Preparing for the Board Assurance framework for 7DS with guest speaker from University Hospitals Plymouth NHS Trust.

www.england.nhs.uk
Seven Day Hospital
Services Webinar
January 2019
Preparing for 7 day
Services Board Assurance
Framework
Sue Cottle, Programme Lead
7 Day Services, Sustainable Improvement
NHS England (South)
Hosted by:
Sustainable Improvement
NHS England South

www.england.nhs.uk
Establishing a Virtual Community for All to
Connect, Share and Learn
• Series of National and Local webinars
• Share practical examples – discuss barriers and
generate improvement solutions
• NHS E Specialist Support Team - Sustainable
Improvement
• Work in collaboration with NHS Improvement and each
SE and SW UEC Programme Board
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7 Day Hospitals – Virtual Community

www.england.nhs.uk
This webinar will provide you with:
• An update on the requirements of the new Board
Assurance Framework for 7 day services
• An opportunity to hear the experience of University
Hospitals Plymouth NHS Trust which was one of the pilot
sites
• An opportunity to raise queries and share learning
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7 Day Hospitals – Objectives
Objectives

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7 Day Hospitals – Guest Speakers
Our guest speakers today are:
A Board Assurance Framework for 7 Day Hospital Services: An
introduction for providers of acute services
Sue Cottle, Programme Lead, 7 Day Services, Sustainable
Improvement, NHS England (South)
Lessons Learned from Piloting Board Assurance Framework
Neil Hammacott, Head of Service Improvement, University Hospitals
Plymouth NHS Trust neil.hammacott@nhs.net
Opportunity to ask questions
Giancarlo Laura, Programme Manager, Medical Directorate, NHS
England

WORKING TOGETHER FOR THE NHS
Board Assurance Framework for Seven Day Hospital
Services: an introduction for providers of acute
services
November 2018
NHS England
NHS Improvement

The Seven Day Hospital Services Programme aims to deliver
improvements for patients by supporting high quality care seven days a
week
The Seven Day Hospital Services (7DS) Programme supports providers of acute services to tackle
the variation in outcomes for patients admitted to hospitals in an emergency, at the weekend across
the NHS in England.
This work is built on 10 clinical standards developed by the NHS Services, Seven Days a Week
Forum in 2013. With the support of the Academy of Medical Royal Colleges, four of these clinical
standards were made priorities for delivery to ensure patients admitted in an emergency receive the
same high quality initial consultant review, access to diagnostics and interventions, and ongoing
consultant-directed review at any time on any day of the week.
The 7DS Programme
• Standard 2: Time to initial consultant review
• Standard 5: Access to diagnostics
• Standard 6: Access to consultant-led interventions
• Standard 8: Ongoing daily consultant-directed review
Priority 7DS
clinical standards

7DS Board Assurance Framework Published
7DS Board Assurance Framework was published in
November 2018
• The 7DS BAF is a new measurement system that replaces the previous self-assessment
survey.
• NHS Improvement published guidance in provider bulletin, 28th November 2018.
• All CCG Accountable Officers and Chairs of A/E Delivery Boards have been informed by
letter of new measurement system on 18th December 2018.
• Introductory briefing pack, guidance, FAQ’s and self-assessment template can be
downloaded from https://improvement.nhs.uk/resources/board-assurance-framework-
seven-day-hospital-services/
• SE and SW Regional Medical Directors have recently written to all Medical Directors of
acute providers requesting submission of templates by 28th February 2019.

8
The board-assured assessments of 7DS delivery will feed into
local and national accountability frameworks
The NHS Standard Contract will require
providers to undertake the 7DS board
assurance process bi-annually. The results
from this will form a 7DS metric in the CCG
improvement and assessment framework to
allow CCGs to assess local delivery of 7DS.
7DS accountability
The CQC inspection regime assesses 7DS
performance as part of its judgement on a
trust’s effectiveness. CQC will use providers’
self-assessments of 7DS delivery will be used
by the CQC as supporting evidence in its
inspection processes covering 7DS.

The 7DS Board Assurance Framework will be implemented gradually,
with a trial run followed by full implementation
• In place of the proposed autumn 2018 7DS
self-assessment survey, providers of acute
services will undertake a trial run of the
board assurance process
• This trial run will take place from November
2018 to February 2019. All providers of
acute services will complete the template
and gain board assurance of the self-
assessment
• As this is a trial, providers of acute services
are not required to complete any new audits
to support these self-assessments. Data
from the previous 7DS survey can be used
as evidence.
Board assurance implementation
• Full implementation of the 7DS board
assessment framework will take place in
March to June 2019
• This will follow the same process of
completing the measurement template and
subsequent board assurance of the self-
assessment
• This self-assessment will be based on local
data, such as consultant job plans and local
clinical audits, as outlined in the full 7DS
board assurance framework guidance.
Trial run – Nov 2018 to Feb 2019 Full implementation – Mar – Jun 2019

