Embed Size (px)
Citation preview
www.england.nhs.uk
The Ambition for a
7 Day NHS
Marie Tarplee Programme Lead 7 Day Services
NHS England, Sustainable
Improvement Team
Midlands & East Region
Dan Duggan UEC PMO Lead
NHS England
Midlands & East Region
March 2017
Objectives for the webinar session
• Provide the detail of ‘The Ambition for a 7 Day NHS’
• Share the latest information about the delivery of Seven
Day Services
• Provide an update on the timescales for delivery
• Provide an update on progress to date
• Provide links to available resources
A 7 Day NHS – Objectives for the session
7 Day Programme
Context and background
By 2020, the ambition is that everyone will be able to have access to:
Weekend and evening access to primary care.
Faster, more streamlined access to urgent care, seven days a week through the
111 phone number.
Consistent standards of urgent and emergency hospital care, senior doctors and
diagnostics no matter which day of the week you are admitted.
Routine General Practice: “If I need to make a routine, planned appointment to
see or speak to a GP, I can get an evening or weekend appointment. My GP
surgery offers a mix of face-to-face, telephone, email and video consultations.”
Urgent care: “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 appropriate
health professional – any hour of the day and any day of the week.”
Emergency hospital admissions: “If I need to be admitted to hospital in an
emergency, I will receive the same high quality of assessment, diagnosis and
treatment, 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
diagnostic and treatment services I need.”
NHS 111
A 7 Day NHS – The Ambition
7 day services is about reducing variation, and ensuring high quality care
for all people every day of the week
Along side this is ongoing work to ensure that patients have 24/7 access
to mental health crisis care
NHS Five Year Forward View
“To reduce variations in when
patients receive care, we will develop
a framework for how seven day
services can be implemented
affordably and sustainably,
recognising that different solutions
will be needed in different localities”
5
7 Day Hospitals – Background and context
There is evidence of variation in outcomes for patients
admitted to hospital at the weekend.
A substantial body of evidence exists which indicates significant variation in
outcomes for patients admitted to hospitals in an emergency, at the weekend across
the NHS in England.
This variation is seen in:
o patient experience
o length of hospital stay
o re-admission rates
o mortality rates
Additionally medical, nursing, other health professional and managerial staffing
levels, as well as trainee doctors’ perceptions of supervision by consultants, also
vary by day of the week.
A 7 Day NHS – Background and context
Seven Day Services - National Clinical Standards Four priority standards have been selected from the 10 clinical standards developed
by the NHS Services, Seven Days a Week Forum as most likely to have the greatest
impact in tackling variations in mortality, patient flow and experience: Selection is
supported by the Academy of Medical Royal Colleges.
A 7 Day NHS - Seven Day Clinical Standards
• Standard 2: Time to consultant review
• Standard 5: Access to diagnostics
• Standard 6: Access to consultant directed interventions
• Standard 8: On-going review by senior decision makers
The 4 priority standards will be measured through the Bi annual survey:
25% population March 2017, 50%: March 2018, 100%: March 2020
Clinical standards
which enable
sustainable delivery
• Standard 1: Patient Experience
• Standard 3: MDT Review
• Standard 4: Shift Handover
• Standard 7: Mental Health
• Standard 9: Transfer to primary, community and social care
• Standard 10: Quality Improvement
DH Ministers NHS England
Executive Board NHS Improvement Executive Board
7DS Regional Steering Group
(London)
7DS Regional Steering Group
(North)
7DS Regional Steering Group (Mids & East)
7DS Regional Steering Group
(South)
7DS Implementation Sub-group
