This workshop event, hosted by NHS England and NHS Improvement, brought together acute trust’s working towards the delivery of the four priority clinical standards by March 2018. Trust clinical leads and operational managers shared local challenges and solutions to delivery.

1. Seven Day Hospital Services:
South East Workshop
8th February 2018
WIFI
Network: Park Plaza Victoria
Password: No password

2. Welcome
Dr. Rachael de Caux
Regional Medical Director, South, NHS Improvement

3. Seven Day Hospital Services:
Setting the scene
Dr. Rachael de Caux
Regional Medical Director, South, NHS Improvement

4. Overview
4
• 7 Day Services - the what and the why?
• National and regional progress
• Challenges identified across the SE identified by
7DS self-assessment gap analysis tool
• Role of NHS Improvement & NHS England in
supporting delivery
• Questions

5. 7-day services – what they mean for patients
“If I need to make an appointment to see or speak to a GP, I can get an
evening or weekend appointment if I need to. My GP surgery offers a
mix of face-to-face, telephone, email and video consultations.”
“If I have an urgent need, I can phone or electronically contact NHS 111
and the NHS will arrange for me to see or speak to a GP or other health
professional – any hour of the day and any day of the week.”
“If I need to be admitted to hospital in an emergency, I will receive the
same high quality of care any day of the week and any hour of the day.
An experienced clinician will make timely decisions about my care and I
will be able to access the services I need.”
NHS 111
24/7 access to
health advice
“I can always get
health advice from
the NHS on my
laptop, phone or
through the
internet.”
7-day community
pharmacy
“I can get
health advice 7
days a week
from a range of
services, like
pharmacy.”
7-day community
support
“If I need
community
support when I
leave hospital, I
can get this any
day of the week”
5

6. 7-day hospital services: standards and outcomes
6
Patient
involvement
Time to consultant
review*
Multidisciplinary
team review
Shift handovers
Access to
diagnostics*
Consultant-led
interventions*
Mental health
Ongoing review*
Transfers to other
care environments
Quality
improvement
1
3
5
7
9
2
4
6
8
10
Reduced
mortality for
admitted
patients
Reduced length
of stay
Reduced
readmission
rates
10 clinical standards, of which four are national priorities
… driving four main outcomes
Four priority standards tracked to assess provider readiness
Better patient
experience
Outcomes to be measured every six months

7. 7-day services: wider benefits
Patient flow
• Improving patient flow across the week and reducing spikes of
activity, e.g. the ‘Monday morning’ effect
• Improving A&E performance
Asset
utilisation
• Making more effective and efficient use of equipment and theatres
across the week, by avoiding decision traffic jams on Monday
mornings
NHS Improvement and NHS England are working with providers and local
health economies to help ensure that implementation of 7-day services drives
benefits across a number of areas
Main
outcomes
• Reducing mortality
• Reducing hospital readmissions
• Reducing length of stay
• Improving patient experience
Working lives
• Supporting greater flexibility in staff working patterns, eg through
use of self-rostering
• Enabling staff to take on enhanced roles
7

8. 7-day hospital services – the journey
8
By 2020-21, the four priority standards
will be guaranteed for c.100% of the
population (phase 3)
By March 2017, the four priority
standards will be guaranteed for
25% of the population
(phase 1)
By March 2018, the four priority
standards will be guaranteed for
50% of the population (phase 2)
2016-17 2017-18 2018-19 2019-2025% 50% 100%

9. To meet these objectives, it is essential that all hospital
providers and local health economies make
sustained progress in each year from now to 2020.
9
Frimley Health
Buckinghamshire Healthcare
Oxford UH
UH Southampton
2016-17 2017-18 2018-19 2019-2025% 50% 100%
Although the timetable allows for different finishing points, this does not
mean we are staggering the starting point
Ashford & St. Peter’s
Dartford & Gravesham
Hampshire Hospitals
Portsmouth Hospitals
Royal Berkshire
Queen Victoria H
Surrey and Sussex Healthcare
Western Sussex H
Brighton & Sussex UH
East Kent HU
East Sussex Healthcare
Isle of Wight
Maidstone & TW
Medway
Royal Surrey CH

