
y
ay
da
da
a
da
da
id
sd
sd
on
ur
n
es
Fr
ne
ur
Su
t
M
Tu
Sa
Th
ed
W
Admissions Discharges

13. Admissions and Discharges by day of
week for 1 year
8500 Trust B 9000 4500
<6000
10,000
9,000
8,000
7,000
6,000
Number
5,000
4,000
3,000
2,000
1,000
0
y
y
ay
ay
y
y
ay
da
da
da
da
id
sd
sd
on
ur
n
es
Fr
ur
ne
Su
t
M
Tu
Sa
Th
ed
W
Admissions Discharges

14. Bed Occupancy
Monday Tuesday Wed Thursday Friday Saturday Sunday
103 102 100 99 96 98 102

15. Question….
Would solving the problem of ‘the
weekend’ also solve the problems of
the other 5 days?

16. Potential benefits
More senior cover at all times….
•Quicker decision making
•Better decision making
•Fewer delays for patients
•Shorter lengths of stay
•Fewer complications
•Better use of expensive equipment eg MRI & CT
•Better training opportunities
•Fewer bed pressures in-week
•Fewer cancelled admissions
•Meeting the expectations of patients

17. Potential barriers
•Costs of additional senior staff
•Rota management
•Reluctance of staff to change work patterns
•Need to engage with social services
•Availability of transport
•Support directorates as well as medicine and
surgery etc
•Issues around bank holidays
•…..Doubtless many others!

18. RCP Statement on 7 day working
The RCP is concerned with the mounting
evidence of poor care delivered to patients in
hospital, and has recommended… that any
hospital admitting acutely ill patients should
have a consultant physician on-site for at
least 12 hours per day, seven days a week,
who should have no other duties scheduled
during this time.
RCP Council November 2010

19. RCP Statement on 7 day working
All medical wards should have a
daily visit from a consultant; in most
hospitals this will involve more than
one physician.
RCP Council November 2010

21. AoMRC Report
Standard 1: Hospital inpatients should be reviewed by an on-site
consultant at least once every 24 hours, seven days a week, unless it has
been determined that this would not affect the patient’s care pathway.
Standard 2: Consultant-supervised interventions and investigations
along with reports should be provided seven days a week if the results
will change the outcome or status of the patient’s care pathway before the
next ‘normal’ working day. This should include interventions which will
enable immediate discharge or a shortened length of hospital stay.
Standard 3: Support services both in hospitals and in the primary
care setting in the community should be available seven days a week to
ensure that the next steps in the patient’s care pathway, as determined
by the daily consultant-led review, can be taken.

22. Barriers
Dr Paul Flynn, Chair BMA Consultants Committee
Daily Telegraph 22 February 2013
•He said there was not enough money in the NHS to operate a seven day
working week
•"It is inconceivable that they will be able to staff operating theatres and
clinics seven days a week, let alone provide all the other resources that
this activity will consume”.
•He said: "I fear that an entirely seven day NHS is catering for the
convenience of the middle class and not the needs of those who are the
greatest users of the NHS.”

24. Are we making progress?
The Healthcare Commission realises that, due to a shortage of suitably
trained radiologists, it is not possible to provide full time cover for
interventional radiology in all obstetric units. However, given the potential
to save the lives of patients who have catastrophic postnatal bleeding,
trusts with delivery units should, where feasible, engage with their
neighbouring trusts to discuss the formation of networks. The aim should
be to provide an emergency interventional radiology service that is
responsive to patients’ needs wherever and whenever they arise.
August 2006
Investigation into 10 maternal deaths at, or following delivery at,
Northwick Park Hospital

25. “The longest of journeys begins with the first step”

26. Thank you
nick.bishop@cqc.org.uk