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, Ophthalmology hub, –bidding to be a Vascular hub and Hyperacute Stroke unit A whole system approach, Acute, Community, CCGs and Council

5. 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 Competing priorities & challenges

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 !