Trust HQ

Updated 6 September 2019

The provider, South Western Ambulance Service NHS Foundation Trust (SWASFT) provides four regulated activities: Treatment of Disease, Disorder or Injury; Diagnostic and Screening Procedures; Transport Services, Triage and Medical Advice provided remotely and Surgical procedures.

The ambulance service have two emergency (999) operation centres, in Exeter and Bristol and an NHS 111 operation centre in St Leonards, Dorset.

This report relates to the inspection of the NHS 111 services provided for the population of Dorset by SWASFT.

The South West Ambulance Trust Headquarters is located at:

Trust HQ, Abbey Court, Eagle Way, Sowton Industrial Estate, Exeter, Devon, EX2 7HY

The Trust operates the Dorset NHS 111 service from one main call centre location:

East Division Headquarters Acorn Building, Ringwood Road, St Leonards, Dorset, BH24 2RR.

Further clinician and quality support is available from the Exeter Trust Headquarters hub base and remotely.

The provision of the NHS 111 service is part of the Integrated Urgent Care Service provided by Dorset Healthcare and covers the county of Dorset. The area covered has a geographic area of 1024 square miles, a population of 422,900 and a high influx of visitors per year. There is one clinical commissioning group (CCG) who have a contract with the Trust for NHS 111 service. (NHS Dorset CCG)

SWASFT NHS 111 service operates 24 hours a day 365 days of the year. It is a telephone based service where patients are assessed, using computer based ‘NHS pathways’, given advice and directed to a local service that most appropriately meets their needs. For example, this could be a GP service (in or out of hours), walk-in centre or urgent care centre, community nurse, emergency dentist, emergency department, emergency ambulance, pharmacy or home management. In addition to the standard staffing mix for a 111 service, the service also employ clinicians including GPs, nurses and paramedics during the in hours period who gives additional clinical input to calls.

For this inspection we visited the East Division Headquarters Acorn Building, Ringwood Road, St Leonards, Dorset, BH24 2RR.

Updated 6 September 2019

This service is rated as Good overall. (Previous inspection May 2018 – Good)

The key questions are rated as:

Are services effective? – Requires Improvement

Are services well-led? – Good

We carried out an announced focused inspection of Trust HQ- South Western Ambulance Service NHS Foundation Trust (SWASFT) NHS 111 service on 23 and 24 July 2019 in response to concerns regarding performance and staffing. We looked at whether the service was providing effective and well led services.

At this inspection we found:

• Performance of the service and outcomes for patients was mixed. The provider has been open with commissioners, staff and regulators about the difficulties the service has faced, future plans and current measures to attempt to keep the service safe.

• The provider worked effectively and had systems of ongoing monitoring of the services. Efforts had been made to address gaps in services (including: ongoing staff recruitment, use of national contingency resources/plans, staff incentives, call audit performance).

• 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 people with compassion, kindness, dignity and respect.

• The service had 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.

• There were embedded systems in place in relation to learning from adverse incidents and significant events and joint working and sharing with external stakeholders, other providers and patient representatives (Duty of Candour).

• Continued positive feedback from patients about the care received.

• During our inspection we found sections of staff, notably advisors and first line managers to be highly dedicated and proud of the important work they were undertaking. However, they were also open and honest about the challenges they were facing on a daily basis. Staff were positive about the support received from direct line managers. Support from the senior management team was less embedded and needed improvement to improve working relationships.

• There was a continued and focused programme of recruitment.

• There was a focus on continuous learning and improvement at all levels of the organisation.

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

Ensure care and treatment, including call answering, call abandonment and clinical advisor call back rates, are delivered in a safe way for service users.

The areas where the provider should make improvements are:

• Continue with the planned programmes to improve staff engagement and disconnect between staff and leadership teams.

• Continue with the ongoing recruitment of staff.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care