Agenda item

To brief Well-being & Policy Development panel members on the introduction of the new NHS 111 Service to the Bath & North East Somerset area and to report on current performance.

Panel members may be aware from both local and national media reports that the introduction of the new 111 service has been problematic in B&NES and other parts of the country. The briefing paper explains what actions are being taken locally to improve performance.

Panel members are asked to note current performance and the actions agreed with Harmoni, the local provider of the 111 service to improve performance in line with both national and local service specification requirements.

Panel members may wish to request a further update on the progress of the local service in 3 months’ time as a separate stand-alone briefing item or as part of the Clinical Commissioning Group’s regular update on key matters of interest.

The Chairman invited Tracey Cox (CCG Chief Operating Officer), Dr Elizabeth Hersch (NHS 111 B&NES and Wiltshire Clinical Governance Lead) and Dr Russell Kelsey (Regional Medical Director – Harmoni) to give the presentation.

The following points were highlighted in the presentation:

·  Service Overview

·  Service Aims

·  Local Implementation – Timeline

·  Soft Launch – Key Issues

·  Intense Six Week Period of Rectification – Key Highlights

·  Current Performance

·  Patient Quality & Safety Processes

A full copy of the presentation is attached as Appendix 5 to these minutes.

The Panel made the following points:

Tracey Cox drew Panel’s attention to factual accuracy in the report.  At page 27, under paragraph 3.5.1, there were 5 serious incidents reported, across B&NES and Wiltshire, at the time this report was written.  Since that time there were further analysis on those 5 incidents, which are now downgraded to 1-2 serious incidents.

The Panel asked what the definition for serious incident is.

Dr Kelsey explained that serious incident in this context is a technical term that the National Patient Safety Agency developed.  There are series of criteria that apply to incident that occur when applied medical services are far and above the usual medical provision. 

The Chairman asked how come that serious incidents are downgraded from 5 to 1-2.

Dr Kelsey explained that when something goes wrong, it is then brought to the attention of commissioners or Harmoni with the intention to make an immediate assessment on whether there is a case of serious incident.  Sometimes it is obvious that there is service failure, which can lead to a patient’s death, but it is not always clear.  In this case, 4 out of 5 incidents did not fulfil any of national criteria that would normally be associated to serious incidents. 

The Panel asked about the significant service failure in the first three months.

Dr Kelsey replied that there were a number of assumptions made by Harmoni before the launch of the process.  Some of these assumptions were right though some others were wrong.  This was a very complex process that has never been done before on this scale in England.  There were a number of pilot sites which were done on a much smaller scale.  Harmoni thought they learned lessons through these pilot sites. When the implementation of services on a much larger scale started, the complexity of the staffing combined with the volume of calls was more than the Harmoni thought it would be.  Effectively, Harmoni was understaffed to deliver the service required.

The Chairman asked if the figures displayed in the presentation are Harmoni’s figures or from the CCG.

Dr Kelsey replied that the figures are produced from Harmoni’s computer system and presented to the Department of Health.  Harmoni’s IT systems are checked and there is no way for those figures to be manipulated.  There is an agreement with commissioners not to hide anything in this process.  The commissioners are allowed to share Harmoni’s raw data.

The Panel asked why is it that the service here is so much worse than in other areas.  Why is it that the Minister particularly singled out the South West as an area with very poor 111 services.  The Panel commented that when Harmoni did the trial they must have known, as highly paid professionals in this field that it was going to be very difficult to train people to use something so complex.  The fact that Harmoni didn’t realise that it would take a long time to train people to use it, even though they did a trial before the soft launch, seems to be an unacceptable failure.

Dr Kelsey agreed that the initial service was not acceptable.  South West 111 service was singled out because it was very poor when it was launched.  It was one of the worst launches in the UK.  Harmoni did not have the experience on such a large scale service.  It was the worst service though it is much better now though the performance is not as good as it should be. 

The Panel asked what the current view from the Wiltshire CCG is.

Tracey Cox replied that B&NES CCG works closely with the Wiltshire CCG and they are in similar position in terms of their concerns for commencement of the service.

The Panel said that the official from the Department of Health commented that this was a commissioner and provider failure.

Dr Hersch responded as a local commissioner the CCG went through all Department of Health gateways though there are still a lot of lessons to learn.

The Panel noted that one of the points in the six week period of rectification was that Harmoni committed more management resources to the Bristol Call Centre and asked what led to the decision to have more managers.

Dr Kelsey replied that it meant more supervision in the call centre for the health advisors and an improved management for the workforce on the floor.

The Panel asked how the call to 111 services is put through – is it held in the queue or dealt with in some other ways.

Dr Kelsey responded that the caller would get an answer to wait, in case the service is busy.  That is the national specification – standard message that says ‘You are in the queue’.  Dr Kelsey said that at this stage people are not told how many other people are in the queue before them and how long they are likely to wait before their call is answered.  This question was raised and the Harmoni are happy to change their telephony system to use this facility.  Harmoni contacted the Department of Health if they would be happy for the Harmoni to change their telephony system but they haven’t given that permission yet.

The Panel asked if the Harmoni would offer an apology to the Panel Members, as representatives of the residents who suffered under the introduction of the 111 scheme.  The Panel felt that it is important that the residents understand that Harmoni is sorry for what had happened.

Dr Kelsey, on behalf of Harmoni, gave sincere apology to anyone, whether individual or family, who experienced distress and difficulties in getting through the 111 service.  Harmoni acknowledged they made mistakes that had an effect on people.

The Panel said that they acknowledged that both commissioners and providers are working on service improvement and asked for a further report/update for the September meeting of the Panel.  The Panel also commented that residents are asked too many questions once they got through to health advisor.  The Panel felt that Harmoni should monitor what the average summation of the call is.  Some Members of the Panel said that boat dwellers and travellers have great difficulty accessing services and felt that people who are not in standard housing should be treated like the rest.

Dr Kelsey replied that the average handling time per caller is 8 minutes.  Initially it was much longer, around 20 minutes, but that was when the service was new.  There is a process of what questions have to be asked during the call in order to assure non-clinical staff that person is safe and also for the staff to understand what is going on.

The Panel asked about the NHS Pathways system.

Dr Kelsey responded that the NHS Pathways is a system of clinical content assessment for triaging telephone calls from the public, based on the symptoms they report when they call.  The system is used by non-clinical staff.  It has been used for 3-4 years and very well tested.  It also has an integrated directory of services, which identifies appropriate services for the patient’s care if an ambulance is not required.

The Chairman noted that the Harmoni is now in extended soft launch period of the 111 services which is now 3 months behind the schedule from the proper launch date.  The Chairman read out from the report that Harmoni is commissioned for 5 years and asked when the 5 year period starts.  The Chairman also asked if the current provision is at the cost of Harmoni.

Dr Kelsey responded that he is not familiar with financial details though, as far as he is aware, services are provided at Harmoni’s cost at the moment.

The Chairman thanked everyone who participated in this debate.

It was RESOLVED that:

1)  The Panel noted the current performance and the actions agreed with Harmoni to improve performance in line with both national and local service specification requirements;

2)  The Panel are disappointed in the poor quality of the 111 service in the first three months;

3)  The Panel appreciated the apology from Dr Russell Kelsey, on behalf of Harmoni, to anyone, whether individual or family, who experienced distress and difficulties in getting through the 111 service; and

4)  The Panel requested a further update on the progress of the local services for September 2013 meeting as a separate stand-alone item.