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Evaluation of NHS 111 Pilot Sites Final Report

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Evaluation of NHS 111 Pilot Sites Final Report Evaluation of NHS 111 pilot sites Final Report Janette Turner Alicia O’Cathain Emma Knowles Jon Nicholl Jon Tosh Fiona Sampson Patricia Coleman Joanne Coster August 2012 Contents Page Acknowledgements 5 Glossary of terms 6 Executive summary 7 1. Introduction 13 1.1 Policy background to the development of NHS 111 13 1.2 NHS 111 service development 14 1.3 NHS 111 service evaluation 14 2. Evaluation aims and design 15 2.1 Aims and objectives 15 2.2 Evaluation design 15 2.3 Study sites 18 2.4 Ethics 19 3. Evidence base 20 3.1 Introduction 20 3.2 Methods and findings 21 3.3 Results 22 3.4 Discussion 30 4. NHS 111 service models and implementation 32 4.1 Introduction and methods 32 4.2 Core service principles 32 4.3 NHS 111 operational framework 33 4.4 Pilot site service descriptions 35 4.5 Implementation activities 36 4.6 Early implementation lessons learnt from the four pilot sites 40 5. How NHS 111 was used 42 5.1 Introduction 42 5.2 Methods 42 5.3 Results 43 5.4 Discussion 56 6. Users’ views of NHS 111 58 6.1 Introduction 58 6.2 Methods 58 6.3 Results 60 6.4 Discussion 79 7. Impact on perceptions of the urgent care system 80 7.1 Introduction 80 Evaluation of NHS 111 pilot sites – Final Report Page 2 7.2 Methods 80 7.3 Results 82 7.4 Discussion 87 8. Impact of NHS 111 on the emergency and urgent care system 88 8.1 Introduction 88 8.2 Methods 88 8.3 Results 91 8.3.1 Durham & Darlington 92 8.3.2 Nottingham City 100 8.3.3 Luton 108 8.3.4 Lincolnshire 116 8.3.5 Summary of findings for individual sites 126 8.3.6 Consideration of overall demand for system 126 8.3.7 Combined analysis for all pilots 131 8.3.8 ‘dose’ of NHS 111 in system 131 8.4 Discussion 132 9. Preliminary exploration of achievement of ‘right place, first time’ 134 9.1 Introduction 134 9.2 Methods 134 9.3 Results 137 9.4 Discussion 142 10. The implementation of NHS 111 within local health economies 144 10.1 Introduction 144 10.2 Methods 144 10.3 Results 145 10.4 Discussion 156 11. Awareness, use and equity 159 11.1 Introduction 159 11.2 Methods 159 11.3 Results 159 11.4 Discussion 163 12. Economic evaluation 165 12.1 Introduction 165 12.2 Methods 165 12.3 Results – observational analysis 167 12.4 Results – implementation analysis 175 12.5 Discussion 179 13. Comparison of models 182 13.1 Introduction 182 Evaluation of NHS 111 pilot sites – Final Report Page 3 13.2 Results 182 13.3 Discussion 185 14. Discussion and conclusions 186 14.1 Summary of main findings 186 14.2 Has NHS 111 achieved the expected benefits? 187 14.3 Wider considerations 189 14.4 Strengths and limitations 193 14.5 Key messages 194 14.6 Future research 195 References 196 Appendices Appendix A - Pathways reported by NHS 111 users (Chapter 6) 201 Appendix B – Population survey findings (Chapter 7) 203 Appendix C – Expert panel review criteria (Chapter 9) 209 Evaluation of NHS 111 pilot sites – Final Report Page 4 Declarations of interest Professor Alicia O’Cathain and Professor Jon Nicholl are co-applicants on an NIHR Applied Research Programme led by Professor Chris Salisbury on behalf of NHS Direct: the Healthlines study. The focus of this project is the evaluation of NHS Direct delivering telehealth interventions for long term conditions. NHS Direct staff are part of this research team. In June 2012 a family member of Professor Alicia O’Cathain won a contract to offer patient feedback for NHS 111 sites in London. Dr Claire Ginn obtained the routine data for the impact analysis and analysed it according to instructions by Professor Jon Nicholl. Dr Ginn works for the Department of Health Commissioning Analysis and Intelligence Team. Acknowledgements We would like to thank: Professor Simon Dixon for advice about the economic analysis. Neil Shephard for statistical help with the system impact analysis. Staff at NHS Direct (Trish Buckley, Annette Knipe, and Janet Cooke), and the North East Ambulance Service NHS Trust (George Marley, Sally McClure, Sonia Byers and Michelle Taylor) for their assistance in the administration of the user survey. The members of the expert panel who assessed calls. Funding This is an independent report commissioned and funded by the Policy Research Programme in the Department of Health. The views expressed are not necessarily those of the Department. Evaluation of NHS 111 pilot sites – Final Report Page 5 Glossary of terms Abandoned Call (NHS 111) A cal where the caller hangs up after 30 seconds from being queued for a call advisor to answer. 