Tracey Broom, General Manager Diagnostics, Therapeutics & Central Operations Meeting the 7 Day Diagnostic Access Challenge

Diagnostics & Therapeutics Group Diana Princess of Wales General Radiology CT/MR Ultrasound + community locations Mammography Physiological Measurements (PM) Audiology + community locations Nuclear Medicine Medical Engineering Pharmacy Endoscopy Outpatients Nursing Cancer Services Specialist Practitioners – Transfusion & Immunology Scunthorpe General General Radiology CT/MR Ultrasound + community locations PM Audiology + community locations Medical Engineering Pharmacy Endoscopy Outpatients Nursing Cancer Services Specialist Practitioners - Transfusion & Immunology Goole District General General Radiology Audiology Endoscopy Outpatients Nursing Cancer Services 611 staff £30 million budget

Re-Shaping Diagnostics - The Diagnostic Innovation & Improvement Plan  Fit for the Future Implementation 2011 saw integration of Finance and HR across Diagnostics bringing harmonisation and efficiencies into the then Diagnostics, Therapeutics and Path Links Teams.  Diagnostics had followed a continuous process of service reconfiguration/ modernisation for a number of years but were struggling to meet demand from both the Acute and then Primary Care sector.  Main aim for Re-Shaping Plans were to increase productivity levels at a lower cost whilst maintaining quality, introducing a more responsive and flexible service provision.  Need to support 7-day working. Challenges – Our Transitional Journey is Underway

 Workforce Redesign – introduced stronger clinical leadership. New posts of Deputy Heads/Deputy Clinical Leaders of Department created in keeping with The Francis Report.  Leadership - Service Management Changes Merged SGH and Goole X- ray.  Process Redesign – 3 session day moved away from reliance on overtime.  Consistent Regulated Quality. Core Elements to Re-Shaping – NHS Change Model

 Moving staff away from locally agreed on-call payments to an out of ours 3 session day shift over 7 days.  Offering a pay protection period to staff to ensure they receive protection of income loss.  Rotation of staff from general radiography to CT/MR using competency based skill packages for staff.  Offering training and support of sonographers by offering secondments to local radiographers to undertake training at local universities – with supported course fees.  Ensuring contracts of staff include working across the 2 main sites both days and nights.  Formal staff rotation through CT, MR and general radiology areas to support maintenance of skills.  Additional staff recruitment. Moving to 7-Day Diagnostics was achieved by:-

 Inpatients and outpatients now have access to CT, MR, General Radiology and Ultrasound 7 days per week.  Same day diagnostic for those attending Consultant outpatient appointment, where possible in General Radiology, Ultrasound and CT  Increased timeliness to access to diagnostics e.g. CT head scan for Stroke patients achieved within Stoke Accreditation targets  Where possible provision of same day diagnostics for Inpatients if the patients preparation time allows.  Wider choice of appointments for all outpatients.  More timely access and diagnosis for cancer. Impact – patients

 Redesign aided other clinical groups to support timely clinical decision making leading to more effective discharge planning.  Wider access for outpatient services.  Initial investment required of an additional £533k to support increased staffing levels. The widening of access brings in more income to off set the expenditure against this.  Full extent of spend on additional recruitment and the savings to be made from working shift systems as opposed to on call yet to be finalised. Overall

 Formal 90 day consultation process.  Staff invited to offer their preferred rotas within the consultation period.  Robust contingency plan for report provision was locally complimented by outsourcing to private providers.  Trial of home reporting kit to compliment Radiologists reporting at home.  Staff recruitment on-going key challenge. Locums are a large cost pressure.  Grow your own culture of Sonographers and CT/MR Radiographers in place.  Recruitment drive continuous, looking at bursary type scheme with HR. Challenges and solutions

Where we are now  All Diagnostics Staff – 7 Day Contracts.  7 Day Diagnostics - X-Ray, CT/MR, Ultrasound.  3 session days in X-Ray, CT/MR over 7 days.  Services appropriately supported with Portering, Nursing, Electronic Requesting, Medical Engineering Service, Diagnostics IT.  Diagnostic Reporting Standards embedded.  Admin roles separated out from clinical roles.  Flexible establishments across the sites.  Harmonised patient information across sites.  Achievement of KPIs – e.g. Stroke 1 hour and 24 hour targets.  Rolling Capital Replacement Plan.  Robust CIP Plans.

Challenges ahead

Emerging Themes & Principles  Review numbers of staff required to deliver safe effective services.  Undertake capacity and demand analysis to help understand how services could be delivered to support waiting times and patient choice.  Review skill mix of staff at all levels to ensure career opportunities. Top Tips Ensure early engagement of staff in reviewing and developing staff shift systems. Produce a strategy document that maps the journey for staff. This ensures staff are kept well informed and wanting to drive the changes themselves. Engage with other interdependencies e.g. Portering, Domestic Services and Diagnostic IT services to ensure 7 day services run effectively.

 Corporate unparalleled changes on the horizon – Diagnostics & Therapeutics need to continue with reconfigurations whilst balancing cost against long term gains for the Trust.  Our short term success in some cases is determined by skills of workforce and ability to recruit.  Concentrate on operational capacity and performance to deliver effective services with robust CIP plans.  Commitment from all staff and strong leadership from the clinician leads and managers to support all clinical services taking a wider strategic viewpoint across the Trust and health community ensuring quality services. Conclusion

Thank you for listening. Any questions?