Chair: David Levy
(NHSE, NHSI, HEE, CQC, UEC)
7 Day NHS Governance Group
(DH, NHSE, NHSI, CQC, HEE)
7 Day Hospital Services Delivery
Group Chairs: Kathy McLean, Richard Barker
(NHSE, NHSI, Trusts, CCGs, DH)
A 7 Day NHS – Programme Governance
Robust governance arrangements reflect NHS England’s and NHS
Improvement’s shared responsibility for delivery
A 7 Day NHS – Commissioning for effective delivery
The Governments
Mandate to NHS England
2017/18
Sustainability and
Transformation Plans
NHS Planning Guidance
CCG Improvement
and Assessment Framework
Improvement Support
NHS Standard Contract
Improvement Support
CQC Inspection Framework
Improvement Support
Delivery of 7DS is supported through prominence in national
guidance and direction-setting documents as well as through local
hands-on support
March 2017
25%
population
coverage
March 2018
50%
population
coverage
2018/19
March 2020
100%
population
coverage
There are parallel programmes to deliver seven day hospital
services for all patients admitted in an emergency as 'generalist'
and 'specialist'
November 2017
100% population
coverage for 5
urgent network
services
Seven Day
Hospital
Services for
emergency
admissions
Seven Day
Hospital
Services
for urgent
network
services
Urgent network specialist
services:
• Emergency vascular
• Acute stroke
• Major trauma
• STEMI Heart attack
• Paediatric intensive care
A 7 Day NHS- Trajectory for delivery
• Acute Trusts have been contacted by NHS Improvement to
determine their trajectory for delivery
• March 2017 – 2020 ‘all in’ approach – trusts need to be working
towards delivery now.
• A number of trusts have been requested to achieve this by
March 2018
11
Trajectory for delivery 2017 - 2020
A 7 Day NHS - Trajectory for delivery
7 Day Hospitals – Progress to date
NHS Improvement: Have requested a number of Trusts to achieve by March 2018. This is subject to change.
West Midlands North Midlands Central Midlands The East
Birmingham Women's & Children's NHS FT
Burton Hospitals NHS FT
Bedford Hospital NHS Trust
Cambridge University Hospitals FT
George Eliot Hospitals NHS Trust
Chesterfield Royal Hospital NHS FT
East and North Hertfordshire NHS Trust
Hinchingbrooke Health Care NHS Trust
Sandwell and West Birmingham Hospitals NHS Trust
Sherwood Forest Hospitals NHS FT
Luton and Dunstable University Hospital NHS FT
Peterborough and Stamford Hospitals FT
South Warwickshire NHS FT Shrewsbury and Telford Hospital NHS Trust
Ipswich Hospital NHS Trust
The Dudley Group NHS FT Papworth Hospital FT
University Hospitals Birmingham NHS FT West Suffolk FT Walsall Healthcare NHS Trust The Princess Alexandra
Hospital NHS Trust
Wye Valley
When measured nationally results from the September 2016 7DS
self-assessment survey showed that meeting standard 2
presented the greatest challenge to trusts
Achievement of the four standards at different thresholds
Over 90% 70-90% 50-70% Under 50%
CS2 -Time to
consultant review 6% 30% 53% 11%
CS5 - Access to
diagnostic tests 3% 71% 26% 0%
CS6 - Access to
consultant directed
interventions
63% 27% 8% 2%
CS8 - Ongoing
review 31% 45% 21% 2%
7 Day Hospitals – National progress
7 Day Hospitals – Self assessment survey –quick wins
Improvement Support
Demonstrating achievement of clinical standard 2: time to first
consultant review
Quick wins
Underreporting of achievement
Those meeting standards had
excellent documentation
Good systems for recording:
CONSULTANT NAME
STAMPS
Clinical leadership and
staff engagement in
audit
Patient tracking system – alerts when breach 14
hrs
Inclusion of post-take ward rounds in job
plans
Staff rotas and working practices
Ensure acute take consultant presence from 8am to 8pm every day (especially for high volume specialties such as medicine).
On high volume units such as most AMUs use rolling ward rounds through the day to keep up with the new patients arriving.
Best clinical practice
Write into policy the expectation that patients admitted before 8pm will be seen by the evening take consultant before he/she goes home.
