AH ANNUAL REPORT 2018

Developing a System of 7 Day Working
Aim: To achieve the same level of access to clinical
services across all 7 days of the week
Targets: To meet the 4 core national standards*:
1. Std 2 - Time to consultant review < 14 hours
2. Std 5 - Access to diagnostics
3. Std 6 - Access to interventions/key services
4. Std 8 - Ongoing senior review
*Core standard 2 required for 2017/18
Outcomes - 2017/18:
1. October 2017 Updated baseline by audit (S2 only)
2. Stabilised trainee doctor numbers over winter to
ensure consultant availability
3. Developed standardised electronic ward round
package to mandate recording of consultant
presence
4. Prepare for Spring Audit 2018 (4 core standards)
5. Engagement and planning for redesign of
paediatric delivery model
Evidence exists that lack of access to resources at
weekends across the NHS can be associated with
delays to care and increased risk of adverse outcomes.
The Trust is required to deliver national standards
designed to address this variation and to focus on 4 of
10 of the agreed national standards. Generally good
progress has been made with standard 2 requiring
more thought and attention.
In implementing the system of 7 day working, the Trust
has established a Trust wide “7 day Working Steering
Group” to coordinate Trust approach, and to oversee
mandated audits. To pull together this multifaceted
approach, we have established the ‘Best in Acute Care’
working group which oversees activities and outputs
of Out Of Hours working group, New Models of Care
working group, Escalation policy and development of
Rapid Response Nursing Team.
Achievements 2017/18
1. Clinical Standard 2 - Time to 1st Consultant
Review: 54% of patients were seen and assessed
by a suitable consultant within 14 hours of
admission.
2. Improved ability to record when consultant review
takes place on hospital information system.
3. Established an Out Of Hours working group
(Junior Doctors, General paediatric and Specialty
Consultants, Senior Clinical Leaders, Service
Managers and Medical Staffing Lead)
4. Created an action plan including surveillance of
junior doctor numbers and gaps, recruitment to
additional posts, and wellbeing of junior staff.
5. Recruited over and above expected trainee
establishment (in anticipation of gaps).
6. Appointed 3 experienced Foundation (F3) doctors
(across general paediatrics and surgical teams) in
addition to trainee establishment.
7. Appointed 4 zero hours contract doctors to support
covering gaps in rotas.
8. Also introduced an additional 2 Advanced
Nurse Practitioners to contribute to junior doctor
responsibilities.
9. Developed a ‘New Models of Care’ working group
looking at a new model of consultant delivery of
care to different patient groups across Alder Hey.
10. Weekly meetings commenced July 2017
addressing a number of work streams including:
a. Clarifying general paediatric and specialty team
‘rules of responsibility’
b. Determining best model of care for emerging
Complex Care patient group
c. Determining best model of care for consultant
support to High Dependency Unit
d. Determining most appropriate paediatric support
for surgical patients (complex and non-complex)
11. Models of Care agreed in principle and supported
by the Executive Team
12. New Models of Care work Programme has been
agreed as one of the Trust’s 5 key Operational
Priorities for 2018/19, and each of the above work
streams will be progressed with an implementation
programme agreed.
13. Developed standardised electronic ward round
documentation in place should make the process
of monitoring compliance with the standards easier
and allow for improvements to be made in a timely
way.
Alder Hey Children’s NHS Foundation Trust 122
Annual Report & Accounts 2017/18