Recommended
More Related Content
What's hot
What's hot (20)
Similar to Seven Day services - Healthcare Science presentation (Blower)
Similar to Seven Day services - Healthcare Science presentation (Blower) (20)
Recently uploaded
Recently uploaded (20)
Seven Day services - Healthcare Science presentation (Blower)
- 2. 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
- 3. 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
- 4. 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
- 5. 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…”
- 6. The 10 Clinical Standards Patient Experience Time to first consultant review MDT Review Shift Handovers Transfer to community and Primary and social care Mental Health Quality Improvement Diagnostics On-going review Intervention /Key services
- 7. Standard 5 Diagnostics Hospital 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 Source RCP (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
- 8. Standard 6- Intervention/key services Hospital 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 Source NCEPOD (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
- 9. The Timescale • Standard contract to include action plan for delivering the clinical standards Deadline - 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
- 10. Seven Day Services Partners
- 11. Seven Day Services Programme Improvement 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
- 12. Early Adopters
- 13. Levels Level 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.
- 14. 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
- 15. 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?
- 16. HEALTHCARE SCIENTIST SEVEN 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
- 17. Healthcare Scientists conference feedback 12 November 2014Services which should be provided 7/7 Services which don’t need to be 7/7 Enablers Barriers Remote cardiac monitoring Cardiac echo Biochemistry Haematology Histopathology (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
Editor's Notes
- This is what Bruce Keogh has christened the 7 day services work and it has stuck. I have always been completely signed up to the need for some services to be delivered across 7 days and even when I worked clinically as a 5 day a week physiotherapist just doing on calls at weekends, I used to question our relevance if we could withdraw our services for two or more days at a time. If I had needed further persuading the story Fiona Carey told at the recent EOE event would have done it. for the sake of a senior review her friend could have spend two more of her 5 last precious days at home instead of spending them over a weekend in a hospital ward.
- Increasing body of evidence re poor outcomes - Mortality rates* - Re-admission rates - Length of stay - Patient experience Growing recognition that 5 day service model does not meet patient and public needs or expectations.
- Commitment made in ‘Everyone Counts: Planning for Patients 2013/14’ - “The NHS will move towards routine services being available seven days a week. This is essential to offer a much more patient-focused service and also offers the opportunity to improve clinical outcomes” Seven Days Forum set up by National Medical Director Sir Bruce Keogh to support this. Initial focus on urgent and emergency care services, and supporting diagnostic services (Phase 1) 5 workstreams: Clinical standards; Workforce and organisational development; Finance and costing; Incentives, rewards and sanctions. Service models Forum published its findings and recommendations in Dec 2013. (NHS Services, Seven Days a Week - Summary of initial findings). This report listed ten clinical standards that are crucial in moving towards a seven day heath system NHS England Board (17 Dec 2013) agreed its recommendations, including the adoption of the clinical standards and full implementation of these by March 2017. Seen as a legitimate ambition for the NHS – no other healthcare system has attempted this.
- Also agreed that the remit of the Forum should be widened and that it should be asked to develop proposals for creating a fully integrated service delivering high quality treatment and care seven days a week. (Phase 2 ) NB - Report due shortly 5YFV “To reduce variations in when patients receive care, we will develop a framework for how seven day services can be implemented affordably and sustainably, recognising that different solutions will be needed in different localities.”