10. In the South East, a breakdown of performance by acute trust shows variation in performance
with CS2, with 5 trusts below the national average of 71%.
10
Hospitals Sept 2017 March 2017
CS2
Trend CS2 CS2 CS5 CS6 CS8
A Decrease 62% 71% 100% 100% 86%
B Decrease 94% 100% 94% 94% 97%
C Decrease 87% 95% 100% 100% 92%
D Increase 95% 64% 100% 100% 82%
E No return No return 97% 100% 100% 92%
F Decrease 79% 81% 100% 100% 91%
G Decrease 62% 68% 100% 100% 91%
H No return No return 74% 100% 100% 93%
I Increase 72% 51% 86% 22% 100%
J Decrease 55% 70% 87% 100% 87%
K Decrease 67% 68% 97% 94% 94%
L Increase 67% 66% 91% 94% 88%

11. www.england.nhs.uk
A self- assessment readiness tool used included criteria in 5 domains:
1. Leadership and governance
2. Data capture and information quality
3. Performance and change management
4. Workforce readiness
5. Pathway policies and procedures
There was an 83% response rate*
*Note: 6 Trust’s were excluded from survey as they were were compliant or close to delivery in 2017. These
included: Buckinghamshire Healthcare, Frimley Health, Oxford University Hospitals, University Hospital
Southampton, Royal Bournemouth & Christchurch, Salisbury
11
In Summer 2017 acute Trusts across the South of England were asked to
complete a 7DS gap analysis return
Gap analysis tool returns

12. www.england.nhs.uk
Across the South East, 50% of trusts reported there was no provision of a 12
hour Consultant present rota across the day
83% response rate. 14 out of 15 Trusts* in SE
 77% report no ability to currently capture
data electronically and 62% of Trusts did not
validate 7DS survey data validation prior to
submission.
 58% report challenges with delivering
Consultant daily ward/board rounds across a
7 day week and recording of delegation of
Consultant review was a key challenge (67%)
 58% of trust reported no 7DS delivery plan and
57% reported that 7DS not discussed across
the system at the A/E Delivery Board.
 50% do not have 12 hour Consultant
presence rota across the day
 43%% reported difficulties in creating a
shared 7DS vision across the trust and
challenges with clinical/ departmental
ownership
*Non returns of gap analysis – Hampshire Hospitals. Trusts close to /compliant with
standards.were excluded

13. *Latest NHS Quality Account requirements request that providers of acute services are asked to include a statement regarding how they
are implementing the priority clinical standards for seven day hospital services. https://improvement.nhs.uk/news-alerts/provider-
bulletin-31-january-18/#quality-accounts-requirements
Improvement
Support
Sustainability
and
Transform-
ation
Partnerships
NHS Planning
Guidance
CCG
Improvement
and
Assessment
Framework
Improvemen
t Support
NHS Standard
Contract
Quality
account
Requirements
*
CQC
Inspection
Framework
There are many levers to support the
delivery of 7 day services with partners

14. Support for 7 day services in region
14
Regional Programme Leads
Sue Cottle SI NHSE
Sue.cottle@nhs.net
Charlotte Wood NHSI
Charlotte.wood@nhs.net
South East SI Team
Sue Cottle
Wendy Keating
 Delivery planning
 Enabling system wide conversations
 Communicating between the trusts
and the ALBs
 Helping with the ‘how to’
 Supporting measurement

15. www.england.nhs.uk
Questions?

