7 Day WorkingA 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 Learning1. 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 ChangeWhat do you think the main barriers are to implementing/

extending 7 day working?

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

Financialconstraints

Recruitmentshortages

Patients will notwant to attend

Lack of staffwillingness

Other

Stakeholder Views Do you believe we should be delivering more healthcare

services 7 days per week?

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

Yes No No View

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?”