A substantial body of evidence exists which indicates significant variation in outcomes for patients admitted to hospitals in an emergency, at the weekend across the NHS in England. This variation is seen in mortality rates, patient experience, length of hospital stay and re-admission rates. Additionally medical, nursing, other health professional and managerial staffing levels, as well as trainee doctors’ perceptions of supervision by consultants, also vary by day of the week.
To tackle this, in 2013 the NHS Services, Seven Days a Week Forum developed 10 clinical standards to end variations in outcomes at the weekend. These standards, a Summary of Initial Findings from the NHS Services, Seven Days a Week Forum, along with an evidence base document, a survey of acute trusts and separate reports from the Forum’s workstreams, are available to download:
The 10 clinical standards
At a glance: Our partners at NHS Improvement have put together a short video which explains the standards
First stage report and paper to the Board of NHS England
- NHS Services, Seven Days a Week Forum : Summary of Initial Findings
- NHS Services, Seven Days a Week : Board Paper NHS England
- Evidence Base
- Survey data
Professor Sir Bruce Keogh, the NHS Medical Director, supported by the Academy of Medical Royal Colleges, identified four of these standards which if met would be most likely to have the greatest impact on reducing variation in mortality risk.
These Priority Clinical Standards are:
- Standard 2: Time to Consultant Review
- Standard 5: Access to Diagnostics
- Standard 6: Access to Consultant-directed Interventions
- Standard 8: On-going Review
However, although these four standards have been prioritised, we also want to promote implementation of the six other clinical standards developed by the Forum as these are considered best practice for improving quality of care on every day of the week.
Delivering Seven Day Hospital Services – the ambition
The provision of seven day services is about ensuring that patients receive consistent high quality safe care every day of the week. It has three key elements:
- Routine general practice; access to GP appointments in the evenings and at weekends
- Urgent care; access to healthcare advice 24/7 via NHS 11
- Quality hospital care that will provide 100% of the population with access to the same level of consultant assessment and review, diagnostic tests and consultant-led interventions every day of the week by 2020.
For hospital services, the Government’s Mandate to NHS England for 2016/17 sets a priority deliverable that NHS England will work with others to:
- Rollout 4 priority clinical standards in all relevant specialties to 25% of the population in 2016/17; by 2020 roll out 7 day hospital services to 100% of the population (with progress also made on the other six standards identified by the NHS Services, Seven Days a Week Forum), so that patients receive the same standards of care in hospitals, seven days a week.
What does this means for patients?
For extreme emergencies like serious injuries, heart attacks and strokes the NHS already provides care 24 hours a day, seven days a week. The four priority clinical standards, once in place, will ensure that if you are admitted to hospital with sudden severe illness you can expect to receive the same quality of assessment, diagnosis, treatment and review in hospital on any day of the week.
This means you should be seen by a consultant within a few hours and at the latest by the morning after arrival. If the consultant advises urgent tests or treatments you should get these the same day. While you are being treated in hospital you can expect to see a consultant or one of their team every day to make sure that your care is progressing and that you are given information and an opportunity to ask any questions.
What does this mean for the NHS?
Delivering the Forward View: NHS planning guidance 2016/17 – 2020/21 sets out that every health and care system should work together to produce a multi-year Sustainability and Transformation Plan, showing how local services will evolve and become sustainable over the next five years.
Seven day hospital services should be an integral part of these plans and local areas should set out how they intend to deliver the four priority clinical standards, which in turn should support implementation of the other six standards.
This programme is about patients admitted in an emergency having access to the same high quality of in-patient care on every day of the week. It does not mean that elective care needs to be available every day. It also doesn’t mean that all staff working will work on a seven day basis, although many already do so. It also doesn’t mean that all providers should be offering all specialities seven days a week, as trusts can work together in networks to ensure that people have access to seven day services.
Progress so far
In summer 2015, acute hospitals across England self-assessed their services against the priority standards. The data from that exercise and the results as they appear on MyNHS are available below.
This baseline exercise marked the start of our commitment to a bi-annual survey of seven day in-patient services in hospitals to measure progress. The latest survey took place in March-April 2016 and consisted of prospective case note review to be undertaken, involving sampling for seven consecutive days. More details of the latest survey can be found at:
Next steps and support
To meet the ambition of delivering the four priority clinical standards for 25% of population by March 2017, a first wave of NHS trusts have been identified. They have been working on the delivery of the standards, supported by NHS England’s regional Service Improvement Teams.
Following on from this, further NHS trusts will be identified to form phase two of this work, with the aim of delivering the four priority clinical standards for 50% of population by 2018, with remaining NHS trusts working towards implementation and 100% coverage by March 2020.
Alongside this, by autumn 2017, the four priority clinical standards will be rolled out to all urgent network specialist services which include vascular, stroke, major trauma, heart attack and children’s critical care.
To help trusts with delivering seven day hospital services we have produced a resources page, which contains case studies of innovative working which can support local implementation. We will also be providing an updated seven day services implementation checklist shortly.