The document outlines the Royal Wolverhampton NHS Trust's journey to achieve 7-day service compliance from 2010 to 2017, highlighting key strategies, challenges, and improvements in patient care, particularly through the introduction of weekend consultant ward rounds. It details compliance metrics for various medical specialties, showcases a case study in oncology, and emphasizes the importance of collaboration and leadership in implementing these changes. The trust continues to face challenges such as staff vacancies and the need for external agency coordination, while aiming to monitor ongoing financial and operational impacts.

1. Safe & Effective | Kind & Caring | Exceeding Expectation
Achieving 7day service compliance
Jonathan Odum MD
Gwen Nuttall COO
Royal Wolverhampton NHS Trust

2. Royal Wolverhampton NHS Trust
New Cross Hospital- Acute Services
Cannock Chase Hospital- Elective/Rehab
West Park Hospital-Community Rehab
865 beds: non-elective and elective
ED 380 patients/day
Tertiary services:
Cardio-thoracic; Oncology; Renal

3. The 7 day journey: 2010-2017
HISTORY:
Mortality statistics ↑
Gaps in service provision
Capacity / Patient Flow:
SUIs relating to incidents at the weekend
CCG supported Acute Trust with £1m for weekend consultants in
medicine
Gastroenterology, Diabetes pilots

4. Local Evidence
Gastro: Introduction of weekend Consultant ward
rounds Q4 2010

5. Local Evidence
Diabetes: Introduction of weekend Consultant ward
rounds 2012
Saving 635 bed days per annum

6. 2017 Compliance against 4 priority 7DS standards
Acute Medicine ICCU
Renal General Surgery
Gastroenterology T&O
Diabetes O&G
Respiratory Cardio-thoracic
Oncology Haematology
Paediatrics Cardiology
Stroke

7. “Partial” Compliance
Upper GI Surgery
Urology
H&N/ENT
Care of Elderly

8. Case Note Review July 2016 and April 2017
September 2016 April 2017
Standard 2 77% 92%
Standard 8 72% 96%
Standard 5 100% 100%
Standard 6 IR an issue 100%

9. The 7DS Journey as an early implementer: 2016/17
“Formalised” 7DS as a Trust ‘priority’
“7 day services aren’t just about undertaking weekend working”
Led by MD/DMD & COO & Project Manager
Supported by NHSI/NHSE and CCG

10. Governance Structure
Operational meetings monthly – chaired by MD
Reviewed and “defined/clarified” the national standards
Involved all directorates (CD & GM) in face to face gap analysis
Quarterly reports to Trust Management Committee and Trust Board
Individual Directorate capacity/needs were assessed directly
eg bed base to consultant ratio; OP/theatre commitments etc
Peer Pressure from directorates
Embed 7DS provision in job plans (consistently)
NHSE/I 7DS meetings: bi monthly with national updates

11. Trust Actions: Introduce and embed process
22:00 finish for ‘physician on take’ across the 7 days
Evening ward rounds to complement morning round:
surgery, cardiothoracic, cardiology; gynaecology
Morning board rounds to prioritise overnight admissions
Ward round documentation/pro forma
“Empowering” CDs and GMs to implement 7DS

12. Case Study: Oncology
Historically had a very “traditional” model of care.
Introduced ‘Consultant of the Week’ including urgent admissions
Requires flexibility: Outpatient changes
Radiotherapy planning
Peer support
Impact: Discharges/week 8.8 vs 10.0
LOS /patient 10.5 vs 9.2
Staff satisfaction: Junior docs, ward and specialist nurses
Reported improvement in relative/pt access to decisions

13. The “Easy”, the Challenging and the Difficult!
Consultant expansion supported by robust business
cases and Mid Staffs disaggregation
Specialties challenged by consultant vacancies:
Urology; CoE; UGI surgery
Difficult colleagues!

14. Team Work….
Maintaining business and operational performance across the
Trust:
Objective challenge to some proposed changes to working
practices – you can’t just stop respiratory outpatients Dr Odum!
Understand and quantify that there is an immediate financial impact
Qualitative/ outcome measures take time to come through and be
evidenced, but you know this is the right thing to do.

15. The Future:
Vacancies: Urology, Care of the Elderly
Cross Site/Trust working produces challenges : Head and Neck
What should the ward look like at weekend?
Seniority of nurses
More junior docs
Ward clerks
Pharmacy
Visiting Community Services
What about external agencies? Mental Health, Primary care, Nursing
Homes, Residential Care Homes, Local authority

16. Summary - Journey
Trust Priority
Executive leadership and small, senior, project team
Discussions with all specialties to understand their issues – time
External support from NHSI/E
Early Commissioner support in 2010 for additional consultant posts
Monitor financial and operational impacts
More to do