This presentation describes the strategic plan and journey of how Universal Hospital Southampton NHS Foundation Trust have developed and implemented out of hours and seven day services, using innovative workforce models and supporting culture change. This has led to improvements in patient outcomes, patient and staff experience and more effective patient pathways.

1. Seven Day Services
Top tips to engage
your stakeholders in
the delivery of 7 day
services
Juliane Kause Lead Consultant for Out of
Hours and Seven Day Services
University Hospital Southampton
Webinar hosted by
Sustainable Improvement
NHS England South
August 2017

2. Seven Day Services at UHS
the journey so far and strategic plan
7th July 2017
Juliane Kause
Lead Consultant for Out of Hours and Seven
Day Services at
University Hospital Southampton
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3. Background
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4. University Hospital Southampton Approach
• 5 year strategy (2012) – initially focussed on
strengthening out of hours care
• Involved in national work since 2015
• Very committed CEOs
• Clinical Lead appointed
• Significant investment in clinical posts – nurses,
pharmacists, consultants
• Gap analysis of “out of hours” and then 7DS
• It is becoming “what we do around here”
• Not perfect and there remains much to do
4

5. Strategic plan for 7DS
Transform
“hospital at
night”
2012-2017
7DS Early
implementer
site
April 2016
Action plan
for UHS and
CCGs
STP and SRG
University Hospital Southampton Approach
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6. Transform “Hospital at night” to Out of
hours team
• Senior leadership
• Hospital vs department/general vs specialist
• Shift harmonisation between different
healthcare professions
• Strengthened handover
• Real time out of hours education
• Patient feedback
• Sleep and rest policy
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7. Early implementer site
• Foundations laid by OOH work at UHS
• Awareness raised and culture change started
• Staff/patient comms strategy
• Changes in service delivery:
– New job roles: eg Doctors administrators, Medical
Assistants as ward round coordinators, Acute Care
Fellows
– Educational packages for MDT
– Shift harmonisation – therefore team available to
conduct consultant ward round
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8. 7DS UHS plan
• ..always open, always ready....
• Embedded in STP and SRG. Next update August 2016
• Gap analysis by
– Care group/specialty
– Workforce
– Budget setting
– Discharges: NEL – weekday vs weekend
– Community links
• Our priorities for 2016/2017:
– Pharmacy
– Therapy
– Admin and clerical support in clinical areas
– Mental health in ED
– Early pregnancy unit
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9. Our challenges delivering 7DS at UHS
• Consistency of delivering clinical services
seven days a week
• Weekend ultrasound services
• Weekend therapy services
• Weekend community services
• Boundaries between urgent and emergency
care
– Role of primary care/community services
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10. UHS weekend effect
10
Day of admission Spells Observed
(%)
Expected
(%)
Relative
Risk
Monday to Friday
2013-2014 48933
1591
(3.26)
1470
(3.01) 108.2
Saturday and
Sunday 2013-2014 16337 522 (3.2)
495
(3.04) 105.35
Monday to Friday
2015-2016 53416
1564
(2.93)
1628
(3.06) 96.02
Saturday and
Sunday 2015-2016 17901
522
(3.09)
561
(3.14) 98.28

11. UHS – consultant data
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12. Value of consultant delivered care
• Productive hospital – reference cost 0.96
• Medical Staff WAU - £598 compared to
national median £523
• Based on data sources including ESR, HES,
Financial
• How does this correlate to outcomes?
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13. UHS Staff surveyAdam Lott, NHSE March/April 2016
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Corporate
Managers
Medical
Staff
Clinical
Staff
Local
leaders

