Delivering a 7-Day Service in Health & Social Care Dr Nick Bishop 15 October 2012 Senior Medical Advisor

CQC’s Role We make sure that the care people receive meets essential standards of quality and safety. We encourage ongoing improvements by those who provide or commission care

What does the law say? Regulation 22 of the Health and Social care Act 2008 states: In order to safeguard the health, safety and welfare of service users, the registered person must take appropriate steps to ensure that, at all times, there are sufficient numbers of suitably qualified, skilled and experienced persons employed for the purposes of carrying out the regulated activity

The Dowager Countess’ view “What is a weekend…?”

Question…. What does “out of hours” mean in the context of healthcare?

One step at a time….. 7 days versus 24/7

7-Day services Many Shops Holiday booking Insurance booking Fuel stations Car servicing

24/7 services AA/RAC Ambulances Police Fire Coastguard RNLI A&E Midwifery Hospital Radiology maintenance* Drain clearance …..and some branches of Tesco, Asda etc

“If I had to reduce my message for management to just a few words, I’d say it all had to do with reducing variation.” – W Edwards Deming

Admissions and Discharges by day of week for 1 year

Admissions and Discharges by day of week for 1 year <6000

Bed Occupancy MondayTuesdayWedThursdayFridaySaturdaySunday

Question…. Would solving the problem of ‘the weekend’ also solve the problems of the other 5 days?

Potential benefits More senior cover at all times…. Quicker decision making Better decision making Fewer delays for patients Shorter lengths of stay Fewer complications Better use of expensive equipment eg MRI & CT Better training opportunities Fewer bed pressures in-week Fewer cancelled admissions Meeting the expectations of patients

Potential barriers Costs of additional senior staff Rota management Reluctance of staff to change work patterns Need to engage with social services Availability of transport Support directorates as well as medicine and surgery etc Issues around bank holidays …..Doubtless many others!

RCP Statement on 7 day working The RCP is concerned with the mounting evidence of poor care delivered to patients in hospital, and has recommended… that any hospital admitting acutely ill patients should have a consultant physician on-site for at least 12 hours per day, seven days a week, who should have no other duties scheduled during this time.

RCP Statement on 7 day working All medical wards should have a daily visit from a consultant; in most hospitals this will involve more than one physician.

Question…. Why should a person who needs medical care be treated differently on a Sunday to a Tuesday?

…and finally Once we’ve solved the 7-day challenge do we need a 24/7 service...and if we do, what stops us delivering it?

“The longest of journeys begins with the first step”

Thank you