East Midland Clinical Senate 7 Day Services Programme Chesterfield Royal Hospital NHS Foundation Trust and East Midlands Clinical Senate

 Successful pilots Winter 2012/13 ‘improving patient flow and outcomes’  1 of 8 trusts involved in HFMA led Finance workstream of 7 Day Service Forum  Fieldwork Summer 2013 (Emergency and Urgent Services + Supporting Diagnostics)  Report released December 2013  NHS IQ ‘early adopter Site’ successful application – December 2013 Local Context

 Main cost driving standards  Standard 2 - Consultant Time to Review  Standard 3 – MDT Review  Standard 5 – Diagnostics  Standard 6 - Interventions  Standard 8 – On-going Review (daily consultant ward rounds) CRH Costing Summary

 Gross investment of c£3.8m  2.9% of our pay bill  Or 2.0% of patient care income

 Convinced morally ‘the right thing to do’  Applied for early adopter - Health Community Supported  Determined must be strategic Health Community approach  Driven and overseen by our 21 st Century Healthcare group  Multi-Disciplinary / Multi Agency Project Board Vision

 Part of East Midland Acute Provider baseline assessment  Continuing to build on approach from earlier pilots  Submitted first cut data through NHSIQ tool  Working across East Midlands to understand opportunities  Launching live (health comm.) Project Board for delivery  Working collaboratively with SYMYND on early challenges as well as East Midlands providers  (ENT/Max Fax/Ophthalmology/Diagnostic s/Paediatrics) Current Position

 Agreed principles and enabling behaviours for clinical collaboration - test on delivery of seven day services  Phase acute trusts:  common understanding of the challenge – community of practice  platform for organisational development and change  inform future commissioning and provision  Providers as a key gear in the system; responsible for engaging with local health and care community partners  Workforce as a key enabler: Health Education East Midlands EM Collaborative Project

Overarching Approach Gap Analysis & Implications 1.Site/ Trust 2.Unit of Planning 3.East Midlands Options Development Care Pathways Financial Workforce

Whole System View 9 Emergency Department GP Referrals Self- Referrals Hospital Transfers Other Health Care Provider Usual Place of Residence Community Hospital Nursing/ Residential Home Primary/ Community Care Social Care Packages Urgent and Emergency Care Pathway & Supporting Diagnostics Admission Sources Discharge Sources Third Party Resources Interfaces NHS | East Midlands - Seven Day Services Programme | 12/06/2014 Acute Trust e.g. Interventional Radiology

1.Patient Experience: inconsistent pro-active engagement 2.Time to First Consultant Review: lack of monitoring 3.MDT review: involvement of therapies 4.Shift Handovers: inconsistent guidelines and approach 5.Diagnostics: workforce and technology - radiology 6.Interventions: accessibility out of hours/weekends 7.Mental health: liaison services, input to A&E 8.On-going review: lack of consultant led daily ward rounds 9.Transfers: access new packages of care at weekends, requirement to reassess 10.Improving quality:. inconsistent supervision of trainees Emerging Issues and opportunities

 Identification of options for future improvement  Trust / Site level:  Operational improvements / transactional change  Organisation-specific transformation  System level:  Local health and care community / units of planning / Urgent and Emergency Care Networks  East Midlands – and beyond  Data improvements and ongoing monitoring  Potential to align priorities and delivery plans - Phase 2? Next Steps

Questions 12