Clinical standards - Celia Ingham Clark NHS England Presentation from the 'NHS services open seven days a week: every day counts' event on Saturday 16 November at The Metropole Hotel, Birmingham. This event was hosted by NHS Improving Quality and NHS England to share the views and ideas of public, patients, carers, NHS England and health and social care staff on how to improve access to services for patients across the seven day week. More information at http://www.nhsiq.nhs.uk/improvement-programmes/acute-care/seven-day-services.aspx or #7DayServices

1. Clinical standards
Celia Ingham Clark
NHS England (London region)
16 November 2013
1 NHS | Presentation to Seven Day Services Forum | 10 June 2013

2. Evidence base
• There is often inadequate involvement of senior medical personnel in the
assessment and subsequent management of many acutely ill patients,
particularly at the weekend.
• A survey of acute hospitals in England shows that only 34% have a dedicated
admitting medical consultant on the acute medicine unit for at least 12 hours a
day at weekends, in line with national recommendations.
• Limited access to diagnostic services and allied health professionals at
weekends to establish management plans and facilitate discharge.
• Poor weekend emergency service provision is associated with an increased
variation in outcomes such as:
– Mortality rates (11% to 16% increase risk of dying at the weekend);
– Patient experience; and
– Length of stay.
• Evidence based standards for inpatient hospital care were developed to address
these issues although it was widely recognised that a whole-system approach to
seven day working is required for seven day services to be a success, both in
respect of the benefits to patient care and the clinical and financial viability of
services.
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3. Key survey findings
Consultant review within 12/14 hrs
Only 16% of hospitals
review all emergency
medical admissions
within 14 hours of
arrival
Rapid access to diagnostics
Availability of core MDT
Nearly 80% have
5 or more MDT
members during
the week. This is
just 30% at the
weekend
X-ray and CT availability is
consistently high but other
services vary considerably
making informed decision making
difficult
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4. 10 Clinical standards for inpatient care
The Clinical Reference Group have developed 10 clinical standards based
on the evidence and recommendations from Royal Colleges and expert
bodies. These follow the patient pathway, apply seven days a week and
aim to ensure:
• Prompt access to consultant review and multi-disciplinary assessment;
• Availability of diagnostics to support decision-making;
• Timely treatment and interventions; and
• Planned, safe and appropriate timing of discharges.
All standards have supporting information and definitions to ensure clarity.
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