Progress

Measuring our progress

To support quality improvement and measure progress in the achievement of seven day hospital services, acute trusts completed a self-assessment survey in March 2017.  It covered the management of patients admitted as an emergency, measured against the four priority clinical standards for seven day services.

To complete this self-assessment survey, trusts analysed patient case notes to assess their achievement of the standards for first consultant review (clinical standard 2) and ongoing consultant reviews for patients (clinical standard 8) and provided an assessment of their provision of relevant diagnostics (clinical standard 5) and consultant directed interventions (clinical standard 6).

153 trusts were eligible for the survey and 148 (96.7%) submitted data using the online seven day hospital services self-assessment tool. The data for the survey were provided by a combination of clinicians, managers and clinical audit teams and were approved by the trust’s medical director before submission to NHS England. More information on the survey, including supporting tools and guidance for trusts, is available on the 7 Day Service Self-Assessment tool.

Survey Results

Individual trust performance against the four clinical standards

Results for individual NHS trusts against the four priority 7 day hospital services clinical standards can be found in survey results document, along with the methodology used to calculate these results.

Aggregated national performance against the four clinical standards

Table 2 below shows the proportion of the survey sample population who received care which met the 7 day hospital services clinical standards, which equates to a percentage of patients nationally.

These results show that on a national basis, performance against standards 5, 6 and 8 (for weekdays) is higher than for standard 2 and standard 8 (for weekends). Trusts performing well against standard 2 and at weekends for standard 8 have focused on matching consultant availability with peak patient demand.

Table 2: Percentage of patients that received care meeting the clinical standards

7 day average Weekdays Weekends
Percentage of patients who had an initial consultant review within 14 hours of admission (CS2) 72.3% 73.0% 70.3%
Percentage of patients that had access to diagnostic tests (CS5) 95.9% 99.7% 92.1%
Percentage of consultant directed interventions  available to patients (CS6) 93.5% 95.2% 91.9%
Percentage of patients that received ongoing daily consultant reviews (CS8) 85.2% 90.9% 69.7%

Table 2 shows an aggregated score for each of the clinical standards. For standards 2 and 8, the figures are based on the percentage of total reviews undertaken which meet the standards for all patient case notes used in the survey. For standards 5 and 6, the figures are based on an average of the total scores for these standards from all participating trusts. Further details of the methodology for calculating scores for individual standards for trusts can be found in the survey results document.

Table 3 below shows the breakdown of achievement by trusts for each the diagnostic tests measured in the survey for clinical standard 5. The standard is achieved where the trust self-reported 7 day access to the diagnostic test is available on-site or by formal arrangement with another trust.

These results show that at present fewer trusts report access to MRI and particularly echocardiography at weekends compared to other diagnostic tests. Some trusts are exploring ways to improve access to MRI through a networked approach, while a broader approach is required to improve echocardiography capacity.

Table 3: clinical standard 5: number and proportion of trusts providing each diagnostic test

Diagnostic test

Proportion (and number) of trusts meeting

the standard n= 148

7 days Weekday  Weekend
CT 99.3% (147) 100% (148) 99.3% (147)
Microbiology 98.0% (145) 99.3% (147) 98.6% (146)
Upper GI Endoscopy 89.2% (132) 95.3% (141) 90.0% (133)
Ultrasound 87.8%(130) 98.6% (146) 87.8%(130)
Echocardiography 55.4% (82) 97.3% (144) 56.1% (83)
MRI 74.3% (110) 98.0% (145) 74.3% (110)

The scores in table 3 are calculated separately for the weekday and the weekend, and the combination of these two scores is used to show the achievement over 7 days.  The 7 day score may be lower than both the weekend and weekday, as different trusts will meet the standard for different tests. Full details of the methodology used for all standards is available in the survey results document.

Table 4 below shows the breakdown of achievement by trusts for each the consultant directed interventions measured in the survey for clinical standard 6. The standard is achieved where the trust self-reported 7 day access to the intervention is available on-site or by formal arrangement with another trust.

These results show that at present trusts report the greatest variation in weekend access to interventional radiology and urgent radiotherapy compared to other interventions. Trusts are exploring ways to improve this through a networked approach.

Table 4: clinical standard 6: number and proportion of trusts providing each intervention

Intervention

Proportion (and number) of trusts meeting

the standard n= 148

7 days Weekday Weekend
Critical Care 98.7% (146) 98.7% (146) 98.7% (146)
PPCI 91.2% (135) 93.2% (138) 91.2% (135)
Cardiac Pacing 90.5% (134) 95.3% (141) 90.5% (134)
Thrombolysis for Stroke 93.2% (138) 93.2% (138) 93.2% (138)
Emergency General Surgery 95.3% (141) 95.3% (141) 95.3% (141)
Interventional Endoscopy 91.9% (136) 93.9% (139) 91.9% (136)
Interventional Radiology 73.65% (109) 87.8% (130) 73.65% (109)
Renal Replacement 89.2% (132) 91.2% (135) 89.9% (133)
Urgent Radiotherapy 76.4% (113) 81.8% (121) 77.7% (115)

The scores in table 4 are calculated separately for the weekday and the weekend, and the combination of these two scores is used to show the achievement over 7 days.  The 7 day score may be lower than both the weekend and weekday, as different trusts will meet the standard for different interventions. Full details of the methodology used for all standards is available in the survey results document.

Improvement support for trusts

These results reflect significant efforts made by trusts to deliver care which meets the four standards. To support trusts to further improve, both NHS England and NHS Improvement have been providing hands-on direct support through regional teams. Further information including case studies of where trusts have been successful in implementing 7 day hospital services can be found on the NHS England’s website and on the NHS Improvement’s website.

Survey Assurance

The 7 Day Services survey was awarded the Standardisation Committee for Care Information (SCCI) assurance – mark (No: SCCI2173) by NHS Digital (Standardisation Committee for Care Information) in May 2016, and is valid until May 2019. This confirms that it has been rigorously assessed and meets the SCCI quality assurance criteria.