A recipe for successful seven day services

Recently I attended a session on how to write a blog, which described it as following a recipe. So with that in mind (and currently hooked on Masterchef and Bake Off) my appetizer comes from Chris Roseveare’s blog about a lady wanting to do the right thing for her dying husband and get him out of hospital and home at a weekend.  It took many calls, discussions and pleas to make it happen by the consultant (the head chef – suspect there were a few under the breath “Ramsey moments”) but this is not something to make light of.  It is a true story that captures the reality, practicality and the moral purpose of why seven day services are so important… this is about CARE. This is not a starter that would get the taste buds flowing. In fact it leaves a nasty taste in the mouth to know that what we are serving to our patients at weekends is not always as good as it should be. Some may say it’s the best we can do with the ingredients we have but like any good recipe we have the opportunity to put it right and not serve it again.  A new recipe is required.

After the opening bite we move on to the entrée. This is more than a nibble but one that will set you up for the feast ahead. I am talking about seven day diagnostics.  Did you know there are over 50 health care scientific tests, plus tests and interventions from other diagnostic services? It’s like looking at the pantry shelf and wondering which ingredient to use or whether to grab the first thing that comes to hand?  This preparation stage is vital, so why do we sometimes not value the importance of the preparation time? Food for thought!

Then for the main course a cornucopia of dishes. We frequently get asked about the alignment between seven day services and urgent and emergency care but there is no alignment; it is a key part of urgent and emergency care, integrated care, mental health, social care, patient safety. The list is endless. Seven days is not a separate entity, it is a basic ingredient of the recipe; like the egg that binds everything together, it’s a core principle that should be integral in everything,

Understanding patient flow is another main course. Think of a fast stream (a hot main) and a slow stream (cold main); you need to know where both streams start, who is involved, what they do – it’s all in the preparation and that needs time.  Understanding patient flow from different perspectives is like following a recipe but if you miss out an ingredient or skip a stage you will not get a picture of the whole system and the result could be an unsustainable “quick fix”  or an unintended negative consequence…….. like a “soggy bottom!”

Over the last few weeks there have been a few seven day conferences on the menu and various views in the press.  This could be described as a dish that has lots of flavours going on. Getting the ingredients right is crucial but its presentation must be attractive, leaving the diner wanting more.  I certainly came away from the recent Hislac conference at the Royal College of Anaesthetists inspired and wanting more.

Finally, the dessert. On recent visits to the seven day services early adopter communities, I heard and saw teams from across the health and care community working together and testing new recipes. I heard about co-design, sharing information, revisiting commissioning frameworks and building seven days into contracts. Clinical teams empowered to change the service. They are having new conversations and building new relationships, sharing the risks and the successes.  However, the real icing on top of the cake will be when seven day services are the norm and not the debate. Then we can finish off by adding the cherry – “the patient” – because like any recipe the devil will be in the detail.

(My blog writing may not have improved but my cooking is getting better!)

Dr Ann Driver

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