The process for 7DS board assurance is consistent for all providers of
acute services
• The new measurement
system consists of a standard
template that all trusts will
complete with self-
assessments of their
performance against the 7DS
clinical standards, supported
by local evidence
• This self-assessment will then
be formally assured by the
trust board. Boards can
decide appropriate processes
and details to include, based
on local systems, governance
structures and timetables.
Board assurance process
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
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
No the intervention is only
available on or off site via
informal arrangement
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
admitted in an
emergency
Twice daily: Yes the
standard is met for
admitted in an
emergency
Twice daily: Yes the
standard is met for
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
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
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
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

The four priority clinical standards are unchanged and remain the main
focus of 7DS measurement
Full details of the measurement criteria for these standards can be found in the 7DS
board assurance framework guidance.
7DS measurement
• Assessment based on a triangulation of
consultant job plans to deliver 7DS, local
audits to provide evidence and reference to
wider metrics.
Clinical Standard 2 – First consultant review
within 14 hours
• As previously, assessment based on
weekday and weekend availability of six
diagnostic tests to appropriate timelines,
either on site or by a formal arrangement
with another provider.
Clinical Standard 5 – Access to consultant-
directed diagnostics
• As previously, assessment based on
weekday and weekend availability of nine
interventions on a 24-hour basis, either on
site or by a formal arrangement with another
provider.
Clinical Standard 6 – Access to consultant-led
interventions
• Assessment based on consultant job plans
to deliver 7DS, robust MDT and escalation
protocols, local audits and reference to
wider metrics.
Clinical Standard 8 – Ongoing consultant-
directed review

www.nhs.uk
1. Clinical Standard 2 and 8 evidence (P5 &10)
EVIDENCE SOURCE 1 - CONSULTANT JOB PLANS
 Are you able to confirm that consultant job plans in all specialties which receive emergency admission provide sufficient
daily consultant presence to deliver standards?
EVIDENCE SOURCE 2 – LOCAL CLINICAL AUDIT
 Do you have sufficient local clinical audit to provide the board with assurance of sustainable performance? You will
need to think about the exact type and level of clinical audit based on whatever is required to ensure that the trust’s board can
provide assurance of performance. Examples can be found on P 5 and P 11.
EVIDENCE SOURCE 3 – WIDER SOURCES OF PERFORMANCE AND PATIENT EXPERIENCE MEASURES
 Have you collated other wider sources of information with potential links to delivery of the standards? Examples
include:
 Patient experience data from weekdays versus weekends covering consultant presence/availability;
 Wider related patient flow and urgent and emergency care metrics (eg number of red-green days and A&E performance);
 Weekday and weekend ratio data in mortality, LOS, readmissions;
 GMC trainee doctor survey data on the support offered by Consultants;
 Audits of staffing level and activity related to 7DS as recommended by the Royal College of Physicians, July 2018;
 Separate targeted ongoing audits of performance in specific specialties or locations as part of trust continuous improvement activity;
 Evidence of systems to support ongoing review (CS8) eg Board round system, system of escalation for deteriorating patients, and a clear
process to decide which patients do not need a daily consultant review.
2. Clinical Standard 5 and 6 continues as a self-assessment evidence (P7)
3. Confirm CS2, 5 ,6 & 8 compliance with the relevant 5 urgent network specialist services (P15)
4. Summarise progress on other 6 Clinical standards – this is a high level summary (P13) – Note: Not nationally measured
Resources: https://improvement.nhs.uk/resources/board-assurance-framework-seven-day-hospital-services/
12
Evidence sources
Check list for preparing the evidence to support 7DS delivery

The measurement template also captures detail on 7DS in urgent
network specialist services and all of the 7DS Clinical Standards
7DS measurement
• Alongside the 7DS clinical standards for all
patients admitted to hospital in an
emergency, providers have been delivering
the four priority clinical standards in five
urgent network clinical services, namely:
• Hyperacute Stroke
• Paediatric Intensive Care
• STEMI Heart Attacks
• Major trauma
• Emergency vascular services
• The measurement template asks providers
of acute services for an updated
assessment of progress against the four
priority standards in the relevant specialist
services on a seven day basis.
7DS in urgent network
specialist Services
• Delivering all 10 7DS clinical standards is
vital to maintaining high quality care seven
days a week
• As well as measuring progress against the
four priority 7DS standards, the
measurement template asks providers of
acute services to summarise progress
against the six standards collectively known
as the 7DS standards for continuous
improvement
• This summary is not a formal assessment of
progress. Full details are in the 7DS board
assurance framework guidance.
7DS standards for continuous
improvement

University Hospitals
Plymouth & Livewell SW
People First
7 day Services Board Assurance Pilot
Mitch Persad
Neil Hammacott
University Hospitals Plymouth
Groups/PeopleFirst/1/1/1 1416/01/2019

