Ambulance Service Also known as NHS 111 Service

Updated 4 September 2019

The Isle of Wight NHS Trust provides the NHS 111 service which covers the whole of the Isle of Wight. It is contracted by the NHS Isle of Wight clinical commissioning group. The NHS 111 service operates 24 hours a day, 365 days a year. The population of the Isle of Wight is estimated to be 140,000, rising to 200,000 during its peak tourist period.

The NHS 111 service is a telephone-based service where people are assessed, given advice and directed to a local service that most appropriately meets their needs. This is achieved by staff, following an initial triage, using the NHS Pathways. (NHS Pathways are a set of clinical assessment questions to manage telephone calls from patients). Patients are signposted to the most appropriate professional using a directory of services that includes all services provided on the Isle of Wight as well as nationally. In 2018, approximately 86,000 calls were received. This was a 12% increase from 2017.

The service is registered with the Care Quality Commission (CQC) to deliver the following regulated activities:

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

Demographically, the average annual incomes on the Isle of Wight are below the national levels and the majority of the Isle of Wight is rural. There is a high percentage of children living in poverty and one in four people are aged 65 years or over.

Further information can be found on the provider’s website at: www.iow.nhs.uk

We visited the only location of the service for the inspection, which is based at:

Ambulance Service

St Mary’s Hospital,

Parkhurst Road,

Newport,

Isle of Wight,

PO30 5TG.

Updated 4 September 2019

This service is rated as Good overall but Requires Improvement for providing effective services.

The previous inspection of this service was completed in January 2018 and the service was rated Requires Improvement overall, with Well-Led rated as Inadequate. We issued two requirement notices for Regulation 17: Good Governance and Regulation 18: Staffing.

At this inspection the key questions are rated as:

Are services safe? – Good

Are services effective? – Requires Improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

We carried out an announced comprehensive inspection of the NHS 111 service provided by the Isle of Wight NHS Trust on 14 and 15 May 2019. This inspection included a review and follow up on breaches of regulations.

We based our judgement of the quality of care at this service on a combination of:

• What we found when we inspected
• Information from our ongoing monitoring of data about the service
• Information from the provider, patients, the public and other organisations

At this inspection we found:

• Positive steps had been taken to address the previously identified issues. For example, training for staff including safeguarding and the Mental Capacity Act 2005 had been completed by all available staff at the service.
• Previous interim managers were now in formally recognised substantive roles and staff reported they were more aware of the management structure including senior managers. We saw evidence of a ‘who’s who’ diagram for the NHS 111 service’s management structure on the wall of the call centre. Staff reported there was a greater management presence and they felt more supported by the management team including team leaders.
• Appraisals for all available staff at the service had been completed within the previous 12 months and the service had a new system to ensure appraisals were completed in a timely way.
• Callers received a safer, more effective and responsive service than they had previously. However, patients were at risk of potential harm as the service’s call answering performance data was below national targets.
• Additional performance support officers (PSOs) had been recruited so the NHS 111 service, they now provided 24-hour management cover. Staff were positive about this change.
• There was an improved focus on staff well-being and staff achievements were widely celebrated within the service.
• Facilities in the call centre hub had improved and staff had access to ergonomic chairs at their work stations.
• 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.
• The service had good systems to manage risk so that safety incidents were less likely to happen. When they did happen, the service learned from them and improved their processes.
• Staff treated people with compassion, kindness, dignity and respect.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

Whilst we identified no breaches of the regulations, there are areas where the provider should make improvements:

• Continue to review call performance data to ensure national targets are being consistently achieved.

• Continue to proactively monitor call demand to ensure staffing levels are appropriate.

• Review how the service identifies significant or learning events that occur in the service.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care