This document discusses the potential benefits of expanding health services to 7 day availability. It notes that patients are at higher risk over weekends and many find it more convenient to access services outside normal hours. Expanding services could improve safety, convenience, and reduce costs. The document considers what types of primary and secondary care services could be expanded and the possible impacts on patient outcomes like mortality, quality of life, and experience of care. It also discusses leadership, planning, evaluation, and roles for different organizations to help progress expanded 7 day services.

1. Seven Day Services
A Domain Director’s Perspective
Professor Sir Mike Richards
March 2013

2. Seven day services: Overview
• Why move to 7 day services?
• What services?
• Potential impact on outcomes?
• How can we use the new system to drive change?

3. Why move to 7 day services?
• Safety: Higher risk for patients at weekends (though
data/analyses are complex)
• Convenience: Many people may find it easier to
access services outside the normal working week
• Cost: Patients spending longer in hospital because of
difficulties with weekend discharges. Others are
admitted because no rapid access outpatient
services are available at weekends

4. What health/illness services?
• We need to differentiate between
– 24/7
– 7 day (but not out of hours)
– 6 day (but not out of hours)
• We need to consider both primary and secondary
care
• What services are not needed 6 or 7 days a week?

5. Points to consider (1)
• Many NHS services are already delivered 24//7
– A&E
– Hospital inpatient services (nursing and medical)
– Some diagnostic services
– Out of hours GP services
– Some community nursing services
• Some other “health” services are available 7 days a week
(often for long hours though not 24/7)
– Some pharmacies
– Many gyms

6. Points to consider (2)
• Many other services are available 7 days a week: some
shops, petrol stations, restaurants and pubs
• Some are available 6 days a week: Hairdressers, opticians
and some shops
• Some are generally available 5½ days a week: Garages,
banks and post offices
• Some are generally only 5 days a week: Solicitors,
accountants and some funeral directors

7. Impact on outcomes
Question: how many people here today are
confident that they can name the five
domains of the NHS Outcomes Framework?

8. The NHS Outcomes Framework made simple
If you were seriously unwell, what would you be
likely to want?
• To have your life saved
• To have a good quality of life thereafter
• To recover quickly
• To have a good experience of care from the NHS
• To be treated safely

9. The NHS Outcomes Framework made simple
If you were seriously unwell, what would you be
likely to want?
• To have your life saved (Domain 1)
• To have a good quality of life thereafter (Domain 2)
• To recover quickly (Domain 3)
• To have a good experience of care from the NHS
(Domain 4)
• To be treated safely (Domain 5)

10. 7 day services:
Potential impact on outcomes (1)
• Easier access to GP services
– More patients (especially of working age) presenting earlier with
possible cancer symptoms? (Domain 1)
– More patients (especially of working age) attending for NHS Health
checks? (Domain 1)
– Easier attendance for patients with long term conditions, reducing
complications? (Domain 2)
– Reduction of A&E attendances / hospital admissions? (Domain 3)
– Greater convenience - improving patient experience (Domain 4)

11. 7 day services:
Potential impact on outcomes (2)
• Easier access to hospital outpatient/day case services
– Rapid access clinics (e.g. TIA, cancer, chest pain)
– Diagnostic services (e.g. Imaging, endoscopy)
– Therapy (e.g. Radiotherapy, day case surgery)
• Benefits in terms of convenience, patient experience (Domain
4), reduced admissions and possible impact on mortality
(Domain 1) and disability / quality of life (Domain 2)
• Running these services gives a critical mass of staff within the
hospital to provide advice on other patients

12. 7 day services:
Potential impact on outcomes (3)
• More senior staff leading care for inpatients
– Better quality of decision making
– Better delivery of interventions
– Earlier discharge
– Fewer errors
• Reduced deaths and disability

13. How can progress be made (1)
• Leadership: Winning hearts and minds
• Planning and modelling
– What will it mean for patients and carers?
– What will it mean for staff?
– What are the likely costs and benefits?
• Patient/public engagement
• Documentation/publication of existing good practice
• Testing and evaluation
• Commissioning
• Incentives
• Monitoring

14. How can progress be made? (2)
Roles for:
• Commissioning Board
• NHS Improving Quality
• Senates
• Strategic Clinical Networks
• Academic health science networks
• Clinical Commissioning Groups
• Health and well being boards
• Trusts and GP practices

15. Summary
• Non-emergency health services are one of the few services
we need which are not routinely available 6 or 7 days a week
• Extending services to 6 or 7 days would almost certainly
improve outcomes as well as convenience
• Some health services are already moving towards 7 day
service provision
• We need to learn from their experience and to spread good
practice