Hertfordshire IUC Service and HUC HQ

Updated 20 December 2023

Hertfordshire IUC Service and HUC HQ is a registered location and provides three specific services to Hertfordshire and West Essex, the area covered by and commissioned by Hertfordshire and West Essex integrated care board (ICB). The service provides a 111 service, a clinical assessment service (CAS), and an out of hours service that includes 9 hubs where patients are seen and a home visiting service

The main hub for all of the services is The Old Ambulance Station, Ascots Lane, Welwyn Garden City, AL7 4HL. All office-based staff in the 111 service are located at this location. The service provides a Pathways-led triage system with input from the CAS as required. The service refers patients to a variety of services in the local area, including Urgent Treatment Centres (UTCs), out of hours services, and referral back to a patient’s own GP service.

The service is a 24/7, 365 days per year service for patients to call so they may be redirected to the most appropriate service.

The service employs health advisors (who take the initial calls), service and clinical advisors, clinical and non-clinical floor walkers (who co-ordinate the service) and a number of other management and administrative staff. Some staff at the service are home workers. The CAS is made up of both home workers and office-based staff, who are healthcare practitioners. The CAS is a clinician led service which reviews Pathways dispositions, provides telephone consultations and advice to patients, and refers them to other services where necessary.

The out of hours service provides consultation services at 9 hubs and a home visiting service from 6:30pm until 8am on weekdays, and 24 hours a day at weekends and on bank holidays. The main address hosts dispatching for the service and management of all equipment and medicines used by the service. There is also a home visiting car service on site. At the time of the inspections, patients could also see a GP, registrar, or nurse at the following nine hubs, some of which also hosted home visiting services:

• Lister Hospital, Coreys Mill Lane, Stevenage, Hertfordshire, SG1 4AB
• QEII Hospital, Howlands, Welwyn Garden City, Hertfordshire, AL7 4HQ
• Hertford County Hospital, North Road, Hertford, Hertfordshire, SG14 1LP
• The Grove Medical Centre, Unit 7A Borehamwood Shopping Park, Borehamwood, WD6 4PR
• St Albans Hospital, Waverley Road, St Albans, Hertfordshire, AL3 5PN
• Hemel Hempstead Hospital, Hillfield Road, Hemel Hempstead, Hertfordshire, HP2 4AD
• Bridgewater Surgeries, 7 Printers Avenue, Watford, WD18 7QR
• Lister Medical Centre, Lister House, Abercrombie Way, Harlow, CM18 6YJ
• Dunmow Clinic, 58 New Street, Great Dunmow, Dunmow, Essex, CM6 1BH

The services are delivered by Herts Urgent Care Limited (HUC). HUC currently provides a number of other 111 and other urgent and emergency care services in the East Midlands, East, and South East of England.

CQC registered the provider to carry out the following regulated services at the service:

• Diagnostic and screening procedures
• Maternity and midwifery services
• Treatment of disease, disorder or injury
• Transport services, triage and medical advice provided remotely.

Updated 20 December 2023

This service is rated as Good overall.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

We carried out an announced comprehensive inspection of Hertfordshire IUC Service and HUC HQ on 20 and 21 November 2023. The service had previously been inspected in November 2015 where it had been rated as good overall, and in all five key questions.

The registered manager is the head of the 111 service. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Our key findings were:

• The service had clear systems to manage risk so safety incidents were less likely to happen. When incidents did happen, the service learned from them and improved their processes.
• The service routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the service easy to use and reported they were able to access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

We saw two areas of outstanding practice:

• The service had implemented a “graduate bay”, where new starters who had completed training were supported into work. Prior to beginning training, new staff could listen into calls to familiarise themselves with work they would be undertaking. On completion of training, an experienced health advisor would sit with the new starters to ensure they could assist with any queries raised by patients, and ensure new staff knew at what stage to involve clinical support. Staff who had been through the graduate bay programme told us that it was a supported introduction to work, and felt that it was positive.
• The service required that training in Pathways (software utilised by health advisors to determine the best clinical pathway for a patient) was extended over and above that required by the Pathways licence. Managers told us that this was to ensure health advisors were confident in how and when to involve clinical input. Staff told us that this led to greater reassurance, and helped them in their role.

The area where the service should make improvements is:

• The service should look to review and improve its performance targets against key performance indicators (KPIs).

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Health Care