The webinar provided information on how therapy teams in hospitals are working to improve patient outcomes, experience, and flow on a 7-day basis. Presenters from the Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust and Buckinghamshire Healthcare NHS Trust discussed their experiences establishing expanded 7-day therapy services and overcoming challenges like staffing concerns. Both organizations developed new staffing models and training programs to support therapists working weekends and evenings, improving continuity of care for patients across all days of the week.

1. www.england.nhs.uk
Seven Day Hospital
Services Webinar
How therapy teams can
work differently to improve
patient flow
Hosted by:
Sustainable Improvement
NHS England South
May 2018

2. www.england.nhs.uk
Establishing a Virtual Community for All to
Connect, Share and Learn
• Series of regional and local webinars
• Share practical examples – discuss barriers and
generate improvement solutions
• NHS E Specialist Support Team - Sustainable
Improvement
• Working in collaboration with NHS Improvement and the
UEC Programme Board, South Region
7 Day Hospitals – Virtual Community
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3. www.england.nhs.uk
Our presenters today are
• Evolution of 7-day Working in Bournemouth – Darren
Sparks, Therapy Services Manager and Jen Rains,
Clinical Leader, Acute Therapy Services both from The
Royal Bournemouth and Christchurch Hospitals NHS
Foundation Trust
darren.sparks@rbch.nhs.uk and jenny.rains@rbch.nhs.uk
• Rapid Emergency Assessment and Care Team (REACT)
Providing a 7 day service – Angela Brooke, Head of
Allied Health Professions, Buckinghamshire Healthcare
NHS Trust
angelabrooke@nhs.net
7 Day Hospitals – Guest Speakers
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4. www.england.nhs.uk
Objectives
This webinar will provide you with:
• Information on the work that therapy services in hospitals
are doing- to improve patient outcomes, experience and
flow
• Top tips on how they have identified gaps and
approached making improvements, and the lessons
learned
• An opportunity to raise queries and share learning
7 Day Hospitals – Objectives
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5. Evolution of 7-day Working in
Bournemouth
Darren Sparks – Therapy Services Manager
Jen Rains – Clinical Leader, Acute Therapy Services

6. Aim/Summary
• Overview of RBCH Structure
• ‘7 day service’ journey
• Lessons learned/outcomes
• Our solutions – direct( e-
learning/competence/confidence) and
indirect (leadership development, right
person, right place)

7. Organisational Structure
Surgical
Care
Group
Anaesthetics
Maternity,
Orthopaedics,
Surgery
Medical
Care
Group
Cardiology,
Medicine, Older
Persons Medicine
Therapy Services
sit in Older Persons
Medicine
Specialties
Care
Group
Cancer Care,
Ophthalmology,
Pathology,
Radiology,
Research &
Innovation,
Specialist Services
Operations
and
Strategy
Eg, Estates,
Commercial
Development,
Performance,
Service
Development

8. Therapy
Services
Acute
Therapy
Specialties
Orthopaedic
Therapy
Older
Persons Care
MSK
Outpatient
TherapyNeuro
TherapySALT
Dietetics
Day Hospital
Interim Care
Therapy Services
Sit in the OPM Directorate, Medical Care Group.
OT/Physio work in highly integrated teams

9. 7DS – Weekend working
20 years ago, 30 hours Physiotherapy provision (Post
Operative respiratory care, Orthopaedic post op and ITU)
Today, 250 hours Occupational Therapy, Physiotherapy
and assistant provision
(‘specialist’, service based, weekend patterns in Stroke,
Older Persons, Orthopaedics and Acute Medical/Surgical)

10. 7DS – Weekend working
• Journey started in 2011.
• Tasked with designing how we could provide a 7
day service for our therapy areas outside of acute
respiratory/ITU within our existing budget.
“Bronze” – limited staffing to facilitate emergency
cover, i.e. post op, admission avoidance, urgent
discharge support
“Silver” – in addition to “Bronze” cover, staff to
provide more general treatment
progression/rehabilitation
“Gold” – replicate near weekday levels of cover

11. Effects on weekday cover
• Services initially aimed for a ‘silver’ service,
found that a bronze service was the
sustainable model
• Some fluctuation dependant on staff pool –
being adaptable with the level of service
provided
• Extending the hours covered during the week
– ‘twilight’ shifts

12. Effects on weekday cover
• Able to spread staffing across 7 days through
efficiency – facilitating flow at the weekend
reduces blockages that takes longer to fix on
Monday
• Reduced ‘Monday morning stress’ on staff
• Better patient care – weekend discharges,
rapid discharge ‘home to die’, able to support
admission avoidance in ED/AMU

13. Pool of staff left for ‘On-Call’ work
October 2016- 12 to 14 staff members on call
(less than recommendations)
Staff doing 2-4 on calls per month, or around
1 in 10 nights (more than recommended 2
per month max).
Heavy reliance on Acute Therapy Team,
exacerbated at times of sickness/ vacancy
Staff burnout and reduced satisfaction
isolated to one team, and the junior members
of physiotherapy