Ensure that handover lists used for take ward rounds include time of arrival, admission and ward for all patients to support the on take consultant to prioritise the order in which they see patients on the ward rounds.
Effective recording
Ensure that entry in the medical notes makes clear that consultant is assessing the patient and the time.
Ensure patients assessed by an appropriate consultant in ED or in clinic prior to admission to hospital are recorded as meeting the standard.
Clinical Engagement
Ensure that all team members, particularly junior doctors and senior ward nurses know the importance of a prompt consultant assessment for new and undifferentiated patients.
Senior staff demonstrate commitment to the aims of the 7DS programme
Trusts could take the following steps to support delivery of clinical
standard 2, taking into account the recently published clarifications
7 Day Hospitals – Top tips evidencing delivery
7 Day Hospitals – Bi-annual Survey
7DS Bi-annual survey national survey
NHSE SI Team - Universal offer to ALL Midlands & East Acute
Trusts
- NHSE SI Team named contact for each trust
- Resource package circulated
- ‘How to’ Survey Webinars delivered
- Same day response to specific enquiries
7 Day Hospitals – Resources to support the bi-annual survey
Bi-annual survey national self assessment survey
http://www.7daysat.nhs.uk/fsresources.aspx
A 7 Day NHS – Regional support
• Delivery planning
• Enabling system wide
conversations
• Communicating between the
trusts and the ALBs
• Helping with the ‘how to’
• Supporting measurement
Midlands &East -
Marie Tarplee [email protected]
London -
Rhuari Pike [email protected]
South - Sue Cottle [email protected]
North – Jo James [email protected]
NHS England Sustainable Improvement team and NHS
Improvement offers support
NHS England – Seven Day Services
https://www.england.nhs.uk/ourwork/qual-clin-
lead/seven-day-hospital-services/
NHS Improvement – Seven Day Services in the NHS
https://improvement.nhs.uk/resources/seven-day-
services/
19
7 Day services resources
7 Day Hospitals – Resources to support delivery
7 Day Services -
urgent network
services
Briefing Update
Dan Duggan UEC PMO Lead
NHS England Midlands & East
March 2017
“By 1st November 2017, meet the four
priority standards for seven-day hospital
services for all urgent network specialist
services.” (pages 7 & 14)
The shared planning guidance outlines the ambition for five
urgent network services to meet the four priority seven day
hospital services clinical standards by November 2017.
Responsibility for ensuring delivery of this ambition lies with the regional urgent and
emergency care networks. The UEC Networks will need to work closely with NHS
Improvement, Regional Specialised Commissioning teams, the regional 7 day
services teams, regional ODNs and relevant Clinical Network clinical leads.
These organisations will in turn be supported by national policy teams involved in
seven day hospital services and the urgent and emergency care programme.
These five urgent network services are:
• Acute stroke services
• Paediatric intensive care
• STEMI heart attack centres
• Major trauma units
• Emergency vascular services
Meeting the four priority clinical standards ensure that inpatients
receive high-quality care on an ongoing 24/7 basis
• Standard 2: Time to consultant review
• Standard 5: Diagnostics
• Standard 6: Consultant directed interventions
• Standard 8: On-going review in high dependency areas
Priority clinical
standards
• These priority standards have been selected from 10 clinical standards developed by the
NHS Services, Seven Days a Week Forum as they are most likely to have the greatest
impact in tackling variations in mortality, patient flow and experience.
Standard 2
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.