14. How did we interview?
• Interviews were not part of a formal research process.
They were conducted as part of an improvement process
collecting feedback from the key stakeholders.
• Semi-structured interviews via telephone and face to face
took place in mid April 2016.
• Responses provided were written down against each
question asked.
• Participants were provided with opportunity to open up
their feedback and give additional narrative against the
topic of 7 day services and the clinical standards at their
Trust.
• All participants were provided with contact details of the
interviewer. This gave opportunity for further questions or
to email or call with additional thoughts, ideas, experiences
and issues.
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15. Workforce
• “In hospitals ward based production lines to be invested in and serious
structural changes particular to careers of nurses – so good competent
nurses stay on and run wards 27/4 rather than specialise and move out to
non 24/7 work…. and how we incentives people to go back to the wards –
and make them dynamic.”
• “…7 days is not difficult sell in hospital – staff think and know it’s about
improving safety of patients - it’s not about working OOHs – it’s about
doing too much generalist stuff for Trust as that’s the main needs – so end
up doing therefore less specialised work they were employed for and most
passionate about…”
• “No ward clerks at the weekend. At the weekend I am a secretary and am
on the phone all the time...”
• “During the week there are two HCA per shift. During weekend, only 1. But
can’t predict how many emergencies will come”.
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16. Improvement
• “…may need to do some work around networking. Some of the very
difficult changes that need to be done affordably 7DS need more robust
strategic regionally support – focussing down to locally too much is a big
mistake…”
• “Want to do more than ticking the boxes and be very clear about how we
make/meet standards – find out what really matters than stipulating
reviews twice daily – like to investigate people in a timely 24/7 shorten
some pathways.”
• “…Fairly careful thought is needed… as once we have made the decisions
of what we want to do, do we have the support team to do it? There is a
danger you get your decision making process going faster than your ability
to make it happen…
• “…EPU Mon-Fri 9-7, not at all weekends. “If they were here to do
emergency scans, we wouldn’t need to admit them…” [patients awaiting
confirmation/diagnosis]
• “…Open the tunnel for transfers! We wait hours for transport and it costs a
fortune…”
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17. Partnership working – Integrating systems
• “If taking to next level need instruction of what community
and social care should be providing and what networks should
be providing”
• “…biggest challenge will be working alongside council and
other health services. It’s a flow issue – all linked –more
concerned that we will never get flow..”
• “…Community MDTs, prevention agenda, not just about UHS
it’s about changing substantially across health care system.”
• “No social services all weekend except a senior ‘I think’.
Delays discharges-6 medically fit patients on ward today. If
Social Services were 7 days, the patients would get shifted
along. Need social services-7 days a week, same as we do-
would facilitate transfers..”
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18. UHS Patient surveyWendy Keating & Juliane Goetz, March 2016
The good...
• Everybody was so kind, so good
• Emergency care is brilliant
• Really good ward, happy to help, more staff to help the doctors, more
human than a few years ago
• Treated ok, Dr very good, tablets too late 11 pm
• We didn't have a truly representative experience due to the doctors
strike, but we have no complaints
• Need more consultants at the weekends, a lot falls to junior doctors so
they dont get things done till Monday, although they are brilliant
• I don't think things can be improved
• Meals are late, care is good
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19. The bad....
• Too noisy to sleep
• Ward temparture needs regulating, too hot at night
• Catering should be improved
• Better comms would be helpful, politer food assistants would be
helpful
• Was queuing in ED, but taken to AMU quickly
• 4 months ago my family was turned away when about to give birth and
taken to another hospital, there should always be doctors available
• There could be more nurses, ...they are trying to do too many things
• 1 nurse should only look after 6 patients not more
• There are more agency staff on duty during the weekend
• I will never return to this hospital, waiting ages for equipment delivery
and ambulance refused to take my wheelchair
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20. UHS seven day services patient survey
• 52 patient questionnaires completed
• Average rating of all departments by day of the week:
– Monday to Friday – core hours 4.31 (of 5)
– Monday to Friday – out of hours 4.29
– The weekend 4.27
• Urgent and emergency care a priority
– Yes = 47
– Blank = 4
– Not Sure = 1
• Good explanation of tests and care: 26 patients (50%)
• Good explanation of medication
– Yes = 41
– I don't need one = 6
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21. Next steps
• UHS Collaboration with other early
implementer in region
• UHS Collaboration with other trusts’ 7DS
clinical leads (regional) to work on 7DS
• Community collaboration
– Seven day community discharge planning
– Patient pathways to continue 7 days a week
– Primary care signposting for urgent care
– Mental health services to provide a 7 day service
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22. www.england.nhs.uk
For further information
Speaker contact: juliane.kause@uhs.nhs.uk
To request webinar recording email: vivrichards@nhs.net
More case studies can be viewed at:
https://www.england.nhs.uk/seven-day-hospital-services/resources/
https://improvement.nhs.uk/resources/seven-day-services/#resources