14. Consultation Process
• Start of Consultation- partnership forum, group meeting with OPAL, Neuro and
Orthopaedics
• September 2017
• Individual Meetings with HR/ Union Reps/ Management
• September to October 2017
• Decision & written evidenced report following consultation- New starters and
OPAL immediately
• November 2017
• Contract Changes March 2018
• Training Starts April 2018
• On Call September 2018

15. Staff Concerns
Concern Solution
Timing/ Shift Patterns Appropriate co-ordination, and
consideration of work life balance as far as
possible
Support Buddy system for first couple (paid), then
mentor ongoing for 6 monthly catch up
(from Acute Therapy Team)
Recruitment and Retention Phased introduction for new starters, one
team to immediately support with least
concern
Team Wellbeing Regular monitoring through survey
monkey and liaison with clinical leads
Knowledge/ skills/ ICU In depth Training programme, meeting
individual needs and accessible for all staff

16. Training Plan
Problem Solution
Time for release for training from other
teams
Singular sessions, repeated to capture
all staff including part time staff
Different learning needs Varied methods including E-Learning,
practical sessions, case studies,
Support Mentor from within Acute Therapy
Team, buddy system, debrief following
call ins,
Theory Initial theory session, BEAT training
Practical Skills Training Practical sessions on cough assist, MHI,
Suction, airways, oxygen, ventilation
Practical Ward Skills 1:1 Time on ICU, Sim suite for case
studies

17. BEAT Module

18. Practical Training

19. On Call Training Feedback
Feel respected and have a
training plan which works for
each of us, meets our needs
and provides support through
the on call journey not just a
one off
The E-Learning module
has been a life saver in the
middle of the night when I
wanted to check
something. It’s so in depth
and accessible
Has been good to get to
know the processes and
the idea of a debrief after
each call out means we
can continue to learn
The training is spread out
and therefore more
accessible from other clinical
areas perspectives as
reduces time out for whole
days

20. What Next?
• Development of training/support structures to
promote leadership skills. Will ensure staff
able to work as part of team, confident in
decision making, and promote their role to
enhance patient quality.
• Develop better outcome measures that enable
meaningful analysis of the therapy role in the
patient pathway

21. RBCH Leadership Strategy

22. www.england.nhs.uk
Discussion
Please raise your hand if you have a
question or comment-
or write it in the chat box to ‘all
participants’.
When speaking please let everyone know
your name, and your organisation
7 Day Hospitals – Discussion7 Day Hospitals – Discussion

23. Rapid Emergency Assessment
and Care Team (REACT).
Providing a 7 day service
Angela Brooke
Head of Allied Health Professions
angelabrooke@nhs.net
May 2018

24. Buckinghamshire Healthcare NHS Trust
• Integrated Acute & Community Trust
• Part of an ICS
• Stoke Mandeville Hospital - Acute and Spinal Unit
• Wycombe Hospital – elective orthopaedics,
Stroke & Cardiology, MIIU
• Community Hospitals & Hubs
• Serving 500,000 population

25. REACT
• Initially developed team in 2013 on the basis of ECIST
recommendations as a 5 days service
• Multidisciplinary and multiagency team to support early
discharge with Community support if required
• Based in Emergency Department at Stoke Mandeville
Hospital working in A&E, AMU, AEC & Short Stay Ward
• Provides rapid assessment and review of ED patients to
support early discharge

26. REACT Function
• Prior to REACT PT, OT, ASC, Community Nursing all
worked discretely
• REACT forms a single team, single assessment, using
single paperwork (Single Joint Assessment) reduces
duplication
• Improved team dynamics, better decision making, more
efficient patient pathway
• Stronger links with Community Services

27. REACT Communication
REACT
Communication
Routes
8- 9am
Referral/Info
gathering from
medical notes,
verbal information
NS/POD/others 9.30am REACT
Huddle Meeting,
intra-team
communication
Single Joint Ax
Sheet, used by
PT/OT /SW
Direct
communication
from NS or Doctors
to any member of
REACT team
during the day
Bleep 930
Documentation in
medical notes re:
REACT
Assessment, brief
outcomes and
plans
Bed Meetings -
REACT member
attends
Single Joint
Assessment sheet
in medical notes -
anyone able to
read

28. REACT Development
• Autumn 2014 REACT had support from winter pressure
funding to increase the size and capacity of the team
• Additional Therapies, Pharmacist, Medicine for Older
People Physician were introduced and a link with PIRLS
created.
• Extension of the service trialled at weekends and bank
holidays with Temporary staffing

29. Development of 7 Day Service
• Additional funding sought via business case
• Costed for 7 days a week – 8am to 8pm
• Staff to work 12 hour shifts
• Initially unpopular with some staff
• Developed 2 Band 7 posts (OT & PT) to lead the
team
• Additional SLT & Dietetic support
• Additional support for ASC

30. Developing the staff model
• Initially therapy and community assessments
(CTOCC) discretely done and then linked to
facilitate discharge.
• Discussion with MDT to find common ground with
regard to assessments. REACT assessment form
created, to encompass needs of PT, OT, SW and
Community Teams requirements.
• Form adopted and adjusted by Trust and now
known as ‘Single Joint Assessment Form’
(S.J.A.F)

31. Developing the staff model
• Established:
– Working boundaries / Informal referral criteria
– Scope of practice issues and resolutions
– Competencies
to allow appropriate inter-professional working, reducing
duplication and enhancing efficiency.
• Now inter-professional assessments done for
each patient. Only one assessor usually required.
• S.J.A.F. now universally accepted by trust and
community teams for referrals.