Standard 5
Hospital inpatients must
have scheduled seven-day
access to consultant-
directed diagnostic tests
and completed reporting
will be available seven
days a week:
• Within 1 hour for critical
patients
• Within 12 hours for
urgent patients
Standard 6
Hospital inpatients must
have timely 24 hour
access, seven days a
week, to consultant-
directed interventions that
meet the relevant specialty
guidelines, either on-site or
through formally agreed
networked arrangements
with clear protocols
Standard 8
All patient with high-
dependency needs should
be reviewed twice daily by
a consultant and all other
inpatients should be
reviewed by a consultant
once daily seven days a
week
March 2017 25%
population coverage
March 2018 50%
population coverage
2018/19 March 2020 100%
population coverage
These standards underpin this work and the parallel programme
to deliver seven day hospital services for all patients admitted in
an emergency
November 2017 100% population
coverage for 5 urgent network
services
Seven Day Hospital Services for all urgent admissions
Seven Day Hospital Services for urgent network services
Urgent network specialist services: • Emergency vascular • Acute stroke • Major trauma • STEMI Heart attack • Paediatric intensive
care
The governance arrangements for Hospital 7DS and Urgent Network
7DS are separate but linked together to ensure consistency
Strategic oversight
Delivery oversight
Regional delivery/
implementation
Key
UEC
Delivery Sub-Group
and Regional Leads
Urgent & Emergency Care
Review Programme Board
Regional U&EC
PMOs
U&EC Networks
National Urgent &
Emergency Care
Delivery PMO
7DS Implementation
Sub-Group and
Regional Leads
7 Day Hospital Services
Delivery Group
Regional NHS
England 7DS teams
Regional NHS
Improvement 7DS
teams
Governance and delivery structure for
Hospital 7DS programme Governance and delivery structure for
Urgent Network Services 7DS programme
At a strategic level, the UEC Programme Board and 7DS Delivery Group will
link to provide input into their respective responsibilities. This will be
complemented at a delivery level by links between UEC Networks and
regional NHS England and NHSI 7DS teams to share intelligence and advice.
To identify where these services are in relation to these standards, a
national baseline exercise was undertaken. At a national level, some
services are largely compliant, while others need further work.
Service Current position
Acute stroke units • Majority of services meet or are close to meeting the
standards.
• Clear need for services to be reconfigured in specific
areas to ensure that standards are met on a 24/7 basis
nationwide.
• Many areas have plans in place to deliver these changes,
other areas will need to drive this forward.
Paediatric intensive
care
• All services currently meet the four priority standards.
STEMI heart attack
centres
• Vast majority of services meet the standards.
• Handful of units need to either move to 24/7 operation or
cease taking patient altogether.
Major trauma centres • All services currently meet the four priority standards.
Emergency vascular
services
• Many services do not meet the standards.
• Concerns over large number of derogations in place
locally.
26
However, it proved difficult to provide a comprehensive picture through the
national baseline exercise. In many cases, proxy measures were used while
other areas had no national data available to measure performance
Service Standard 2 Standard 5 Standard 6 Standard 8
Time to first consultant
review
Improved access to
diagnostics
Consultant directed
interventions
On-going consultant-directed
review
Stroke Reported from SSNAP: % of patients
scanned within 1 hour and 12 hours
of clock start
Reported from SSNAP: % of patients
scanned within 1 hour and 12 hours
of clock start
Reported from SSNAP Organisational
Audit: access to thrombolysis either on
site or through network arrangements
AND
7DS survey: 24 hour access to
thrombolysis 7 days a week, either on
site or via formal network
arrangements.
Reported from SSNAP Organisational Audit:
number of stroke ward rounds per week
AND
Reported from SSNAP: % patients who were
assessed by a consultant within 14 and 24
hours.
PIC No data to directly measure standard:
Service specification recommends
consultant assessment, presumption
this is met due to consultant
presence on 24/7 basis.
7DS survey: For paediatric intensive
care consultants: “% able to access
diagnostic tests and completed
reporting, seven days a week” for all
diagnostic tests.
7DS survey: 24 hour access to
consultant directed interventions 7
days a week, either on site or via
formal network arrangements for trusts
that host a PICU.
No data to directly measure standard:
Service specification recommends
consultant review, presumption this is met
due to consultant presence on 24/7 basis
and twice-daily consultant rounds.
STEMI Heart
attack
Proxy measure reported from BCIS audit: compare door to balloon time across week/weekend as this is a consultant-
directed intervention delivered to a set timescale following appropriate diagnostic tests.
