This webinar will provide: • Key lessons learned from review of 7DS Board Assurance Framework (BAF) return in February • Information on how to prepare for the next submission by 28th June 2019 • An opportunity to raise questions

1. NHS England and NHS Improvement
7DS Board Assurance Framework:
Planning for June 2019 submission
South East and South West Region
April 2019

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This webinar will provide you with:
• Key lessons learned from review of 7DS Board Assurance Framework
(BAF) return in February
• Information on how to prepare for the next submission by 28th June
2019
• An opportunity to raise questions
Objectives
7 Day Hospitals – Objectives

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Introduction
Vaughan Lewis, Medical Director, South East Region
Michael Marsh, Medical Director, South West Region
Preparation for next 7DS BAF return June 19 : What lessons have we
learned?
Sue Cottle, Programme Lead, 7 Day Services, NHS England, South
Opportunity to ask questions
Our guest speakers today are:
7 Day Hospitals – Guest Speakers

4. NHS England and NHS Improvement
7 Day Hospital Services Board Assurance
Framework - Introduction
Vaughan Lewis, Medical Director, South East
Michael Marsh, Medical Director, South West

5. NHS England and NHS Improvement
Preparation for next 7DS BAF return June 19
What lessons have we learned?
Sue Cottle, Programme Lead, South

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1. Trust board’s are required to determine BAF governance and process.
2. CS2 and CS8 - Self-assessment information needs to provide commentary on multiple
sources of evidence (job plans, clinical audit, protocols systems for ongoing review and
related wider performance indicators).
3. Continuous improvement standards – Trusts are required to provide commentary on
work done or in progress. There are no requirements for evidence of meeting the
standards.
4. Urgent Network Specialist Services – commentary is required to headline issues where
there is non-compliance against standards and improvement trajectories.
Key themes: Lessons learned
7 Day Hospitals – Key themes – Lessons Learned

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The self-assessment template has a dual purpose for assurance from
your board and national reporting – the trust board can decide
appropriate processes
• Boards can decide appropriate
processes and details to include,
based on local systems,
governance structures and
timetables.
• The self-assessment template
may be accompanied by a board
paper outlining detailed evidence,
risks and mitigating action for 7DS
delivery.
• This new measurement system
provides one version of the
‘truth’ for use by commissioners,
STP’s/ICS, regulators and CQC.
XX NHS TRUST : 7 Day Hospital Services Self-Assessment - Autumn 2018
this disappears when you write over it
Priority 7DS Clinical Standards
Weekday Weekend Overall Score
Weekday Weekend Overall Score
Yes available on site Yes available on site
Yes available on site Yes available on site
Yes available on site Yes available on site
Yes available on site Yes available on site
Yes available on site Yes available on site
Yes available on site Yes available on site
Weekday Weekend Overall Score
Yes available on site Yes available on site
Yes available on site
Yes mix of on site and off site
by formal arrangement
Yes available on site Yes available on site
Yes available on site Yes available on site
Yes available on site Yes available on site
Yes available on site
No the intervention is only
available on or off site via
informal arrangement
Yes available on site Yes available on site
Yes available on site Yes available on site
Yes available on site Yes available on site
Weekday Weekend Overall Score
Once daily: Yes the
standard is met for
over 90% of patients
admitted in an
emergency
Once Daily: No the
standard is not met for
over 90% of patients
admitted in an
emergency
Twice daily: Yes the
standard is met for
over 90% of patients
admitted in an
emergency
Twice daily: Yes the
standard is met for
over 90% of patients
admitted in an
emergency
Standard Met
Clinical standard Self-Assessment of Performance
Standard Not Met
Clinical Standard 8:
All patients with high dependency
needs should be seen and reviewed by
a consultant TWICE DAILY (including all
acutely ill patients directly transferred
and others who deteriorate). Once a
clear pathway of care has been
established, patients should be
reviewed by a 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.
Historical Compliance: Oct 2016: 73%, April 2017: 95% April: 86%. Compliance shows an historically mixed
compliance rates across the Trust as a whole and an inconsistent performance across directorates. Acute
Medicine performs highly. The evidence has shown that compliance is consistent across all days of the week.
Q: Do inpatients have 24-hour access to the following consultant directed
interventions 7 days a week, either on site or via formal network
arrangements?
Interventional Radiology available at weekends via shared arrangement with local
Trusts. Other interventions available for urgent cases in Trust.
Clinical standard Self-Assessment of Performance
Clinical Standard 6:
Hospital inpatients must have timely
24 hour access, seven days a week, to
key consultant-directed interventions
that meet the relevant specialty
guidelines, either on-site or through
formally agreed networked
arrangements with clear written
protocols.
Critical Care
Interventional Radiology
Interventional Endoscopy
Emergency Surgery
Emergency Renal
Replacement Therapy
Urgent Radiotherapy
Stroke thrombolysis
Percutaneous Coronary
Intervention
Cardiac Pacing
Self-Assessment of Performance
Yes, the standard is
met for over 90% of
patients admitted in an
emergency
Standard Met
Clinical standard
Microbiology
Clinical Standard 5:
Hospital inpatients must have scheduled
seven-day access to diagnostic services,
typically ultrasound, computerised
tomography (CT), magnetic resonance
imaging (MRI), echocardiography,
endoscopy, and microbiology. Consultant-
directed diagnostic tests and completed
reporting will be available seven days a
week:
• Within 1 hour for critical patients
• Within 12 hour for urgent patients
• Within 24 hour for non-urgent patients
Standard Met
Ultrasound
Echocardiography
Magnetic Resonance
Imaging (MRI)
Upper GI endoscopy
Computerised Tomography
(CT)
Q: Are the following diagnostic tests and reporting always or usually
available on site or off site by formal network arrangements for patients
admitted as an emergency with critical and urgent clinical needs, in the
appropriate timescales?
All diagnostics available across 7 days. CT Heads read by ED Consultants
Clinical standard
Clinical Standard 2:
All emergency admissions must be
seen and have a thorough clinical
assessment by a suitable consultant as
soon as possible but at the latest
within 14 hours from the time of
admission to hospital.
Self-Assessment of Performance
Historical Compliance: Oct 2016: 63%, April 2017: 92% Oct 2017: 90% April: 91%. Whilst the data suggests
sustained compliance across the Trust as a whole this masks inconsistent performance across directorates. For
those admitted through the medical wards (60% of our total emergency admission) compliance is as high as 96%.
Patients admitted through Paediatrics, Orthopaedics, Obs and Gynae, Head and Neck and Surgery have not
consistently complied with achievement with results ranging from 78% compliance for Surgery to 43% compliance
in Head and Neck. More latterly the evidence has shown that the results do not differ across the days of the
week.
Yes, the standard is
met for over 90% of
patients admitted in an
emergency
7 Day Hospitals – Lessons Learned 1