- Ten clinical standards that describe the care that patients should expect to receive, seven days a week. Developed with involvement from Academy of Medical Royal Colleges Aims: improve clinical outcomes and patient experience, reduce risk of morbidity and mortality following weekend admission in a range of specialties provide consistent NHS services, across all seven days of the week. 1. Patient Experience 2. Time to first consultant review 3. Multi-disciplinary Team (MDT) review 4. Shift handovers 5. Diagnostics 6. Intervention / key services 7. Mental health 8. On-going review 9. Transfer to community, primary and social care 10. Quality improvement
- Delivering the standards By March 2015 - local contracts to include action plan to deliver the clinical standards By March 2016 - 50% implementation (prioritise those that make the impact) By March 2017 - full implementation
- This is one of the most connected pieces of work to come out of NHS England and our new and rather complicated health and care system Care Quality Commission The CQC and the Chief Inspector of Hospitals have agreed to routinely assess the availability of seven day services as part of the assessment of safety within a hospital. For acute services to be judged safe they have to be safe seven days a week. Health Education England Has agreed that education contracts should include consultant availability to provide adequate supervision of doctors in training, seven days a week. NHS Employers - leading 7DS workforce workstream, linking in with HRDs & leads HiSLAC – High Intensity Specialist Led Acute Care work to determine the cause(s) of increased weekend hospital admission mortality Also, Deloitte is working on understanding the clinical, financial and workforce impact of Seven Day Services across the health and care system
- Dedicated resource for next 3-5 years 3 priorities: spreading diagnostics evidence-based models - signpost evidence from the diagnostic service reviews for 24/7 provisions across England including Interventional Radiology, Endoscopy and Scientific services. ‘Diagnostics’ covers diagnostic services that support urgent and emergency care, investigation, treatment and discharge or transfer. From the first 7DS forum. 2) Engaging all healthcare communities - start the drive for spread, engaging all commissioners and providers in moving towards the provision of services that are delivered in a way that meets NHS England’s Seven Day Services clinical standards. Identifying the top interventions which make a difference 3) Designing and testing new models of seven day services for whole system change (NB work with early adopters) Will hear a lot about the SAT tool and the need to get this as a baseline assessment which is absolutely what is needed to start the change in the system but this is the starting point, to understand the gaps and to implement changes a wider approach with all of the local health and care community is needed
- 13 early adopter sites – signed up earlier this year, mix of trusts and CCGs, some as partnerships At various stages with plans to meet the clinical standards Lots of learning already emerging – challenges and successes
- Help to spread change, foster collaboration and build momentum Help with the ‘how to’: - sharing / spreading learning and knowledge - advice and support (critical friend) - resources to support delivery (eg SAT) - connecting people (learning networks, communities of practice etc) Building capacity and capability - service improvement knowledge and expertise, CCG development, large scale change programmes Champion patient and public involvement To help shape future policy (eg 5YFV) - identifying barriers and challenges We will aim to: • Facilitate the creation and development of relationships between and within organisations to establish an aligned approach to implementing seven day services. • Facilitate cross fertilisation – share learning and experience between ourselves to help spread best practice and learning across health communities. • Capture learning so we can both share it across health communities and use it to influence future policy development. • Tailor support to meet the specific needs of different sites – not a ‘one size fits all’ approach, solutions and learning should reflect the diversity of the sites. • Encourage measurement to support the capture of outcomes, to evidence both the results of implementation and the value we have added. • Increase momentum for change – be positive ‘ambassadors’ for 7 day services and catalysts for action! ANN • Provides dedicated team support, dedicated investment to support local delivery of 7 day services locally. There is an identified Delivery Lead for Geographical Areas supported by delivery Managers and facilitators. The team is a flexible skill based team in order to response to demand and ensure coverage of Engalnd. • Signpost evidence from the diagnostic service reviews for 24/7 provisions across England including Interventional Radiology, Endoscopy and Scientific services to ensure providers and networks have plans in place to implement evidence based seven day diagnostics services and models. • Driving the movement for spread: engaging every commissioner and provider in moving towards the provision of services that are delivered in a way that meets NHS England’s Seven Day Services clinical standards. • Forward thinking improvement working with a range of organisations and communities who are representational of today’s health climate and geographically spread to design and test future 7 day service models and whole system transformation. (early adopter communities) • Support organisations to understand their baseline position – through the development and support 7 Day services self-assessment tool, build on the evidence, measured outcomes. • Identifying the top interventions which will make the biggest difference to supporting delivery of local seven day services across the whole system. • Supporting learning networks, communities of interest, building capability and capacity, communication & engagement. • CCG Development, Service Improvement & large scale change programmes • Share the learning widely across the health and care communities
- Web based tool
- Need to be 7/7 Remote cardiac monitoring Cardiac echo Biochemistry Haematology Histopathology (6/7) Microbiology Radiotherapy – but a critical mass of people is needed to deliver the care (diagnosis, medications, administration, aftercare) not just the HCS. Don’t need to be 7/7 Immunology mainly affects people with LTCs and can readily be planned care and routine monitoring Genetics- planned care. Rarely needed at weekends Barriers Workforce availability, numbers and capability 7/7 Access to medical team 7/7 Access to patient information New registration system could mean that more experienced staff fall outside of the new system and therefore not be eligible for posts in future New Scientist Training Programme (STP) means that depts. Have little idea of what new staff will work with them so workforce planning becomes difficult. New staff trained on STP still need further work on competence? Curriculum review of STP needed? An unknown factor for demand is primary care- once they start working at weekends there may be a greater demand. Staff who are in entrenched positions and want to remain working in 5/7 services