The Care Quality Commission
  • Ambulance service

Ambulance Service Also known as NHS 111 Service

Overall: Good read more about inspection ratings

St Mary's Hospital, Parkhurst Road, Newport, Isle of Wight, PO30 5TG (01983) 534111

Provided and run by:
Isle of Wight NHS Trust

Important: This service was previously managed by a different provider - see old profile

All Inspections

Other CQC inspections of services

Community & mental health inspection reports for Ambulance Service can be found at Isle of Wight NHS Trust. Each report covers findings for one service across multiple locations
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14 May to 15 May 2019

During a routine inspection

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

24 and 25 January 2018

During a routine inspection

This service is rated as requires improvement overall. (Previous inspection March 2017 – Good)

The key questions are rated as:

Are services safe? – requires improvement

Are services effective? – requires improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – inadequate

We inspected this service as part of our inspection programme. We planned to carry out a focused inspection, however during the site visit we changed this inspection to a full comprehensive inspection due to concerns identified.

We carried out an inspection of this service under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

At this inspection we found:

  • 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.

  • Records for the ambulance service clinical business unit showed that there were shortfalls in meeting the training targets set by the Trust for safeguarding and the Mental Capacity Act 2005.

  • Leaning needs of staff were usually identified through a system of appraisals, meetings and reviews of service development needs. At the time of inspection 49% of appraisals for all staff who worked in the hub had been completed.

  • There were shortfalls in facilities and premises for the services delivered. Staff reported that there were broken chairs and the layout of the room was poor; IT systems were slow; and the air conditioning units were not clean.

  • 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.

  • Performance support officers (PSO) reported that they had to cover shifts instead of being able to concentrate on their substantive role which aimed at ensuring a safe service was provided. This left the service response weakened in the event of a significant incident.

  • There was limited resilience for sickness absence and planned annual leave.

  • A report had been produced which highlight constraints on staffing levels and the service operating with minimal staffing levels, which did not allow sufficient resilience and had contributed to staff working excessive hours in a week.

  • The resource team allocated hours over a monthly period, but did not take account of actual hours planned for in a week.

  • The secondment of performance support officers did not enable effective oversight of the NHS 111 service on a daily basis.

  • PSOs were expected to ensure the hospital switchboard was covered; on occasion this led to only minimum levels of call handlers and decreased resilience for unexpected demand.

  • Suitable rest breaks were not planned for in line with health and safety guidelines.

  • The NHS 111 Service did not have any PSOs on site between the hours of midnight and 8am in the morning; cover between these times was provided by an on-call PSO. Current staffing levels meant that no PSO support was provided on site at weekends until 1pm until midnight on Saturdays and Sundays.

  • The NHS 111 service did not consistently meet expected targets on calls handling and response times. There was limited action taken to improve performance.

  • Action was taken to minimise the number of calls that were abandoned by the caller. The average figure for the year was 3.73% of call abandoned. Average figures over the preceding three months prior to the inspection showed that call abandonment rates were consistently within the target of less than 5%, with the averages ranging from 2.12% to 4.81%.

  • Staff involved and treated people with compassion, kindness, dignity and respect.

  • Patients were able to access care and treatment from the service within an appropriate timescale for their needs.

  • Staff reported that more senior managers, not involved directly with the daily management of the NHS 111 service were not always visible. They were not confident these managers were aware of risks to the service provided, such as concerns around the resourcing system for planning shifts.

  • Systems for capturing patient views on the service provided, had not been actioned.

  • Staff surveys were completed, but there was limited evidence to show that concerns were being acted upon and resolved.

  • Responses to whether staff considered they were well supported had worsened.

  • Service performance was discussed at senior management and board level but limited action was taken to improve achievement against national targets.

  • Delays in clarifying leader’s roles and responsibilities had led to staff not feeling appropriately supported.

The areas where the provider must make improvements as they are in breach of regulations are:

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

  • Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment.

  • Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

7 and 8 March 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection of the NHS 111 service operated by Isle of Wight NHS Trust on 7 and 8 March 2017. Overall the service is rated as good.

The NHS 111 service is a telephone-based service where patients are assessed, given advice and directed to a local service that most appropriately meets their needs. For example that could be an out-of-hours GP service, walk-in centre or urgent care centre, community nurse, emergency dentist, emergency department, emergency ambulance or late opening chemist. The NHS 111 Service is part of the Ambulance Service of the Isle of Wight NHS Trust. There are operational managers responsible for the day to day running of the service and the overarching governance of the service provision is carried out by the Trust Board.

