1. Acute Quality Standards Dan Beckett Acute Physician CMO Advisor for Acute & General Medicine

4. Adult Emergency Services – case for change Adult emergency services: Case for Change. London Health Programmes (2011) Increased risk of death for most emergency conditions if a patient is admitted at the weekend, compared to a weekday. If weekend mortality rate was the same as weekday London 500 fewer deaths a year. Evidence suggests services with high quality provision in place, seven days per week, reduces the gap between weekday and weekend mortality rates. In addition variation exists for length of stay and re- admission rates.

5. Development of adult acute medicine and emergency general surgery standards Improving 7/7 services is a key priority Quality standards were developed to address the issues raised in the acute emergency services case for change: Significant variation in service provision across London. Marked variation in working patterns that takes place during normal working hours vs those at the weekend. Standards are based on clinical evidence, national recommendations and best practice represent the minimum quality of care that patients should expect in every acute hospital.

6. London quality standards: Key themes Admissions seen by consultant <12 hours Twice daily ward rounds for all patients MDT plan within 24 hours including EDD Timely access to diagnostics and reports Timely access to interventions including theatre Good information for patients and their carers Timely transfer to next place of care Continuity

7. Timeline Case for change published September 2011 NHS London commissioning standards for acute medicine and emergency general surgery published 2011 – quality standards in April 2012 Audit of acute medicine and emergency general surgery in 2012/13 across all sites –Peer review, case note audit Revised (broader) Acute Emergency and Maternity standards published February 2013 Self-assessment 2013 –Signed off by CEO Results available publically - transparency

13. 2012/13 Audit of acute hospitals - Standards met and not met by category The biggest challenges were in consultant delivered care and multidisciplinary assessment, 7 days a week.

14. 2013/14 Self-assessment of London Quality Standards Providers of acute emergency and maternity services self-assessed their progress towards meeting the London quality standards Highlights progress made in implementing the standards for adult acute medicine and emergency general surgery. –Commissioned from April 2012 and formally audited during 2012/13. Improvements were seen across adult acute medicine and emergency general surgery.

15. Adult Acute Medicine Standards 15 Results from the 2013 self-assessment show there was no one standard not met by all hospitals during weekdays or weekends. Key findings in 2013 v 2012 : 55% v 35% of hospitals deliver consultant review within 12 hours. 35% v 7% of hospitals have twice daily ward rounds by a consultant. 72% v 28% of hospitals provide extended day working by consultants. 38% v 4% of hospitals provide multi-disciplinary team assessment within 12 hours.. 45% v 21% of hospitals meet the standard for 24/7 timely access to diagnostics..

16. Improvements in adult acute medicine Improvements were reported in: Consultant- delivered review within 12 hours; extended day working; twice daily ward rounds; and multi-disciplinary team assessment.

17. Adult Emergency General Surgery Standards 17 There was no one standard not met by all hospitals during weekdays or weekends. Key findings 2013 v 2012: 50% v 15% of hospitals deliver consultant review within 12 hours for emergency surgery. 38% v 7% of hospitals have twice daily ward rounds by a consultant. 69% v 22% of hospitals provide extended day working by consultants during the week. 23% v 0% of hospitals provide multi-disciplinary team assessment within 12 hours for emergency surgery. 46% v 22% of hospitals meet the standard for 24/7 timely access to diagnostics for emergency surgery..

18. Improvements in adult emergency general surgery Improvements were reported in: Consultant- delivered review within 12 hours; access to and provision of theatres; and multi- disciplinary team assessment.

19. Correlating Clinical Quality Standards Self- Assessment returns and A&E performance

20. London hospitals achieve to a greater extent Acute Medical Care Quality Standards compared to Emergency General Surgery standards The Emergency General Surgery standard achieved least consistently by London Hospitals is Standard 2, which refers to the prompt screening of all complex needs inpatients by a multi-professional team. Those Hospitals that achieved a lower proportion of Emergency General Surgery standards typically experience a more challenged YTD All Type performance Headlines 20

21. Less of a correlation is observed however between those hospitals that achieve a lower proportion of Acute Medical Care Quality standards and more challenged YTD All Type performance There is also limited alignment between the achievement of Acute Medical Care Quality standards and YTD Type 1 performance across London hospitals. Those Trusts with higher than average DTOC levels across London are observed as having a higher proportion of Acute Medicine and Emergency General Surgery Care Quality Standards that are not being met. Headlines 21

22. Next steps UC Programme Board has given approval to proceed Unscheduled Care Executive Leads – letter w/b 15 th Sept Self assessment template via Survey Monkey to be developed (examples on the table) Self Assessment guidance issued w/b 29 th Sept Self Assessment to be completed 31 st October

23. Future steps? Random peer review Broadening to all acute emergency and maternity services standards? Revision of quality standards with NHS England (London) and relevant professional bodies to develop UK quality standards…