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A w hole system c hallenge - in a challenged system !

A w hole system c hallenge - in a challenged system !. South East Essex Health and Social Care. South East Essex seven day services. A whole system challenge – in a challenged system !. Population 360,000 Peninsula location 2 CCGs Southend Unitary Council Essex CC. Local context.

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A w hole system c hallenge - in a challenged system !

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  1. A whole system challenge -in a challenged system ! South East Essex Health and Social Care

  2. South East Essex seven day services A whole system challenge – in a challenged system !

  3. Population 360,000 • Peninsula location • 2 CCGs • Southend Unitary Council • Essex CC

  4. Local context • Elderly population > than average at 17%, rising 20% by 2020 • Most densely populated area in East of England • Low GP numbers plus high number of single handed GPs • Southend Hospital has c650 beds, Cancer Centre, Ophthalmologyhub, • bidding to be a Vascular hub and Hyperacute Stroke unit • A whole system approach, Acute, Community, CCGs and Council

  5. Competing priorities & challenges • Southend Council, CCG and Hospital are also partners in the Integrating Health and Social Care programme as a Pioneer site • Year of Care pilot with D0H • In March, poor A&E performance led to a Risk Summit with Monitor • Emergency Care Action plan • Involving all partners, CCGs, CSU, LAT, NHS England etc • Other usual performance challenges, RTT, Cancer

  6. A lot going on !

  7. Where are we now ? • Gap analysis done using the NHSIQ tool and ‘Perfect Week’ • Linking strongly with the Pioneer programme • Embedding the clinical standards in the Emergency Care Action plan • Working with CCGs to address the A&E ‘open door’ issue • Length of stay (LOS) review - very few patients at > 7 days • But a high number of <2 day stays • Address with Standard 2 – Senior reviews • Started to resolve clinical engagement issues • ‘Perfect Week’ completed • Realisation that 7 day services is not a project – it’s a set of standards to be adopted across the system • Governance through Joint Executive Group (CEOs of partners)

  8. Successes • ‘Perfect Week’ highlighting 7 day services issues • Consultant engagement following on from ‘Perfect Week’ • Experienced medical outreach team to address the ‘Deteriorating patient’ out of hours • Implementing NEWS (National early warning scores) in hospital • LOS review highlighted quality of matrons and discharge team • Discharge coordinator 7 days a week supported by rehab teams • Frail Elderly assessment unit • GP Federation in Castle Point CCG - 80% of GPs signed up, will provide closer support to patients in Care Homes • Creation of energy and commitment in the whole system

  9. We’ve come a long way……

  10. But it’s a long journey !

  11. What next ? • Implementing learning from the Perfect Week • 7 day Frail Elderly Assessment Unit • 24 hour ward clerk cover in AMUs 7 days a week • Standardising nurse staffing levels across the 7 days • Increase weekend Rehab/OT support • Focus on increasing availability of Diagnostics at weekends • Embed the SAFER bundle • Twice daily senior reviews • 7 day single point of referral for community care & services • Social worker in A&E • GP hub with integrated MDT working 7 days • Review of 7 day services in community by Pioneer programme

  12. But not necessarily a long walk !

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