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 NHS 111 without the need for the caller to dial the number ‘111’. Capacity Management System (CMS) Operates in real time, taking account of what is available and current activity. This enables a call for urgent care to be automatically matched to a service with the right skills, location and within the required timeframe at the time of the call. Where adequate technical links can be set up, appointments or other contacts can be made by the call adviser at the time of the call. Directory of Services (DoS) Populated locally and jointly by service commissioners and provider services. The available skills of each provider are specified, as are service operation guidance such as location, referral protocols and opening times. 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 NHS 111 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. NHS 111 Programme Board Set up by DH to oversee the strategic development and implementation of a new telephone based service for accessing urgent care. Ofcom The independent regulator and competition authority for the UK communications industries. Public launch Service became fully operational Soft launch Lasted for up to one month prior to the public launch and involved only taking calls that were routed from an existing number such as an out of hours service. During this time the service was not advertised to the public and so there were no direct dial 111 calls. SPA Single Point of Access – A telephone number that manages all requests for urgent health services UCC Urgent Care Centre WIC Walk in Centre Warm transfer A call transferred to a clinical advisor at the time of the call (without the need to call back) Evaluation of NHS 111 pilot sites – Final Report Page 6 Executive Summary Introduction This is the final report of the evaluation of NHS 111, a new telephone based service designed to help people access appropriate healthcare for urgent medical problems. NHS 111 was developed in response to a review of urgent care that highlighted problems the public encounter when trying to access urgent care. The objectives of the NHS 111 service were to simplify access to non-emergency health care by providing a memorable number – 111 – that was free to the caller, provide consistent clinical assessment at the first point of contact, and route customers to the right NHS service, first time. The service is available 24 hours a day, 365 days a year to respond to requests for healthcare where the situation is not life-threatening and callers are unsure about what service they need, or they need to access care out of hours. The expected benefits of the new service are that it should improve the user experience by providing a modern entry point to the NHS and easy access to more integrated services; and improve efficiency in the emergency and urgent care system by matching patient needs to the right service. The purpose of the evaluation was to assess the extent to which this new service achieved its objectives and was a useful and cost effective addition to the emergency and urgent care system in England. The NHS 111 service We evaluated the first year of operation of NHS 111 in four pilot sites. The key features of the service are: • Calls to NHS 111 are assessed by a trained, non-clinical call adviser using the NHS Pathways clinical assessment system to determine both the type of service needed and the timescale within which help is required. • The call handling system is electronically linked to a skills based directory of local services so that callers can be advised about the appropriate services available at the time of their call. • Where possible, appointments can be made with the correct service at the time of the call. • Calls that require further clinical assessment can be transferred to a clinical nurse advisor within the same call. • If a call requires an emergency ambulance response, a vehicle can be dispatched without the need for further triage. Evaluation methods We conducted a mixed methods study assessing processes, outcomes and costs to address a range of objectives. We used a controlled before and after design to measure the impact of NHS 111, comparing changes over time in the four pilot sites and three control sites which did not establish NHS 111.
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