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Assurance of delivery of standard 2 and 8 should be based on
multiple sources of evidence which in combination give a complete
view of performance (more narrative is required)
The narrative must include 3 sources of
evidence:
1. Consultant job plans
2. Local clinical audit
3. Wider performance and
experience measures
Clinical Standard 2
The narrative must include 4 sources of
evidence:
1. Consultant job plans
2. Local clinical audit
3. Systems to support on-going
review
- Protocols for board round system
– including schemes of delegation
which patients do not need daily
review
- Protocols for systems of
escalation deteriorating patients
4. Wider performance and
experience measures
Clinical Standard 8
7 Day Hospitals – Lessons Learned 2
NOTE:
The exact type and level of clinical audit is for
local determination as it needs to be based on
whatever is required to ensure that the trust’s
board can provide assurance of performance.
E.g. focus on areas that require improvement or
snapshot representative of the trust’s normal
emergency admission patient profile
Ref: A Board Assurance Framework for 7 Day Hospital Services: Guidance : For Trusts page 5 section 2.2 for CS2 and page 10 section 2.5 for CS8

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• Weekday and weekend ratio data in mortality, length of stay,
readmissions.
• Wider, related patient flow and urgent emergency care metrics e.g. A/E
performance, weekend discharges.
• Patient experience data from weekdays versus weekends covering
consultant presence/availability.
• GMC trainee doctor survey data on the support offered by consultants.
• Audits of staffing levels and activity related to 7DS as recommended by
the Royal College of Physicians’ Guidance on Safe Medical Staffing.
Include commentary on wider performance and experience measures:
Relative weak performance in any of these areas should be explored to see
if there is a direct link to not delivering CS2 and 8. Provide narrative where
required.
7 Day Hospitals – Lessons Learned 2 continued
Ref: A Board Assurance Framework for 7 Day Hospital Services: Guidance : For Trusts refer r to guidance Page 12 section 2.5

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Provide narrative on work in progress to meet standards in urgent
network specialist services and Continuous Improvement Standards
(standards 1,3,4,7,9 and 10)
10
• Narrative is required where there are gaps
in job plans to deliver the four priority
standards effectively for Urgent network
specialties . These include:
• Hyper-Acute Stroke
• Paediatric Intensive Care
• STEMI Heart Attacks
• Major trauma
• Emergency vascular services
• Please describe current working practice
and progress with provider/network
improvement plans and trajectories..
7DS in Urgent Network
Specialist Services
• The additional 6 standards are referred to
as Continuous Improvement standards.
• You only need to summarise work done or in
progress against these six standards.
• You are not required to provide evidence of
compliance for these 6 standards.
• This summary is not a formal assessment of
progress.
7DS standards for Continuous
Improvement
7 Day Hospitals – Lessons Learned 3
Ref: A Board Assurance Framework for 7 Day Hospital Services: Guidance for Trusts : For specialist services refer to guidance page 15 section 2.7 and for CI standards
refer to page 13 section 2.6

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Questions and answers
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7 Day Hospitals – Questions and answers
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Further information
ShareConnect
7 Day Hospitals – Further information
• Submission of next 7DS Board Assurance Framework template is expected
by 28th June 2019. Please submit additional papers if required.
• For further advice contact your designated Sustainable Improvement contact.
• Example of completed BAF return template.
• Further resources can be found on NHS Improvement website:
• 7DS Board Assurance Framework guidance: For Trusts
• Introduction pack for Trust Board Members
https://improvement.nhs.uk/resources/board-assurance-framework-seven-day-
hospital-services/

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Thank you for joining this webinar the links to the recording will be sent
out shortly for advice and support contact
ShareConnect
7 Day Hospitals – For further advice
Sue Cottle, Programme Lead sue.cottle@nhs.net
Wendy Keating, Senior Improvement Manager wendy.keating@nhs.net
Lou James, Improvement Facilitator lou.james1@nhs.net
Thelma Daly, Improvement Manager thelma.daly@nhs.net
Programme Support Officer vivrichards@nhs.net