32. Staff Rota
• Agreed expectation from Management regarding
weekday and weekend working.
• Agreed one full weekend in four with option of
increasing this on a voluntary basis.
• Initial rota completed 6 weeks in advance and
individually agreed with each staff member.
• Agreed initial rota not working well, changed to
rolling rota of 8 weeks, then to 4 week rota.
• Rolling rota allows up to 6 months planning
reducing staff anxiety re: shifts, annual leave etc.

33. Rolling Rota Example
1st week Mon Tue Wed Thu Fri Sat Sun 3rd week Mon Tue Wed Thu Fri Sat Sun
Band 7 OT Band 7 OT
Band 7 PT Band 7 PT
Band 6 OT Band 6 OT
Band 6 PT Band 6 PT
Band 6 RNC Band 6 RNC
Band 6 RNC Band 6 RNC
Band 4 CSW Band 4 CSW
Band 4 CSW Band 4 CSW
Band 3 CSW Band 3 CSW
Core Staff No. 5 5 6 4 4 3 3 Core Staff No. 5 5 5 5 5 2 2
12 Hr Shifts No. 4 4 4 3 3 3 3 12 Hr Shifts No. 4 4 4 4 3 2 2
2nd week Mon Tue Wed Thu Fri Sat Sun 4th week Mon Tue Wed Thu Fri Sat Sun
Band 7 OT Band 7 OT
Band 7 PT Band 7 PT
Band 6 OT Band 6 OT .
Band 6 PT Band 6 PT
Band 6 RNC Band 6 RNC
Band 6 RNC Band 6 RNC
Band 4 CSW Band 4 CSW
Band 4 CSW Band 4 CSW
Band 3 CSW Band 3 CSW
Core Staff No. 4 5 5 5 5 3 2 Core Staff No. 5 6 5 4 4 3 4
12 Hr Shifts No. 3 4 4 4 3 2 2 12 Hr Shifts No. 4 5 3 3 4 2 2
12 Hour Shift
7.5 Hour shift

34. Staff Feedback
7 Day working / 12 hour shift pattern
Pros
* More time to see and sort issues within a
shift. Present for all board rounds / DFM.
* 3 days on 4 days off or 4 days on and 3 days
off per week.
* Flexibility of working patterns
(Changing/swapping shifts).
* Can reduce Annual Leave requests and
allow training.
* More time in day to reassess patients who
are awaiting Scans, Analgesia etc.
* Present at evening handover to inform staff
of plans and changes for patients.
* Can accept and action referrals which
normally would be left till next day.
* Consistent level of service across 7 days.
* Paid weekend working
Cons
* It can be difficult to attract and recruit staff
to this system of working from Therapies.
* Shifts can be more physically and mentally
demanding. Work stresses can become more
pronounced.
* Sickness and Annual leave can quickly result
in shortages of staff and significant increase in
workload.
* Requires flexibility to cover/swap shifts.
* More weekend working
* Can affect Continuity of Care (i.e. staff
changover)

35. REACT Data - Example
Ratio of new patients and same day discharge Number of new and on-going patient contacts
% of New A+E patients seen within 3 Hours

36. Enhancing links with Community Services
• Development of a new 7 day service in the
Community – Rapid Response & Intermediate
Care with Therapy & Assistant support
• Launch of a Single Point of Access (CCCT)
• On-going use of SAFER principles and enhanced
Single Joint Assessment paperwork
• Merging of Social Care Re-ablement team with
the Intermediate Care Ream

37. Community Assessment & Treatment Service
• In April 2017 piloted the closure of 2 small
Community Hospitals & re-purposed as CATS
services with Geriatrician, GP, Therapy & Nursing
to support admission avoidance
• Development of Frailty Bays on Elderly Care
Ward supported by the REACT model of care

38. REACT – the Team

39. www.england.nhs.uk
Discussion
Please raise your hand if you have a
question or comment-
or write it in the chat box to ‘all
participants’.
When speaking please let everyone know
your name, and your organisation
7 Day Hospitals – Discussion7 Day Hospitals – Discussion

40. www.england.nhs.uk
7 Day Hospitals – Advice and support
For advice and support, contact the
Sustainable Improvement Team
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
Suzanne Cullen, Improvement Manager suzanne.cullen@nhs.net
For general information vivrichards@nhs.net
LearnShareConnect
NHS Improvement
Caroline Poole, Professional Head of Allied Health Professions (AHPs)
caroline.poole4@nhs.net

41. www.england.nhs.uk
•
For other 7 day service resources:
https://improvement.nhs.uk/resources/seven-day-services/#resources
https://www.england.nhs.uk/seven-day-hospital-services/
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