16. 7 Day Hospital Services:
National Learning to date
Dr. Arrash Arya Yassaee
Clinical Fellow, NHS Improvement
arrash.yassaee@nhs.net

17. 7 day services in hospitals - milestones
17
April 2017
25%
April 2018
50%
2018/19 April 2020
100%
By April 2017, the four priority standards
available to 25% of the population
By April 2018, the four priority standards
available to 50% of the population
By 2020/21, the four priority standards
available to 100% of the population

18. Regional learning events
18
North
95 attendees
38 organisations
Mids & East (1)
42 attendees
21 organisations
London
57 attendees
19 organisations
South
89 attendees
40+ organisations
Mids & East (2)
37 attendees
19 organisations

19. Preliminary Learning
19
What trusts will now do differently:
• “Simplify admissions process, unified clerking pro forma”
• “Friday ward round sheet – identify those need to be seen”
• “Explore the idea of perioperative practitioners”
• “review capturing electronically and setting count downs on assessment
standard 2”
What support can we provide them:
• “an evidence base from Trusts employing various interventions and
even better, ‘off the shelf’ business cases for each”
• “provide clearer guidance on the standards, with examples or case
studies to illustrate”
• “Explain core standards to trust members; support us with engagement
events”

20. 7 day services in hospitals: challenges
20
Workforce
Reconfiguration
& Networks
Communications
& Engagement

21. Learning document
21
Key themes:
• Understanding and Implementing
Clinical Standard 2
• Job planning
• Winning hearts and minds
• Clinical Handover
• Workforce constraints
• Reconfiguring and networking
services
https://improvement.nhs.uk/uploads/documents/Seven_day_hospital_services_challenges_and_solutions_FINAL_3.pdf

22. 22
Understanding and implementing
Clinical Standard 2
• Trusts should refer to the Seven Day Services Clinical Standards – updated
September 2017.
• Providers and commissioners can make local decisions on how to confirm with
the guidance – this could include:
• increasing the number of formal protocol pathways in operation
• cross-cover arrangements between subspecialties
• network solutions
• Consultant review offers clinical benefit to the patient but also helps ration
investigations and facilitate discharge.
• Risk stratification and prioritisation tools (including electronic solutions) help
provide real-time data and decision-making support to achieve CS2.
• Systems-level approaches (e.g. care home visits, changing GP visit times etc)
have helped reduce demand on acute centres.

23. 23
Job planning
• Job plans should reflect shared objectives and job planning processes should
align with trust’s business planning process.
• Several hospitals have operated various solutions in increase OOH consultant
presence:
• Designating a set number of PAs for OOH care for all newly appointed
consultants.
• Appointing consultant leads for OOH care.
• Integrating weekend discharge team responsibilities in consultant job
plans.
• Involving other health professionals in consultant job planning process helps
identify tasks that other members of the MDT can do.
• New roles with clearly defined job descriptions can free up clinical time of
senior staff:
• Medical support workers
• Therapy assistants (to improve PT/OT capacity)

24. 24
Handover and workforce constraints
• Several trusts discussed how they improved handover of clinical care as well
as the capacity of their staff:
• Easily accessible information on referral pathways, OOH services and
guidelines.
• CCG-level single agreed assessment-for-discharge process.
• Weekend handover sheets with clear instructions of weekend plan
(including suggested action, escalation plan, grade of doctor needed to
review patient) can benefit both clinical team and for subsequent audit.
• A number of trusts have increased use of ambulatory care pathways with
up to 50% of surgical patients and up to 30% of medical patient managed
in this way.

25. Next steps (1) – upcoming projects
Documentation
review
Use of
protocols and
pathways
Expediting
consultant
review in AMU

26. Next steps (2) – Detailed case studies
Reconfiguration
& Networks
New clinical
roles
Use of
technology
New patterns of
working
Financial case
studies

27. Questions?
27

28. Refreshment break
WIFI
Network: Royal Plaza Victoria
No Password

29. Workshop One - Delegation
of consultant reviews and
clinical handover strategies:
sharing successes and
challenges

30. Workshop One - Delegation of consultant
reviews and clinical handover strategies:
30
Step 1: Talk through one example of a patient pathway (eg medicine,
surgery, T&O, care of the elderly – Consultant directed/ delegated or
non-consultant protocol)
Step 2: How have you engaged staff/approached the pathway to improve
CS2 and CS8 achievement?
Step 3: What were the hurdles? How did you overcome them?
GROUP FEEDBACK – 10 mins
One practical step that you feel would be useful to take forward

