7 Day Working

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• 7 Day Working
• A Practical Perspective

Dr Janet Williamson, National Director, NHS
Improvement
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Casting the net wide

• SHA Medical Directors
• NCDs Professional networks
• Presidents ex presidents
• Clinical networks
• E-bulletins heart, pathology,etc.
• Contacts - Trusts, primary care and community
• Conference speakers
• Site vists

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30 Practical examples

• Cardiac care
• Integrated older peoples service
• Community health care
• Diagnostics
• General medicine
• Integrated systems
• Women's services

• Mental Health
• Orthopaedics
• Pharmacy
• Respiratory care
• Stroke care
• Telemedicine
• Therapy services
• Cancer Care

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4 Level Model

• Level 1 Services limited to one department or
  a service that is beginning to deliver some
  services beyond the 8am - 6pm Monday to Friday
  service.
• Level 2 - Services that are delivered 7 days per
  week, but not always offering the full range of
  services that are delivered on week days.
• Level 3 - A whole service approach to 7 day
  service delivery that requires several elements
  to work together in order to facilitate clinical
  decision making or treatment, often covering more
  than one work force group
• Level 4 - A whole system approach to 7 day
  service delivery by integrating the requirements
  for elements of 7 day services across more than
  one specialty area

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6 Key Drivers for Change

• Personal desire to make the service more
  equitable
• Policy and professional guidance
• Commissioning
• Improving access / increase in demand
• Financial
• Operational

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• Personal desire to make the service more
  equitable, it feels wrong as a professional
• Less than optimum service
• Patient safety (real perceived)
• Difficult carrying on delivering the service,
  once you recognise the impact on your patients

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• Policy drivers and professional guidance
• Policy (Stroke strategy indicators)
• Recommendations from professional organisations /
  royal colleges RCP statement
• ( can also lead to different models e.g. NCEPOD)
• Compliance with clinical targets
• Safety performance targets

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• Commissioning drivers
• To be a provider of choice, offering something
  competitors dont, but clinically justifiable
• Commissioners holding patient events /
  consultations to shape the services they want to
  commission
• Enhanced tariffs
• Access standards

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• Improving access / increase in demand
• No more capacity in office hours
• Increasing demand / or rising waits
• (often having tried WLIs)
• New service demand servicing other departments
  who now need your service
• New demand can be policy driven, clinically
  driven, access driven, commissioner driven!

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• Financial
• The need to save money high cost of on call
• New business opportunities provider of choice
• Reduce LOS
• Enhanced tariff

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• Operational
• Monday morning chaos backlogs, delayed
  discharge, cant do anything else for catching up
  (elective capacity lost)
• Risk / safety chaos leads to error, pts not
  being managed appropriately, not treated
• Mergers different conditions (inequity)
• Excellent Leadership a can do attitude

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Impact of 7 day examples

• Emerging Learning
• Admission prevention
• Early diagnosis / intervention
• Early supported discharge

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Admission Prevention

• Services that are designed to care for patients
  in their usual place of residence during times of
  poor health or mental illness
• Birmingham Rapid response service
• Pan Gwent Frailty Programme
• Lancaster Intensive support team

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Early Diagnosis / intervention

• No delays in assessment, diagnostics and
  treatment leading to an earlier diagnosis and
  intervention.
• Golden Jubilee National Hospital enhanced
  recovery
• Royal free Hampstead Trust -7 day microbiology
  service
• Heart of England Hospital -7 day consultant ward
  rounds

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Early Supported Discharge

• Patients returning home once they are able to be
  supported in their own home by services
• Lancaster Intermediate support team
• Birmingham community rapid response Team

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Barriers to Change
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Stakeholder Views
Less than 20 have implemented
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• I was lucky. Shouldnt everyone of us have the
  best chance possible, no matter what time of the
  day or day of the week it is?