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-April 2018.  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).

151 trusts were eligible for the survey and 146 (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 and NHS Improvement.

Survey results

Individual trust performance against the four clinical standards

Survey 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. This document also contains the results from the previous self-assessment survey, completed in March-April 2017, for comparison purposes.

Aggregated national performance against the four clinical standards

The table below shows the number of 7 day hospital services priority clinical standards met by trusts over a seven day period, based on an achievement threshold of 90%. Also shown is the national population coverage for each of these trusts, based on the proportion of emergency admissions for each organisation.

These results show that 33% of the population are served by trusts that achieve all four of the priority clinical standards, with a further 35% of the population covered by trusts which meet three out of four standards.

Table: Number of trusts achieving 7DS standards and population coverage, March – April 2018

Total number of trusts achieving 7DS priority standards over a seven day period % of national population covered by these trusts
4 standards 49 32.98%
3 standards 97 68.06%
2 standards 130 90.16%
1 standard 144 98.33%

Note: Trusts covering 0.98% of the national population did not submit results for this survey and trusts covering 0.69% of the national population failed to achieve any standards.

Future 7DS measurement proposals

As noted in NHS Improvement’s Provider Bulletin dated 28 November 2018, the way that the improvements delivered by trusts are measured is changing. As detailed above, providers of acute services have previously completed a biannual self-assessment survey to measure progress against the four priority 7DS standards.

This was completed through a combination of case note reviews and self-assessment. Though useful in supporting implementation, this survey placed a significant administrative burden on trusts in terms of reviewing a large number of patient case notes.

To reduce this burden and to allow trust boards to provide direct oversight of 7DS progress, 7DS will be measured through a board assurance framework. This process consists of a standard template to assess progress in delivering 7DS, which is then assured by the trust board before submitting results to regional and national 7DS teams.

This process will be implemented gradually by a trial process from November 2018 and February 2019, followed by full implementation from March to June 2019. Trusts will receive support from regional teams to manage this transition.

Full details of the new process and documentation for trusts are available on the NHS Improvement website.