31. Lunch and networking
WIFI
Network: Park Plaza Victoria
No Password

32. Our journey to date:
challenges and solutions
Constantinos Yiangou,
Associate Medical Director and Seven Day Services
Lead,
Portsmouth Hospitals NHS Trust

33. Page 33 3/6/2018

34. National Seven Day Services Surveys
Table 1: Patients audited (sample of emergency admissions)
SURVEY Weekday Saturday Sunday TOTAL
Spring 2016 189 21 33 243
Autumn
2016
145 24 25 194
Spring 2017 146 17 26 189
Autumn
2017
141 30 29 200

35. Clinical Standard Two
Table 2: Patients seen within 14 hours from admission by a consultant
SURVEY Weekday Weekend Saturday Sunday
Spring
2016*
68.3% 78% 81% 75.8%
Autumn
2016
66% 67% 72% 64%
Spring 2017 84% 77% 82% 73%
Autumn
2017
77% 83% 77% 90%
*for this survey the arrival time was used

36. Clinical Standard Two – Autumn 2016
Chart 1: Proportion of patients who received a first consultant review within
14 hours of arrival to hospital

37. Clinical Standard Two – Spring 2017
Chart 2: Proportion of patients who received a first consultant review within
14 hours of admission to hospital

38. Clinical Standard Two
Table 3: Documented evidence that patients/families/carers informed
within 48 hours of diagnosis/treatment plan
SURVEY Weekday Weekend Saturday Sunday
Spring 2016 49.7% 52% 61.9% 45.5%
Autumn
2016
76% 73% 94% 59%
Spring 2017 95% 74% 65% 81%
Autumn
2017
52% 71% 67% 76%

39. Clinical Standard Five
Diagnostics – fully compliant
• CT Scan
• Microbiology
• Echocardiography
• Upper GI – Endoscopy
• MRI scan *
• US Scan
*Indications for out of hours use are spinal cord compression
and cauda equina syndrome

40. Clinical Standard Six
Consultant-directed interventions – fully compliant
• Critical care
• Primary PCI
• Cardiac pacing
• Thrombolysis for stroke
• Emergency general surgery
• Interventional endoscopy
• Interventional radiology*
• Renal replacement
• Urgent radiotherapy

41. Clinical Standard Eight
Table 4. Ongoing once daily review of inpatients by a Consultant or an
appropriate delegate
SURVEY Weekday Weekend Saturday Sunday
Spring 2016 67.6% 67% 50% 75%
Autumn
2016
99% 98% 92% 95%
Spring 2017 95% 81% 83% 79%

42. Clinical Standard Eight – Spring 2017
Chart 3: Proportion of once daily Consultant reviews (or delegated)

43. Clinical Standard Two – Autumn 2016
Chart 4: Cumulative hours between admission and 1st consultant review

44. Clinical Standard Two – Spring 2017
Chart 5: Cumulative hours between admission and 1st consultant review

45. Clinical Standard Two – Autumn 2017
Chart 6: Cumulative hours between admission and 1st consultant review

46. 3/6/2018
Clinical Standard Two
Table 5: Emergency patients seen within 14 hours from admission in the
eight busiest specialties (N: number of admitted patients; %: percentage
seen by a Consultant within 14 hours
Specialty Spring 2017 Autumn 2017
Weekday Weekend Weekday Weekend
N % N % N % N %
Acute internal
medicine
58 95 14 86 57 89 27 93
Cardiology 3 100 2 50 9 78 8 88
General
Surgery
10 70 6 67 16 69 1 100
Geriatric
Medicine
19 68 5 80 22 64 7 71
Oncology 4 50 0 N/A 6 83 2 50
Paediatrics 12 67 3 67 8 38 4 50
Stroke
Medicine
9 67 2 0 9 78 4 75
Trauma and
Orthopaedics
23 96 6 100 4 100 3 100

47. Summary
• Strong clinical involvement
• Improvement in some specialties (clinical
standards 2 and 8)
• Diagnostics and interventions – no issues
• Performance similar throughout the week
• Benchmarking data encouraging
• 14-hour threshold missed by 2-3 hours

