7 Day Working A Practical Perspective Dr Janet Williamson, National Director, NHS Improvement

Casting the net wide SHA Medical Directors NCD’s – Professional networks Presidents & ex presidents Clinical networks E-bulletins – heart, pathology,etc. Contacts - Trusts, primary care and community Conference speakers Site vists

30 Practical examples Mental Health Orthopaedics Pharmacy Respiratory care Stroke care Telemedicine Therapy services Cancer Care Cardiac care Integrated older peoples service Community health care Diagnostics General medicine Integrated systems Women's services

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

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

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

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

Commissioning drivers To be a provider of choice, offering something competitors don’t, but clinically justifiable Commissioners holding patient events / consultations to shape the services they want to commission Enhanced tariffs Access standards

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

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

Operational “Monday morning chaos” – backlogs, delayed discharge, can’t 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

Emerging Learning 1.Admission prevention 2.Early diagnosis / intervention 3.Early supported discharge Impact of 7 day examples

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

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

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

Barriers to Change

Stakeholder Views Less than 20% have implemented

“ I was lucky. Shouldn’t everyone of us have the best chance possible, no matter what time of the day or day of the week it is?”