People FirstProcess for standards 2 and 8
• A daily list of admitted patients was taken from our
systems for 13th to 19th October 2018
• 7 Medicine and 3 Surgical patients were randomly
selected, 10 per day, 70 in total (as we are a large Trust)
• Used national 7 day templates to gather standard 2 and
8 data (one per patient)
• Used bed management system to identify location of
patient
• The Discharge Case Manager or SI Lead would review
the notes on the respective wards
• Patients were reviewed daily until they were either
discharged from hospital or at the end of the 5th day
after admission
16/01/2019 Groups/PeopleFirst/1/1/1 15

People FirstAdditional data sources
• For standard 2, our bed management system records a
date and time stamp (when updated) that a consultant
review has occurred
• This time was compared to that in the notes for
additional verification

• After the survey ended, we took the
completed templates and calculated results
• 87% weekday performance and 71% weekend
performance vs 14 hr standard (RED)
• 97% weekday reviews, 73% weekend reviews
vs standard 8 (GREEN and RED)

• For standard 5, we spoke to our Imaging
colleagues to confirm current provision
– GREEN
• For standard 6, we spoke to Surgical
colleagues to confirm current provision
– GREEN

People FirstProcess for additional sections
• For 7DS clinical standards for continuous
improvement
– Summarised our plans from our working group
• For 7DS and urgent network clinical services
– Summarised findings / provision from clinical
colleagues

People FirstBoard Assurance Process
• Findings reviewed & “signed off”
by Trust 7 Day Project Group
(includes Medical Director)
• We update Our Trust Executive
every 6 months on progress and
will update again by end Feb 2019
• We will include the Excel template
as an appendix
• We plan to “close the loop” by
building in an annual update to
our Trust Board provisionally
through a Safety and Quality
committee route (awaiting
confirmation)

People FirstNature of update
• Exec Summary
• Progress against four priority
standards
• Update on latest survey results
• Supporting metrics
– Mortality (SHMI)
– Weekend admission LOS
– ED Breaches
• Conclusion, recommendations
and outstanding activities

People FirstSupporting metrics

People FirstSeptember 18 headlines
• Positives
– Best ever Standard 2 performance
– Standard 8 performance good
– NEWS2 implementation
– Standard 2 attributes progress
– Progress on Endo and US non-emergency
IP lists
• Challenges
– Staffing for take and morning imbalance
– Definition of senior review in SAU /
pathway exceptions
– Gaps in weekend review for HCE, Resp and
medical outliers

People FirstLessons learnt from survey (1)
• Notes were not easily accessible - ward rounds,
MDT meetings, notes sent for coding, or reviews
by physio’s OT’s etc, so on occasions had to re-
visit to complete
• Having a usable performance report, helped to
easily identify a mix of patients to review
• By using the report and identifying all eligible
patients (typically 70 to 80 pts / day) meant
– We could choose a 70/30 Medicine / Surgery split
– We could choose patients admitted at different times
of the day (mix of AM and PM admissions)

People FirstLessons learnt (2)
• Having the same person reviewing the notes
allowed for continuity
• Reviewing the patients in hospital helped with
accessing the notes rather than having to
request them from our store post-event
• Exercise is still driven by our change team (SI),
we are talking to governance colleagues to
make this business as usual
• We’ve not perfected our board reporting yet
either!

People FirstLessons learnt (3)
• Reviewing 70 patients rather than 260 has
been a lot less labour intensive
• Even though we’ve sampled less patients,
results have not provided any surprises as to
where we need to improve
– Standard 2: reviewing late afternoon admits same
day can be challenging for us
– Standard 8: known weekend senior review gaps
highlighted in results

People FirstNext steps for UHP - surveys
• Hand over process to quality governance to
make it business as usual
• Complete work around defining TME and
board review
• Use data gathered to inform team review /
improvement huddles in relevant areas

www.england.nhs.uk
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7 Day Hospitals – Discussion
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
Click on here to open the
‘chat’ function so you can
type in questions or
comments
Click on here to
raise your hand to
ask a question

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7 Day Hospitals – Next Steps
Next steps and further information
• Secure date at February and June 2019 Board meeting to sign off the
template and 7DS Board Report.
• For further advice contact your designated Sustainable Improvement contact
if required.
• Submit 7DS Board Assurance Framework template by 28th February 2019.
• Further information and resources can be found via NHS Improvement
provider bulletin and website https://improvement.nhs.uk/news-
alerts/provider-bulletin-28-november-2018/

www.england.nhs.uk
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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
For general information vivrichards@nhs.net

www.england.nhs.uk
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7 Day Hospitals – Resources
Thank you for joining this webinar the links to the
recording will be sent out shortly
For more information: Contact: vivrichards@nhs.net
For other 7 day service resources:
https://improvement.nhs.uk/resources/board-assurance-framework-
seven-day-hospital-services/

Preparing for the Board Assurance framework for 7DS with guest speaker from University Hospitals Plymouth NHS Trust.

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Preparing for the Board Assurance framework for 7DS with guest speaker from University Hospitals Plymouth NHS Trust.