48. Challenges/Solutions
• Documentation – electronic?
• Protocols for standard presentations
• Allocation of additional resource to unscheduled
care – “medical model” and surgeon of the week
• Outliers – bed reconfiguration, cohorting patients
• Appropriate delegation – board rounds
• Handover lists – electronic?
• The late afternoon/early evening admissions –
evening ward rounds
• Job planning and the impact on scheduled care

49. PHT Medical Model - 1
• The medical model commenced in earnest on Sept 4th 2017.
• The model supports the delivery of a 7-day per week 08.00-22.00hrs consultant led medical take.
• The model has supported safer care of medical pts in ED and the emergency corridor, particularly
OOH with extended senior cover.

50. PHT Medical Model - 2
• Work is effectively identified and tracked using the AMU Take List on BedView allowing those
individuals and teams participating in the take to be able to see which patients are already being
reviewed by another team and which patients still need to be seen.
TAKE LIST Patient level data
entry

51. PHT Medical Model - 3
• We are tracking data daily data from BedView demonstrating the percentage of pts having a
consultant review within 14 hours, with a weekly data update.
• Medical take trend line below shows continued improvement from 67% of pts having a consultant
review within 14 hours before medical model to 86% by 21.01.18

52. Questions?
52

53. Our journey to date:
challenges and solutions
Roger Duckitt,
Clinical Lead – Acute Medicine,
Western Sussex Hospitals NHS Foundation Trust

54. Western
Sussex
Hospitals
NHS
Foundation
Trust
7DS National Survey
- Progress Overview –
February 2018

55. 55
WSHFT Headlines from Self Assessment – October
2017
The Results have remained static from the last self assessment in the Spring 2017.
WSHFT Trust wide Baseline:
Proportion of patients reviewed by a
consultant within 14 hours of admission at
hospital
September
2016
March 2017 October 2017
50% 68% 66%
October 2017 Results
Split by Site
Sample Number Suitable consultant
review within 14
hours of ADMISSION
% compliance
Worthing 122 80 66%
St Richard’s 123 82 67%
Overall 245 162 66%

56. 56
WSHFT Headlines from Self Assessment – October
2017
The Results have remained static from the last self assessment in the Spring 2017.
WSHFT Trust wide Baseline:
Proportion of patients reviewed by a
consultant within 14 hours of admission at
hospital
September
2016
March 2017 October 2017
50% 68% 66%
October 2017 Results
Split by Site
Sample Number Suitable consultant
review within 14
hours of ADMISSION
% compliance
Worthing 122 80 66%
St Richard’s 123 82 67%
Overall 245 162 66%
<1% of total admissions

57. 57
Standard 2: Time to 1st Consultant

58. 58
Standard 2 - (Day of Admission)

59. 59
Standard 2 (Compliance by Speciality)
St Richards Hospital

60. 60
Standard 2 (Compliance by Speciality)
Worthing Hospital

61. 61
Key Challenges
• Sample size small
• Wide variation
• Weekends!
• Manual notes reviews
• Data collection
• Staffing and processes

62. 62
Seven Day Services 2018/19 - Next Steps
• Divisions Service Prioritisation 2018/19 to include 7DS
• Restructure of medical rotas to meet compliance ahead of
2020
• Quality and depth of data to be improved
• Use data available to establish areas of focus
• Seven Day services as Trust Corporate Project

63. 63
Divisional Prioritisation – Chiefs of
Service

67. 67
WSHFT – What have we tried?
General Surgery / Medicine / Elderly Care
• Technical / Data collection
• Staffing / Rota changes

68. 68
WSHFT – Data Collection and Reporting
• e-Whiteboard (2003)
• Emergency Floor admissions dashboard
• 7DS Dashboard
• e-Handover (update due 2018)

69. 69
e-Whiteboard

70. 70
e-Whiteboard

71. 71
e-Whiteboard
• Currently Medicine, DOME, General Surgery, Urology, T&O
• Compliance is the key obstacle

