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NHS Wales – Review of the 111 Pathfinder in Association with Janette Turner, University of Sheffield Final Report – November 2017

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NHS Wales – Review of the 111 Pathfinder in Association with Janette Turner, University of Sheffield Final Report – November 2017 NHS Wales – Review of the 111 Pathfinder In Association with Janette Turner, University of Sheffield Final Report – November 2017 THE POWER OF BEING UNDERSTOOD AUDIT | TAX | CONSULTING TABLE OF CONTENTS NHS WALES – REVIEW OF THE 111 PATHFINDER ................................................................................. 1 IN ASSOCIATION WITH JANETTE TURNER, UNIVERSITY OF SHEFFIELD .......................................... 1 FINAL REPORT – SEPTEMBER 2017 ........................................................................................................ 1 GLOSSARY OF TERMS .............................................................................................................................. 3 1 EXECUTIVE SUMMARY ................................................................................................................... 5 2 INTRODUCTION AND BACKGROUND ......................................................................................... 12 3 STRATEGIC CONTEXT .................................................................................................................. 20 4 LITERATURE REVIEW ................................................................................................................... 23 5 CONSULTATIONS .......................................................................................................................... 26 6 SURVEY RESULTS ......................................................................................................................... 31 7 ACTIVITY LEVEL ANALYSIS ......................................................................................................... 70 8 IMPACT OF THE 111 PATHFINDER .............................................................................................. 90 9 COMPARATIVE ANALYSIS ......................................................................................................... 111 10 CONCLUSIONS ............................................................................................................................. 121 This report has been prepared on the basis set out in our Project Initiation Document (“PID”) dated April 2016 and should be read in conjunction with this. This report is for the benefit of NHS Wales (“the CLIENT”) only and has been released to the CLIENT on the basis that it shall not be copied, referred to or disclosed, in whole or in part, to any third party, knowingly or, unknowingly without our prior written consent. Other than in the limited circumstances as set out in the PID, we have not verified the reliability or accuracy of any information obtained in the course of our work. This report is not suitable to be relied upon by any party wishing to acquire rights against RSM PACEC for any purpose or in any context. Any party that obtains access to this report or a copy (under the Freedom of Information Act 2000 or otherwise) and chooses to rely on this report (or any part of it) does so at their own risk. To the fullest extent permitted by law, RSM PACEC does not assume any responsibility and will not accept any responsibility in respect of this report to any party other than the original addressee. © 2017 RSM UK Group LLP, all rights reserved Glossary of Terms Table 0:1 Glossary of Terms Term Abandoned Call (111 Wales) A call where the caller hangs up after 60 seconds (in Wales) from being queued for a call advisor to answer. Adastra Clinical system being utilised by out-of-hours services across Wales Ambulance call A call to the ambulance service for an emergency response originating from the emergency number, requests from other health professionals (e.g. GPs, NHS Direct) or NHS 111. Ambulance incident All cases where an ambulance response is sent to and arrives at an incident scene. Auto-routed Calls routed from another service to 111 without the need for the caller to dial the number ‘111’. CAS Clinical Assessment Software operated by NHS Direct Wales Concentrator The technical ‘bridge’ linking CAS /Adastra and ensures that data flows across to the GPOOH service electronically. CSPT Call Streaming and Prioritisation Tool – system within which the 111 calls are assessed and prioritised by non registrant call takers DOS Directory of Services – system that provides information on local health, Local authority and third sector services ED Emergency Department GP OOH General practice out of hours service Minimum Data Set (MDS) Routinely collected information on the efficiency and effectiveness of the different service models MIU Minor Injury Unit NHS Pathways Delivers a single clinical assessment tool that can provide triage over the telephone in any setting taking calls from the public (only used in England) NHS 111 Programme Board Set up by Welsh Government to oversee the strategic development and implementation of a new telephone based service for accessing urgent care. Page | 3 Term Primary Care Centre A centre where patients who need to see a GP out of hours are directed to. Ofcom The independent regulator and competition authority for the UK communications industries. Soft launch A period of limited marketing and phased roll out across ABMU over a 3 week period with GP answerphone messages being changed to direct patients to 111 at the same time as the ‘old’ GPOOH service remained operational. SPA Single Point of Access – A telephone number that manages all requests for urgent health services UCC Urgent Care Centre (not available in Wales) WIC Walk in Centre (not available in Wales) Warm transfer A call transferred to a clinical advisor at the time of the call (without the need to call back) Page | 4 1 EXECUTIVE SUMMARY Context of the Review There have been a number of reviews and reports which have highlighted that the unscheduled care system in Wales is not resilient to unexpected and unusual surges in external demand, or demand shifted within it. This lack of resilience leads to increased attendance at ED units and increased waiting times at these units1. In response to these issue the NHS Wales Urgent and Unscheduled Care Programme Board has developed a wider strategy to transform urgent and unscheduled care services in Wales2. The overall aim of the strategy is to co-ordinate and manage unscheduled care demand in a different and organised way, to help meet the needs of patients within their own communities and possibly to slow the year on year increase (or, to slow the increase in demand) on hospital-based services. A key element of the strategy was the development and implementation of a free to call helpline that provides a single access point that is intended to help patients’ access urgent help when they need it; as well as improving access to health information and advice3. The 3-digit number (111) that is free-to-call from both landlines and mobile telephones can offer support and advice to callers 24 hours of the day, 7 days a week. The 111 service integrated the current telephony service provided by NHS Direct Wales with the front-end call handling and triage function used by GP Out-of-Hours (GPOOH) Services in the Abertawe Bro Morgannwg University Health Board (ABMU) area to provide a single service for patients to access if they need urgent help, or access to health information and advice. Welsh Ambulance Services NHS Trust are the host organisation. A technical bridge (a concentrator) was created to enable communication between the two clinical systems in use. The service is hosted by the Welsh Ambulance Service (WAST). NHS Wales established an Implementation Board to oversee the implementation of the pilot service which is known as the 111 Pathfinder and the work is supported by a national 111 programme team who have worked closely with WAST and ABMU Health Board. The new service is being piloted in the ABMUHealth Board area and was launched in October 2016. Patients in the six other Welsh Health Boards can continue to access health advice through NHS Direct Wales and have access to urgent care through their own Health Board based GP Out-of-Hours (GPOOH) services. In May 2017, the Carmarthenshire area (which is part of the Hywel Dda University Health Board) was brought into the 111 pathfinder. However, as this was outwith the evaluation window, no data on this service has been included in this report. A comprehensive set of standards were developed for the service which provided targets and parameters for how the service should operate, for example 95% of calls should be answered within 60 seconds of the end of the telephone message, 95% of urgent (priority one) calls should receive a call back within 20 minutes and 95% of routine (priority 2/3) calls should be clinically assessed within 2 and 4 hours respectively. Terms of Reference and Methodology RSM PACEC in collaboration with the University of Sheffield (Medical Care Research Centre Unit) were appointed to undertake a review of the NHS Wales 111 / Out of Hours Pathfinder Project. Specifically the terms of reference stated, that the evaluation should include: 1 E.g. see External Factors (‘Drivers’) Affecting Long-Term Trends and Recent ‘Pressures’ on Unscheduled Care Use and Performance in Wales. Public Health Wales, 2013. 2 The Way Ahead for Unscheduled Care in Wales. Unscheduled Care Improvement Board 2014. 3 The telephony element of the 111 service is hosted by WAST under the NHSDW element of the Trust, which currently uses a CAS telephony service. GPOOH in the ABMU area which provides the triage and clinical support element of the service uses ADASTRA to handle calls and record data. Page |
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