East Midland Clinical Senate 7 Day Services Programme

1. East Midland Clinical Senate7 Day Services Programme Chesterfield Royal Hospital NHS Foundation Trust and East Midlands Clinical Senate

2. Local Context • 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

3. CRH Costing Summary • 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)

4. CRH Costing Summary • Gross investment of c£3.8m • 2.9% of our pay bill • Or 2.0% of patient care income

5. Vision • 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 21st Century Healthcare group • Multi-Disciplinary / Multi Agency Project Board

6. Current Position • 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/Diagnostics/Paediatrics)

7. EM Collaborative Project • Agreed principles and enabling behaviours for clinical collaboration - test on delivery of seven day services • Phase 1 - 10 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

8. Overarching Approach 7 Day Services Information Domains Gap Analysis & Implications Options Development Care Pathways Financial Workforce Site/ Trust Unit of Planning East Midlands

9. Whole System View Acute Trust Admission Sources DischargeSources Emergency Department Urgent and Emergency Care Pathway & Supporting Diagnostics Usual Place of Residence GP Referrals Community Hospital Self- Referrals Nursing/ Residential Home Hospital Transfers Primary/ Community Care Other Health Care Provider Social Care Packages Interfaces Third Party Resources e.g. Interventional Radiology NHS | East Midlands - Seven Day Services Programme | 12/06/2014

10. Emerging Issues and opportunities Patient Experience: inconsistent pro-active engagement Time to First Consultant Review: lack of monitoring MDT review: involvement of therapies Shift Handovers: inconsistent guidelines and approach Diagnostics: workforce and technology - radiology Interventions: accessibility out of hours/weekends Mental health: liaison services, input to A&E On-going review: lack of consultant led daily ward rounds Transfers: access new packages of care at weekends, requirement to reassess Improving quality:. inconsistent supervision of trainees

11. Next Steps • 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?

12. Questions