Ensuring services are available around the clock to meet the 24/7 aspiration is a significant challenge for every trust even before finances are taken into account. With NHS trusts forecasting a combined end-of-year net deficit of around £2.3 billion for 2016/17, many are focusing their efforts on cost reduction.
Although there is some debate about what 24/7 care looks like, the 10 clinical standards set out by Sir Bruce Keogh are considered a useful yardstick. These standards take an overview of care to ensure that all elements involved in the patient journey are available as and when needed.
Trusts seeking to meet the 24/7 challenge often start by trying to reduce demand on emergency departments as way to smooth the patient journey and ensure resources are available to all patients throughout the week, day and night.
Successful trusts are challenging traditional ways of working, ensuring that not only is the emergency department co-located with other services, such as community pharmacy, but that services offered are patient-centred. They recognise that the department is part of the whole system and work with primary and community care providers. Improved access to primary care and mental health services is one of the benefits of this joint working and an important aspect of delivering 24/7 care.
The best trusts also ensure they understand patterns of activity and are able to match the skillsets of staff with patient demand. They fast-track patients with certain conditions to help to enhance patient flow and improve the overall experience. This can involve setting up ambulatory emergency care, medical assessment units or frail elderly wards to help reduce the bottlenecks that lead to long waits and delayed treatment.
The aim of the CHKS Best Practice in 24/7 care report is to share best practice; it highlights practical ways that trusts are overcoming the challenge by looking at three trusts in particular. These trusts were shortlisted for the CHKS Excellence in Delivering 24/7 Emergency Care Award 2016 and were identified by an analysis of relevant indicators before being asked to submit award entries. Our expert panel of judges included Royal College of Emergency Medicine president Cliff Mann, Royal College of Nursing head of nursing practice JP Nolan, and head of transformation at NHS Improving Quality, Hannah Wall.
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