Seven Day Services Transformational Programme Ann Driver Head of Programmes NHS IQ

1. Seven Day Services Transformational Programme Ann Driver Head of Programmes NHS IQ

2. The Challenge NHS Director promises seven-day service by 2017 ‘unstoppable movement’ Sir Bruce Keogh The Sunday Times July 20th 2014

3. So what are we to do? Spread what we know works Develop models to take us further Enroll every provider & commissioner Build a momentum for change Engage the public & patients Commission the best See local change happen at scale & pace. “How can we take on the extraordinary challenge of integrating services into a seamless, consistent, high quality seven day service?” Fiona Carey, Cancer & Patient Representative

4. NHS Improving Quality 7 Day Services Improvement Programme • The next 3to 5 years, dedicated support, dedicated investment • Signpost evidence from the diagnostic service reviews for 24/7 provisions across England including Interventional Radiology, Endoscopy and Scientific services to ensure providers and networks have plans in place to implement evidence based seven day diagnostics services and models. • Start the drive for spread: engaging every commissioner and provider in moving towards the provision of services that are delivered in a way that meets NHS England’s Seven Day Services clinical standards.

5. NHS Improving Quality 7 Day Services Improvement Programme • Support organisations to understand their baseline position – self assessment tool, build on the evidence, measure outcomes. • Start to identify the top interventions which will make the biggest difference to supporting delivery of local seven day services across the whole system. • Supporting learning networks, communities of interest, building capability and capacity, communication & engagement. • CCG Development, Service Improvement & large scale change programmes • Share the learning widely across the health and care communities

6. The next three to five years improvement programme - dedicated support, dedicated investment

7. Self Assessment: Early Signs 1. Patient Experience – Lack of active social care across 7 days. 2. Consultant review – NEWS score widely used upon admission. A shortfall in clinical assessments, consultation involvement. 3. MDT – Significant variation, in terms of access to timely complex needs assessment and medicines reconciliation. No area reports having access to patients’ primary and community care records. 4. Shift Handovers – Little electronic recording of clinical data, the standard is achievable across the country

8. Self Assessment: Early Signs 5. Diagnostics – Lack of weekend access to Bronchoscopy, Histopathology and MRI 6. Intervention / key services – The majority of inventions / key services are available across 7 days across the country, variation in urgent radiology 7. Mental Health – One area of the country has excellent access to mental health assessments, variation in access across the rest of the country 8. On-going review – Lack of an electronic record is hindering achievement 9. Transfer to care – Lack of weekend access to equipment provision, occupational therapy, social services, senior clinical expertise& access to an integrated care record 10. Quality improvement – Good involvement of those who deliver care in the review of patient outcomes, majority of sites give training that is consistent with General Medical Council and Health Education England recommendations

9. Taking on the challenge • Clinical & managerial engagement and leadership • Strong senior clinical champions with a clear responsibility for 7 days • Involvement of Workforce Lead , HR and Finance at the start • Organisational leadership and sponsorship • Standing item on executive team meetings , keen interest on how things are progressing and intervene when obstacles present • Collaborative/partnership working • Senior representatives from all stakeholder organisations meet regularly and work in partnership to achieve outcomes. Shared ownership of constraints and difficulties • Some see transformation and working together as the only way forward and are making efforts to engage with others • Sharing the financial risks & benefits • Patient focus and a “Can do” attitude • Patients as partners in service redesign and reconfiguration and a belief in what they are trying to achieve • Dedicated management and capacity • Recognition of the workload to achieve significant change across organisational boundaries and at scale and pace

10. Taking on the challenge • “Competition between Trusts and lack of trust between us is one hurdle”. • “Stakeholders are finding it difficult to ‘see outside their own front door’ due to operational pressures and cost reduction” • “There are numerous plans and strategies in place but little positive action and achievement” • “Patients want 7 day services but react when we need to close, relocate services to offer a 7 day service" • “We were slow to realise that it not about additional funding or simply adding to acute workforce, we were not thinking laterally across the whole health economy” • “Everyone thinks that the CCG’s should be driving the agenda as they have the legitimate power but in some areas leaders are questioning whether they have the courage to be radical”

11. Partnerships Care Quality Commission • The CQC and the Chief Inspector of Hospitals have agreed to routinely assess the availability of seven day services as part of the assessment of safety within a hospital. For acute services to be judged safe they have to be safe seven days a week. Health Education England • Has agreed that education contracts should include consultant availability to provide adequate supervision of doctors in training, seven days a week.

12. HS&DR Programme • Aim: to determine the cause(s) of increased weekend hospital admission mortality • Hypothesis: reduced specialist input at weekends • Phase 1: Develop metrics, measure specialist intensity • 16,000 consultant and associate specialists across 119 acute Trusts recently completed the HiSLAC point prevalence survey • Phase 2: Link intensity to HES data, local PAS data, quality of care (4000 case record reviews) and ethnography; create health economics model; measure changes over time. Website: www.hislac.org Twitter: @HISLACProject Supported/endorsed by: • Contacts: • Prof Julian Bion, Chief Investigator:c.s.price@bham.ac.uk • Dr Cassie Aldridge, Project Manager: c.p.aldridge@bham.ac.uk • Ms AmunpreetBoyal, Research Fellow: a.r.k.boyal@bham.ac.uk

13. Our work is focused on understanding the clinical, financial and workforce impact of Seven Day Services across the health and care system Across all settings of care UEC OOH Planned Social Services Define relevant standards and services Workforce impacts and wider impacts Cost / benefit analysis Minimise cost / maximise benefit • Pathway- and issue-based analysis • Review of UK and international evidence base • Interviews with providers for each of the two local health economies • Workshops with leads • Challenge with Deloitte and NHS England clinicians • Refine • Interviews with providers • Data request • Challenge with Deloitte and NHS England clinicians • Benchmark with information (including data from Monitor, London 7DS team, HFMA, and early adopters) • Define costs / benefits • Develop framework • Estimate overall NPV • Challenge findings • Define a plan for each cost / benefit • Use a workshop to refine • Develop implementation recommendations • High level implications for wider landscape (e.g. impact on providers, access etc). Identify case study providers Our deliverable for NHS England will be a report outlining service definitions as well as impacts. This will include a technical appendix with our modelling approach

14. Delivering 7 Day Services • Our role in Engagement: • Connecting HRDs/Workforce • Leaders on 7 day services • work-stream • Influencing • national policy • Support and share – • enabling function

15. Seven Top Tips 1. Use a systematic Approach 2. Understand your baseline position – “Don’t jump to solutions before you understand the real problem “ 3. Engage, communicate, partner, network , align with the whole system - “You cannot achieve this alone” 4. Keep the focus on patients , safety, quality of care & outcomes Don’t ignore the big challenges 6. If your not measuring– your not improving - If you are only measuring you’re not improving, but measure & improve the right thing that adds value 7. Get the messages right - services not working. Share the learning. Think scale & pace

16. “ The unstoppable movement”