Our key findings were as follows:

  • There were systems and processes in place to identify, manage and mitigate risks.
  • The NHS 111 service was monitored against the National Minimum Data Set for NHS 111 services and adapted National Quality Requirements. Performance against indicators was above or aligned with national targets, with the exception of calls answered within 60 seconds which had varied in the last 7 months to just below the target of 95%. We were told however that month to date the figure was 96.15%
  • The NHS 111 service was in the process of recruiting additional call handlers to improve their performance in answering calls within 60 seconds.
  • Callers received a safe, effective and responsive service. Call handlers were trained to respond to both 111 and 999 calls and were able to use these skills to provide positive outcomes for patients.
  • Caller’s needs were assessed in a timely manner and received clinician call backs when needed.
  • Adjustments had been made to the referral processes to other health and social care providers to enable speedier access. Examples we saw included information on voluntary groups who may be able to offer assistance, in addition to medical help. Also, callers with wheelchair maintenance issues were able to be patched straight through to the maintenance company for speedy and relevant help. This was useful when a caller had broken down in electric wheelchair and needed immediate help but not medical help.
  • The NHS 111 service worked closely with the clinical commissioning group who commissioned the service.
  • Opportunities for learning from internal and external incidents were identified and discussed to support improvement and safety. This included the introduction of a quick reference sepsis guide.
  • Staff took action to safeguard patient and were aware of the processes to make safeguarding referrals. Systems and processes were in place to safeguard both adults and children at risk of harm or abuse, including frequent callers to the service.
  • Staff were trained to ensure they used the NHS pathways safely and effectively. (NHS Pathways is a Department of Health approved computer based operating system that provides a range of clinical assessments for triaging telephone calls from patients based on the symptoms that report when they call).
  • Calls were regularly audited to meet the NHS Pathways licence and to allow the service to identify areas of development and learning.
  • Staff were supported to receive appropriate training, supervision and appraisals.
  • Callers using the service were supported effectively during the telephone assessment process. Consent to the assessment was sought and individual’s decisions were respected.
  • The NHS 111 service responded to complaints and to caller feedback when raised and responded to staff feedback.
  • There were systems and processes in place for governance of service provision, which included a range of performance reports; meetings at all staff levels; analysis of risks and monitoring of mitigating actions taken.
  • During our inspection we found all staff to be dedicated and proud of the important work they were undertaking and they worked cohesively as a team.

The provider should:

  • Review arrangements to ensure there is effective leadership for safeguarding patients and recognise that a new member of staff is in the lead role and is appropriately supported.
  • Continue to seek ways to gather patient feedback on service provision.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

17 and 18 March 2015

During a routine inspection

We carried out this inspection as part of the development of our approach to inspecting NHS 111 services. Therefore we have not rated the service. We carried out an announced inspection from 4pm to 10.30pm on 17 March 2015 and 11am to 1pm on 18 March 2015.

NHS 111 is a telephone-based service where patients are assessed, given advice and directed to a local service that most appropriately meets their needs. For example that could be an out-of-hours GP service, walk-in centre or urgent care centre, community nurse, emergency dentist, emergency department, emergency ambulance or late opening chemist.

NHS 111 services are usually area specific, but on occasion will take calls from all parts of England.

Our key findings were:

  • The service had suitable systems in place to monitor safety over time, which included learning from incidents and complaints.
  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents.
  • Patients were assessed treated in line with best practice and current national guidance using the latest version of NHS Pathways.
  • Training on use of the NHS Pathways was comprehensive and systems were in place to mentor new staff members until they were competent in its use.
  • Patients were treated with compassion and respect and their privacy was maintained.
  • Patients were involved in care and treatment decisions.
  • The service worked with the clinical commissioning group and health and social care providers to respond to and meet patients’ needs.
  • The directory of services was well maintained and kept up to date by a designated member of staff.
  • The vision and values of the service had been communicated well to all staff members.
  • There were effective day to day working arrangements within the service, with staff having clear roles and responsibilities.

There were areas where the provider could make improvements and should:

  • Consider developing a report which reflects overarching governance of the service provided.
  • Consider informing patients when their calls are being listened to for training purposes.