Taking Care 24:7

Taking Care 24:7' is a group of pilots that were looking at new ways of working for healthcare services over the full 24 hour day. Five pilot projects in this area were announced in November 2006.

The pilots awarded by Skills for Health - Workforce Projects Team were looking at the development of different models of service provision. The aim was to support healthcare organisations across the NHS refocus ways of working and the use of different staff to reduce the dependence on junior medical staff or to restructure the way they work so that compliance with the 48 hour week for junior doctors can be achieved.

The successful schemes looked at new initiatives ranging from a new model of redesigning the management of people with acute illness, through to the reconfiguration of teams in teaching hospitals and a mental health trust to adopt a Hospital at Night team working model for the full hospital day.

The five successful pilots were:

• West Dorset Health Community
  – work between the hospital trust, PCTs ambulance service, practice based commissioning GPs and local council to introduce multidisciplinary acute illness assessment and care pathways across the community.
• Guy's and St Thomas' NHS Foundation Trust
  – extending the Hospital at Night model of team working across the full 24 hours, separating acute care and planned care.
• East Sussex
  – an alternative model of care for patients attending accident and emergency departments in Hastings and Eastbourne that provides effective 24/7 care to the local population.
• Homerton University Hospital NHS Foundation Trust
  – an urgent care model proposing an increase in emergency management and assessment beds, new emergency care rotas and enhanced team working roles.
• Manchester Mental health and Social Care Trust
  – applying the principle of workforce redesign and Hospital at Night reconfiguration to an integrated mental health economy of three psychiatric hospitals linked to three acute trusts in the city.

Pilots received in the region of £300,000 each from the Workforce Projects Team. This was supplemented by an element of matched funding from the organisations. The 'Taking Care 24:7' pilots were the third group of WTD 2009 pilots following the awarding of four ‘cooperative solutions’ pilots in the previous January and nine ‘teamworking, handover and escalation’ pilots in July.

One of the key aims of the pilots work is to share learning from the lifespan of their project with the wider NHS so that other trusts can look at adopting models and ways of working which they developed. The projects ran between 18 months and 2 years and there was ongoing evaluation throughout.

“Work towards the 2004 working time directive target focused on new ways of working at night and led to the implementation of the successful Hospital at Night model,” says Sue Dean, director at the Workforce Projects Team and WTD lead, “The NHS now needs to look at the whole day to achieve the 48 hour target for 2009. The ‘Taking Care 24:7’ pilots will look at how care can be delivered in new ways across the day and will allow the successful trusts to look at new models of care that help them to reduce dependence on junior doctors whilst enhancing patient care.

“There are a good mix of pilots from major acute centres, whole health communities and mental health. These were imaginative solutions to achieving the 48 hour week based around the needs of their local communities and developing care with enhanced staffing roles. One of the key elements is that the ideas are sustainable and have an element of matched funding from the organisations involved and support from the senior management and clinical teams. We’re looking for new ways of working that will have long term benefits for staff and for patients.”

Nearly 40 bids for ‘Taking Care 24:7’ were received and shortlisted. An evaluation panel selected the successful five pilots following presentations from shortlisted trusts.