Wrightington, Wigan and Leigh NHS Foundation Trusts

Dr Sanjay Arya MBBS (Hons), FRCP (London), FRCP (Glasgow) Consultant Interventional Cardiologist Divisional Medical Director, Division of Medicine Clinical Lead for Heart Failure, AQuA, North West Delivering NHS Services, Seven Days a Week

‘‘Patients who are admitted to hospital believe that they are entering a place of safety, where they, their families and carers, have a right to believe that they will receive the best possible care’’. ‘‘Yet there is evidence to the contrary. Patients who are unwell, or become acutely unwell in hospital, may receive suboptimal care’’ Dr Mary Armitage, Guideline Development Group Chair Acutely ill patients in hospital Royal College of Physicians Delivering NHS Services, Seven Days a Week

Patients and family expect that the NHS will provide safe and high quality service consistently seven days a week There is a variation in care depending upon time of the day and the day of the week

Where there is a 7 day service, there is no observed difference in mortality rates in the week and at weekend (Bell M et all: The New England journal of Medicine 345:9) (Schmulewitz L et all: Clinical medicine Nov 2005)

Weekend mortality: Wigan Fosters report: 5 th from the bottom 474 excess deaths

Weekend mortality: Wigan

Weekend mortality: Wigan

HSMR: March 12 – Feb 14

Our Patients Outcome of Real Time Patient Surveys conducted monthly

The 10 Clinical Standards Patient Experience Time to first consultant review MDT Review Shift Handovers Transfer to community and Primary and social care Mental Health Quality Improvement Diagnostics On-going review Intervention /Key services

Addressing delivery of the national clinical standards for 7 day services ‘A&E Clinical Quality Indicators’ Mr Ayaz Abbasi MBBS, FRCS, FCPS, FCEM, PGC Consultant, Emergency Medicine Clinical Director, Emergency Medicine Wrightington, Wigan & Leigh NHS Foundation Trust

Weekends

Monday to Friday

A&E Clinical indicators 1 Ambulatory emergency care 2 Unplanned re-attendance rate 3 Total time in the A&E department 4 Left without being seen (LWBS) rate 5 Service experience 6 Time to initial assessment 7 Time to treatment 8 Consultant sign-off

Unplanned Re-Attendance Rate

Left without being seen

Total time in ED

A&E 4 Hours

Time to Treatment

Initial Assessment

Ambulatory Care

Consultant sign off Non traumatic chest pain in age seventeen and above. Any re attendance within 72 hours with a similar condition. Febrile child less then one year old. All these conditions if discharged from ECC require consultant sign off.

Friends and Family Test Accident & Emergency Friends & Family Test Quality Scores for the Greater Manchester Area TrustJanFebMarAprilMay Wrightington, Wigan & Leigh NHS FT Central Manchester University NHS FT Bolton NHS FT University South Manchester NHS FFT Salford Royal NHS FT Pennine Acute Hospital NHS Trust (Oldham Hospitals) Stockport NHS FT Tameside Hospital NHS FT

Thank you

The whole health community needs to address the problem of increased mortality over the weekend Engaged clinicians (medical,nursing,physio,OT) and managers Developed leadership: Divisional Director & 4 Clinical Directors Involved everyone: Martin Farrier’s weekly mortality data: There should be a 7 day access to all aspects of care: medical, nursing, diagnostics, GPs, Social services, Palliative care COE Consultants in the community – supporting GPs Engaged Nursing / Care homes – advanced care planning Improved end-of-life care for terminally ill patients – rapid discharge Is there a solution?Wigan experience Why are there more deaths? ‘Weekend Effect’

Increased Consultant presence: Cost effective / Reduces mortality Recruited more A&E and MAU consultants Increased presence of Consultants on A&E, MAU and Medical wards on weekends and bank holidays 7 day 12 hour consultant delivered/presence service Is there a solution? Wigan experience Why are there more deaths? ‘Weekend Effect’ Right patient Right ward, beyond the first 24 hours of admission Specialists felt engaged, valued & comfortable in managing patients Increased daily senior review on medical wards Improved patient pathway / journey / care bundles

Support services will also need to adopt 7 day working practice if the full benefits of 7 day Consultant service are to be realised Increased presence of Physio, OT and Social services over weekends and bank holidays Increased availability of diagnostics over weekends and bank holidays Is there a solution? Wigan experience Why are there more deaths? ‘Weekend Effect’

Addressing delivery of the national clinical standards for 7 day services Two questions to address – 1)What are the key challenges around the clinical standards? 2) What suggestions do you have on how those challenges can be overcome? Please use post-it notes to capture your thoughts on key challenges in your locality, you may add your contact details if you would like to discuss this further with us at a later date

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