7 Day Services Programme East Midland Acute Trust Collaborative

7 Day Services Programme East Midland Acute Trust Collaborative

Nigel Beasley

co- Chair

East Midlands Clinical Senate

12th June 2014

Background

• Initiated by East Midlands Chief Executives Group working

with East Midlands SCNs and Clinical Senate

• Agreed set of principles and enabling behaviours to aid

clinical collaboration across organisational boundaries

• Seven day services

– National policy… and a moral imperative

– Increasingly part of business as usual

– Not just about hospitals; it is about the whole system

– Seven day services are within units of planning draft strategic plans

but concepts are still to be defined

2 NHS | East Midlands - Seven Day Services Programme | 12/06/2014

Background – King’s Fund

• https://www.youtube.com/watch?v=l6iKZ_SOKCY

• http://www.kingsfund.org.uk/projects/urgent-emergency-care/alternative-guide-urgent-and-emergency-care-system-england

NHS | Presentation to [XXXX Company] | [Type Date] 3

https://www.youtube.com/watch?v=l6iKZ_SOKCY

https://www.youtube.com/watch?v=l6iKZ_SOKCY

http://www.kingsfund.org.uk/projects/urgent-emergency-care/alternative-guide-urgent-and-emergency-care-system-england



















10 Acute Trusts Involved

• Chesterfield Royal Hospital

• Derby Hospitals

• Kettering General Hospital

• North Lincolnshire & Goole

• Northampton General

Hospital

4

• Nottingham University Hospitals

• Peterborough & Stamford

Hospitals

• Sherwood Forest Hospitals

• United Lincolnshire Hospitals

• University Hospitals of

Leicester

NHS | East Midlands - Seven Day Services Programme | 12/06/2014

10 clinical standards

Clinical outcomes

Workforce / staffing

Demand, capacity and

flow

Finance

Availability of non- clinical

services

Availability of clinical services

Phase 1 – Urgent/ Emergency

5

Baseli

ne A

ssessm

en

t

& G

ap

An

aly

sis

Site/ Trust

Unit of Planning

East Midlands

Op

tio

ns D

evelo

pm

en

t

Care

Pathways

Financial

Workforce


Clinical Standards – Urgent and Emergency

6

Assessment

Referral

Treatment

Referral

Type Emergency Department Urgent /

Short stay In patient

EMU, AMU,

SAU,

Ambulatory

Care, AFU, EFU,

EDU, UCC,

Elderly Acute,

CDU

Community

Specialty

(Ward)

T&O

Paeds

Urology

Cardio

Stroke

Ophth’y

ICU / CCU

/HDU

ENT

?

?

?

Clinical Standard 1 – Patient Experience

Clinical Standard 2 – Time to first Consultant Review

Clinical Standard 3 – MDT Review

Clinical Standard 4 – Shift Handovers

Clinical Standard 5 - Diagnostics

Clinical Standard 6 – Intervention / Key Services

Clinical Standard 7 – Mental Health

Clinical Standard 8 – Ongoing review

Clinical Standard 9 – Transfer to Community Primary Care

Clinical Standard 10 – Quality Improvement

Community

Note: All standards apply to all admissions

Milestones

7

April June August October

Agree design of

baseline

assessment

approach

Baseline assessment and gap

analysis

Develop,

prioritise and

refine options

Finalise options and

produce

recommendations


Whole System View

8

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 e.g. radiology NHS | East Midlands - Seven Day Services Programme | 12/06/2014

Acute Trust

NHS | Presentation to [XXXX Company] | [Type Date] 9

Initial Findings

Initial Findings (Cont’d)...

NHS | East Midlands - Seven Day Services Programme | 12/06/2014 10

Clinical Standard Findings

1. Patient Experience

Variable depending on medical staff and specialty

Lack of/ inconsistent evidence for pro-active

engagement of patients/ family and relatives

2. Time to First

Consultant Review

Inconsistent recording of activity in medical notes

Lack of data available to evidence first consultant

review within 14 hours

3. MDT Review

Not all specialties have a daily MDT review, even less

at weekends

MDTs are not compliant across most sites and

specialties, i.e. not all MDTs include Nursing,

Medicine, Pharmacy, Physiotherapy representatives

MDT currently include junior doctors and nurses

Initial Findings (Cont’d)…


4. Shift Handovers

Nursing shift handovers occur at similar times across

sites and specialties.

No consistent guideline/ policy used to conduct shift

handovers. They range from specialty developed

operating procedures to local ‘way of working’.

Use of locally developed shift handover forms, with

very little information transferred electronically.

High variability with medical shift handovers


Initial Findings (cont’d)…


5. Diagnostics

Generally across East Midlands there is a significant

shortfall in diagnostics resources, e.g. 28%

sonographer vacancies in Lincolnshire in the last 2

years

6. Intervention/ Key

Services

Not all interventions are accessible out of hours or at

weekends

7. Mental Health

High degree in variability from Trusts’ staff views on

Mental Health Liaison Services (MHLS) response time

Variation in service provision across specialties, e.g.

MHLS refusing to assess patients in areas other than

Emergency Department


Initial Findings (cont’d)…


8. On-going Review No issues identified in this area to date

9. Transfer to

Community, Primary

and Social Care

Big challenges in accessing new packages of care

during weekend

New placements in residential/nursing homes require

full re-assessment and 48hours notice, delaying

transfer

Nursing home and community hospitals are unable to

provide level of specialist nursing care

Lack of night visits capacity in community services

10. Improving Quality No issues identified in this area to date


10 clinical standards

Clinical outcomes

Workforce / staffing

Demand, capacity and

flow

Finance

Availability of non- clinical

services

Availability of clinical services

Phase 1 – Urgent/ Emergency

14

Baseli

ne A

ssessm

en

t

& G

ap

An

aly

sis

Site/ Trust

Unit of Planning

East Midlands

Op

tio

ns D

evelo

pm

en

t

Care

Pathways

Financial

Workforce


7 Day Services Programme East Midland Acute Trust Collaborative

Healthcare

Transcript of 7 Day Services Programme East Midland Acute Trust Collaborative