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