72. 72
e-Whiteboard
• Currently Medicine, DOME, General Surgery, Urology, T&O
• Compliance is the key obstacle
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
%PatientswithDocumentedReview
Mean Control Limits (+/- 3s) +/- 1s +/- 2s
Time Stamped ConsultantReview Worthing Surgery

73. 73
e-Whiteboard
• Currently Medicine, DOME, General Surgery, Urology, T&O
• Compliance is the key obstacle
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
%PatientswithDocumentedReview
Mean Control Limits (+/- 3s) +/- 1s +/- 2s
Time Stamped ConsultantReview St. Richard'sMedicine

74. 74
e-Whiteboard
• Currently Medicine, DOME, General Surgery, Urology, T&O
• Compliance is the key obstacle
0.00%
20.00%
40.00%
60.00%
80.00%
100.00%
120.00%
%PatientswithDocumentedReview
Mean Control Limits (+/- 3s) +/- 1s +/- 2s
Time Stamped ConsultantReview Worthing Medicine + DOME

75. 75
Emergency Floor Performance
Dashboard

76. 76
Emergency Floor Performance
Dashboard

77. 77
Emergency Floor Performance
Dashboard

78. 78
Emergency Floor Performance
Dashboard

79. 79
Emergency Floor Performance
Dashboard

80. 80
Emergency Floor Performance
Dashboard

81. 7DS Dashboard

82. Rota modifications
• AIM Cons. – increase daily cover to 7pm
(Worthing)
• AIM Cons. – Twilight Shift to 8pm - weekdays
(SRH)
• AIM/GIM split – 365 cover to 7pm (Worthing)
• DOME Consultants off rota – 5-7pm Twilight shift
• Surgical Consultants – no change

83. Impact of rota modifications
Twilights
20%
Consultant review documented – Arrivals from 08:00 – 19:00 - MEDICINE

84. Impact of rota modifications
Weekends
20%
60%

85. Impact of rota change: Medicine
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
13/04/2014
13/05/2014
13/06/2014
13/07/2014
13/08/2014
13/09/2014
13/10/2014
13/11/2014
13/12/2014
13/01/2015
13/02/2015
13/03/2015
13/04/2015
13/05/2015
13/06/2015
13/07/2015
13/08/2015
13/09/2015
13/10/2015
13/11/2015
13/12/2015
13/01/2016
13/02/2016
13/03/2016
13/04/2016
13/05/2016
13/06/2016
13/07/2016
13/08/2016
13/09/2016
13/10/2016
13/11/2016
13/12/2016
13/01/2017
Percentage Patients with Documented Under 14 Hour Review - Worthing
Medicine
DOME
Surgery

86. Impact of rota change - DOME

87. 87
Key Themes and Challenges
• Weekend variation
• impact of extended hours ?how to achieve cross-site
• Surgical performance
• Assess change in mechanism for data collection
• re-organisation of junior support to PTWR
• ‘Evening Patients’ – seen after night-patients on PTWR
• RCA/deep dives to explore breaches once compliance >90%

88. 88
Next Steps?
• Weekend variation
• impact of extended hours ?how to achieve cross-site
• Surgical performance
• Assess change in mechanism for data collection
• re-organisation of junior support to PTWR
• ‘Evening Patients’ – seen after night-patients on PTWR
• RCA/deep dives to explore breaches once compliance >90%
• Standard 8…

89. 89
Questions?

90. Refreshment break
WIFI
Network: Royal Plaza Victoria
No Password

91. Workshop Two – Acting on
survey results, staff
engagement: sharing
successes and challenges

92. Workshop Two – Acting on survey results,
staff engagement: sharing successes and
challenges
92
Each Trust to discuss – 10 minutes each
Q1. What are you doing with your survey results? How are you sharing
information with staff?
Q2. Where have you seen improvements and why? Where are you still
seeing challenges?
GROUP FEEDBACK – 10 mins
One practical step that you feel would be useful to take forward

93. What have we heard
Feeding back from group workshops

94. Next Steps

95. Close
Thank You For Attending