7-day services: Learning from health care organisations
Dr Janet Williamson, NHS Improving Quality’s Director of National Improvement Programmes, outlines six key messages for commissioners and providers.
NHS England’s Everyone Counts has given a commitment to the NHS moving towards routine services being available seven days a week. Professor Sir Bruce Keogh at the inaugural NHS England AGM said of seven day services: “It is going to be radical, it is going to be difficult but we have to be up for it.”
Last week I had the pleasure of chairing a conference in London on Delivering a 7 Day Health Service. The impressive line-up of speakers was drawn from many leading organisations who have already made significant progress towards moving towards 7 day services. The majority of whom had featured some 18 months ago as a compendium of some 30 case studies, the early evidence of models of 7 day services published by NHS Improvement: Equality for all – Delivering safe care seven days a week.
Organisations such as Northumbria Healthcare NHS Trust, Torbay Hospital , University Hospital Southampton NHS Foundation Trust, Heart of England NHS Foundation Trust, and Torfaen Council part of Pan Gwent .
With Sir Bruce Keogh’s quote in my head I took the chairs prerogative to ask each of the speakers for their key messages for other organisations in their quest to move toward seven day services
Six key messages emerged, with general consensus amongst the speakers that the “how?” is not easy.
Professor Bell, Professor of Acute Medicine, Imperial College stated: “This is a real challenge for healthcare, understanding the how we do this and how we translate into practice.”
The notion of learning from others and developing a better understanding seems a key requirement going forward.
So here are the six messages on 7-Day Services:
- Find out what’s wrong, the first step: Seven days is a complex problem and a wicked problem which requires definition . Each organisation citing the need to be clear about the issue that they are trying to solve with the notion that there is not one model or solution.
- Go back to the pathway of care and walk the pathway and experience in the shoes of the patients and carers: Walk through the buildings and focus on pathways.
- It requires a vision that focuses on the whole system and integrated coordinated care: It is not just about the hospital – it is about healthcare providers, local authorities and the social care system. There are many interdependencies and multiple partners. The emphasis on committed and consistent leadership is being emphasised here.
- Ask the staff: Early engagement of staff is seen as a key factor in moving to 7-DayServices.
- Importance of the clinical team: Recognising that this is not just about the consultant and doctors but about the role of the clinical team and the part they can play in early decision making. Reference was made to clinical pharmacists as independent prescribers, professions allied to medicine leading rehabilitation, recovery and regalement.
- A journey and not a sprint: Transformation takes time, most organisations presenting had been engaged in moving to 7-Day Services upwards of six years, the majority 10-plus years.
This “How to” is going to require committed leadership that has the drive, commitment and an eye for radical redesign. Learning from those already on this journey is key but also learning from others who are just starting out.
The leaders of the organisations who presented at this conference were definitely up for it, the innovators in the field , the enthusiasts from which we have much to learn for the benefit of the wider system.
NHS Improving Quality will be working with NHS England to help support the move to 7-Day Services. The 7 Day Improvement Programme commencing later this year will reach out to every provider and commissioner across the healthcare system. This is a radical transformational change programme and not for the transactional leader.
The ambition: Over the next five years, 7-Day Services will start to become a reality. The “How?” calls for widespread engagement, and learning from these six key messages is a useful starting point distilled from those already in the thick of it.
Dr Janet Williamson
Dr Janet Williamson is Director of National Improvement Programmes for NHS Improving Quality. NHS Improving Quality brings together the improvement expertise for healthcare, working on large scale change and is part of NHS England, Medical Directorate. Janet works closely with policy leaders, Department of Health, public health England, National Clinical Directors for NHS England, clinical networks, commissioning, and providers of healthcare services.
With over 25 years’ experience of managing both clinical and non-clinical services across the NHS, Janet has also been involved in and led a number of large improvement programmes, including total quality management, business process re-engineering and the Cancer Services Collaborative ‘Improvement Partnership’, which was instrumental in reducing GP referral to cancer treatment waiting times from nine months to two.
Between 2007 and 2013, Janet was National Director, NHS Improvement, a national team renowned for its experience and expertise in practical service improvement which has redesigned clinical pathways in cancer, diagnostics, heart, lung and stroke. It demonstrates some of the most leading edge work in England, helping to improve patient experience and outcomes. Much of its work provides the foundation for NHS Improving Quality.
In 2012, NHS Improvement under Janet’s leadership, was officially recognised as one of The Sunday Times 100 best places to work in the not for profit sector.
In 2007, she was awarded a professional Doctorate, identifying critical factors for spreading whole system change in healthcare. This drew on over four years of learning from change in cancer at a national, network and local team level.
One comment
I view the changes in the NHS from the position as a sole inventor and find little if any change has taken place in the assessment of ‘ideas’.. We must move away from independent assessors and declared ‘scope’ into which ideas are squeezed, Allow disruptive innovation to take the lead in the presentation of Fresh ideas, knowing full-well that fresh ideas will meet the opposition from established culture, if I am suggesting you are surplus to requirements, you are unlikely to embrace me. A prime examples is Physiotherapy in the protracted treatment low back pain, the length of treatment creates Anxiety and Depression, which they themselves then seek to solve, they will never be out of work.