The challenge of providing 247 care

It is widely accepted that we now live in a 24/7 society, but some argue the NHS has not kept pace with this, despite the inevitable fact that people will become ill at all hours of the night and day. The aim of round-the-clock, seven-day working is to improve patient care and to make sure that all services are available to all patients whenever they get ill.

A report by the NHS Services, Seven Days a Week Forum highlighted deficiencies in many areas of care and found patients admitted at the weekend had a greater risk of dying within 30 days of admission than those admitted on a weekday. It said many factors could contribute to this, such as: variable staffing levels in hospitals at the weekend; the absence of senior decision makers of consultant-level skill and experience; inconsistent availability of specialist services such as diagnostic and scientific functions; and a lack of availability of specialist community and primary care services to support patients on an end-of-life care pathway to die at home.

The forum also found that an absence of senior decision makers at weekends and evenings can lead to a longer length of stay, which increases the risk of acquiring a hospital-based infection and the degree of lost mobility from time spent in bed.

The guidance developed by the forum aims to standardise care and spread best practice to ensure good-quality care and patient experience is available 24/7 for everyone. However, it recognises there can be no one-size-fits-all approach for trusts and that local solutions are needed. However, finances also need to be taken into consideration. NHS England’s The NHS belongs to the people: a call to action points out that the NHS is facing an unprecedented challenge in terms of finances and quality of provision. The move towards 24/7 services is just one of a number of financial considerations for trusts when setting policy or implementing strategic change programmes.

Following publication of the Seven Days a Week Forum guidance, Sir Bruce Keogh outlined 10 clinical standards, offering an overview of care to ensure all elements of the patient journey are available as and when needed. NHS Providers chief executive Chris Hopson is supportive of the standards. He says: “Given there is still ongoing discussion about the working definition of 24/7 care, having clear clinical standards is very helpful so we know what we need to meet the gold standard.”

The best trusts are endeavouring to ensure that services at weekends resemble those on weekdays as far as possible, not simply by having consultants on site. Pharmacy, therapists and diagnostic and scientific services are crucial to this model. Administrative, clerical, facilities and ancillary services are also being adapted according to local circumstances. In some trusts, management teams are now rostered to ensure they have a presence at weekends to improve continuity and to ensure operational quality is consistent, particularly in areas such as single sex accommodation.

Chris Hopson points out that leadership plays a vital role in moving organisations to 24/7 working. He says: “As I go around the country, my observation is that the people who are making the most advances are those who are clear about their strategy. More often than not this involves having someone on the executive board who has been nominated to oversee the process and has developed a sensibly paced strategy to get there.

“This means, for example, knowing what you are going to deliver over the next four years and having a management change strategy which clinicians have bought into, having been involved in establishing what progress looks like.”

This blog is taken from the CHKS Best Practice in 24/7 Care report which you can download here.
It is widely accepted that we now live in a 24/7 society, but some argue the NHS has not kept pace with this, despite the inevitable fact that people will become ill at all hours of the night and day. The aim of round-the-clock, seven-day working is to improve patient care and to make sure that all services are available to all patients whenever they get ill.