Seven-day services for emergency care can increase efficiency

Connie Brown arrived at hospital in an emergency ambulance. She is 90, has chronic obstructive pulmonary disease and had severe pain in her side. She was quickly assessed in the emergency department, had diagnostic tests, then moved to a specialty ward where she was seen by a respiratory specialist and within four hours of arrival began treatment for pneumonia and pleurisy.

In many places, Connie would have been in hospital much longer before seeing the right specialist and beginning treatment. Going into hospital is a frightening event for most people, especially when admitted as an emergency.

If they remain there longer than necessary, they stand more chance of picking up an infection or losing their mobility.

But in Northumberland, where Connie lives, emergency care services are centralised to ensure there are consistent levels of consultant specialists available in one place, seven days a week. Patients are seen promptly by doctors who can make decisions about their diagnosis and care without delay, while the trust benefits from efficient patient flows through A&E and the rest of the hospital.

Locally, clinical commissioning groups will want to ensure the emergency services they commission meet the standards seven days a week 

The concept

”Connie’s experience is exactly what our new model of emergency care is all about. We know that providing access to specialist consultant-led emergency care seven days a week can have a profound impact on patient outcomes”, says Dr Eliot Sykes, consultant in anaesthesia and intensive care at the Northumbria Specialist Emergency Care Hospital.

In the first 10 months after the Northumbria opened, emergency admissions fell by 5,500. The trust has also substantially reduced average length of stay and readmission rates.

Now all trusts should grasp the opportunity to introduce seven-day consultant-led services for urgent and emergency care as they put together their sustainability and transformation plans (STPs). Change won¹t happen overnight, and trusts will take different approaches. But by March 2017, 25 per cent of the population should have access to high quality services seven-days a week, rising to 50 per cent a year later and 100 per cent by 2020-21.

But what exactly do we mean by seven-day services? Ten clinical standards related to the timeliness of care, supported by the Academy of Medical Royal Colleges, define what patients can expect whatever day of the week they are admitted to hospital. Four are priorities that all hospitals must achieve by 2020 but all 10 are important.

In the first 10 months after the Northumbria opened, emergency admissions fell by 5,500. The trust has also substantially reduced average length of stay and readmission rates.

When the four priority standards are implemented patients admitted as an emergency will be assessed by a suitable consultant within a maximum of 14 hours, though many are seen much earlier. Urgent cases will have access to diagnostic tests and results within 12 hours ­ and within one hour if they are critically ill. They will also have access to specialist, consultant-led interventions. Consultant directed ward rounds will take place daily for patients admitted to hospital in an emergency.

Patients with high-dependency needs will be seen and reviewed by a consultant twice a day, while inpatients will be included in daily consultant-directed ward rounds.

Six other standards cover patient experience, shift handovers, transfers out of hospital and quality improvement.

Although the four priority standards refer to hospital care, they are not limited to acute services. Community and mental health services need to think about how they support patients and service users at weekends.

Work is also going on so that patients can access primary care in the evenings and at weekends, and have access to healthcare advice 24/7 through NHS 111.

The advantages 

We are clear about what seven-day services do not mean. Patient demand at weekends is low for most planned care such as surgery, investigations and some outpatient clinics.

That is why we are focusing on urgent and emergency care now; in future we will consider other services such as non-urgent diagnostic tests, some cancer treatment and day case procedures to improve patient choice.

Seven-day services do not mean that consultants will work more hours, but they will mean new ways of working. This will include hospitals forming networks to help each other achieve the standards, and making sure they share information effectively.

Ten clinical standards related to the timeliness of care, supported by the Academy of Medical Royal Colleges, define what patients can expect whatever day of the week they are admitted to hospital

It may involve new financial incentives and extended or different roles for clinical and non-clinical staff. Hospitals will need to address their weekend staffing levels.

Clinicians started the move to seven-day services and set the standards that trusts must meet. So it¹s essential that clinical leaders are at the forefront of discussing how to introduce seven-day services locally, for example, by playing a full role in developing STPs.

NHS Improvement and NHS England will monitor progress every six months to support hospitals as they make progress in meeting the standards. The Care Quality Commission will review performance against the four priority standards in its inspections.

Locally, clinical commissioning groups will want to ensure the emergency services they commission meet the standards seven days a week 

We appreciate that many trusts will have to overcome significant financial or recruitment problems to meet the commitment to seven-day services. But that should not limit their ambitions: seven-day services offer an opportunity to transform care and increase efficiency as they are linked to A&E performance, patient flow, patient satisfaction and clinical outcomes.

NHS Improvement will help by publicising lessons from trailblazing trusts already offering excellent emergency care services seven days a week, and by organising events to explore key issues. The long-term benefits of seven-day services to patient care, prevention, choice and finance will be immense.

Kathy McLean is the medical director at NHS Trust Development Authority