No data to directly measure standard:
Service specification recommends regular
consultant review, presumption this is met
due to level of consultant presence on 24/7
basis.
Trauma No data to directly measure standard:
Service specification recommends
regular consultant assessment,
presumption this is met due to level
of consultant presence on 24/7 basis.
Reported from TARN: Time to CT
scan for high risk NICE head injury
patients on weekdays and weekend.
Reported from TARN: Compare
median time of arrival to ED and time of
intervention for open lower limb fracture
(Boast 4 standard) for weekdays and
weekends.
No data to directly measure standard:
Service specification recommends regular
consultant review, presumption this is met
due to level of consultant presence on 24/7
basis.
Emergency
Vascular
Derive from NVR: compare number
of procedures for AAA across 7 days
at emergency vascular centres.
7DS survey: % of vascular surgery
consultants able to access CT, seven
days a week.
7DS survey: 24 hour access to
interventional radiology 7 days a week,
either on site or via formal network
arrangements for trusts providing
emergency vascular services.
No data to directly measure standard: not
covered in service specification.
To build on this information and ensure delivery, UEC Networks
should consider the following steps
1. Alignment and Governance
2. Map services
3. Baseline assessment
4. Regional delivery plan
5. Monitor and assure progress
• Regional UEC Networks need to work closely with NHS
Improvement, Regional Specialised Commissioning teams the
regional Sustainable Improvement 7 day services teams, regional
ODNs and relevant Clinical Network clinical leads to deliver this
work.
• To be able to plan joint actions to improve compliance and report on
progress to both the UEC delivery board and the 7 day services
hospital delivery group, robust governance structures should be
established.
• These regional governance structures should be in place by the end
January 2017.
1/ Alignment and Governance: Ensure NHS England and NHS
Improvement regional alignment and that appropriate
governance structures are in place
• Each region needs to undertake a mapping of the 5 services to
understand current provision and where any reconfiguration may
take place.
• Specialised Commissioners should have much of this information
available already. Derogations need to be reviewed to consider if
they should remain or whether services should be recommissioned
elsewhere.
• This mapping exercise should be completed by the end January
2017.
2/ Map Services: understanding provision and any possible
reconfigurations which could help deliver improvements
• Each region should review the compliance of each provider
(identified from the mapping process) for each of the four core
standards for each of the five services they may provide, building on
the national baseline.
• It may be necessary, where national audits do not provide the
assurance needed at unit level, to ask providers to undertake an
audit of their last ten patients treated by that service. This applies in
particular to Vascular, Paediatric Intensive Care and Major Trauma
services.
• This baseline assessment will be completed by the end March 2017.
3/ Baseline assessment: build on national exercise to assess
the regional picture, based on local information
• Each region will be required to develop their own delivery plan
which describes the actions to be taken by NHSE, NHSI, specialised
commissioning and UEC networks with providers to ensure
compliance of services by November 2017.
• This plan would need to signed off by NHSE and NHSI regional
directors and shared with the UEC Programme Board and 7 Day
Services Delivery Group.
4/ Regional Delivery Plan: Develop a plan from results of
regional baseline assessment to deliver the four core
standards for the five services by November 2017
• Regions will continue to monitor progress against their delivery plan
at their regional UEC board. Progress will be reported by exception
to the UEC Programme Board and 7 Day Hospital Services Delivery
Group.
• A further measurement of compliance with the four core standards
would need to be undertaken in September 2017 to confirm
progress has been made and that the four core standards are being
delivered by providers of the 5 specialist services. The same
methodology should be used as used earlier in the year by all
regions.
5/ Monitor and assure progress: Monitor progress against the
delivery plan and undertake a further assessment in
September 2017 to assure progress has been made and
standards delivered
Questions
When speaking please let
everyone know your name
and where you work.
7 Day Hospitals – Opportunity to ask questions
