London, 20th August 2013

Towards 7 day working A whole system change

David Evans

Medical Director Northumbria NHS Foundation Trust

Dave.evans@northumbria-healthcare.nhs.uk

Northumbria 500,000 pop. +/- 1,200 beds 8,500 staff 255 Cons. 280 Docs. 9 I/P sites Turnover > £440 million Largely Emergency driven Provincial Medical School

We are a bit odd…..

Mobile workforce Trust wide contracts 30% off site Flat… Stability Flexibility Willingness to try… Rural pressures Lots of Hub & Spoke Ageing population

Beginnings

3 Trusts into 1 Very low baseline ££££ difficulties Inefficient clinical model Unsustainable services Recruitment difficulties Staff unsettled Political pressures

12 years

A Need for Change….

Key numbers….83 84 More of the same was not an option….

Why not be radical?….

A whole system change….. Create a Specialist Emergency Care Centre Split Elective / Emergency work 24/7 resident Consultant in Emergency Care Extended working day 7/7 , 9 clinical teams Change DGH s for elective / community care KIDD.

Develop Ambulatory Care Elderly assessment Surgical assessment Direct access to palliative care

• ECC location map to do…. *

Front line….

Emergency Care Consultants Acute Care Physicians Surgery x 2 Orthopaedics x 2 Cardiology Respiratory ITU / Anaesthetics O & G. Paediatrics + Nurse practitioners + Pharmacists

Clinical engagement

Build in Safety & Quality Make this the right thing to do It is better for patients Collectivism Business Units Harness the competitiveness No deals , no surprises Use patient feedback Job planning & appraisal All core activity within PA’s

Clinicians Compact of Behaviours Escalation plan Clear policies & Governance systems work….CNST

Clearly understood expectations “No surprises please…” Competency & values framework Revised recruitment process New Consultant programme Leadership development programme Well established & valued appraisal programme Clear and robust job planning

Culture

Stability , Consistency & Honesty Collectiveness Respectful Clinically led Multi-disciplinary Value driven Patient centred Safety & quality are key

Lessons learned

Whole system change can be good People enjoy a challenge Splitting elective / emergency is life changing Public consultations can be good Local councils like local solutions MP’s can get ‘anxious’

For the last 5 years… Every service development is NECC proofed Large work stream reconfiguration programme We will not be moving current ways of working Everyone will change