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CQC tells Trust to improve safety of 111 service

Insufficient and undertrained staff are caring, but struggling to maintain patient safety

Louise Prime

Thursday, 16 June 2016

The Care Quality Commission has told the South Western Ambulance Service NHS Foundation Trust that its NHS 111 service is ‘Inadequate’ overall – although it rated it ‘Good’ for caring – and it must make significant improvements to improve its users’ safety. It said the trust must address its staffing problems, review call handlers’ roles and responsibilities, and monitor call queues and callback times.

The CQC rated the trust, which covers Dorset, Devon, Cornwall and the Isles of Scilly, as Inadequate for safety, effectiveness, responsiveness and being well led. It is currently inspecting all NHS 111 services, but this inspection was brought forward after patients and current and former members of staff raised concerns.

In today’s report of its inspections on 8th, 9th and 12th March, the CQC pointed out that patients using the service were dealt with in a calm, patient and professional manner. Staff listened carefully to what was being said, checked information when necessary and were supportive and reassuring when responding to people calling in distress.

However, inspectors said staff working for the service worked long hours, and often felt highly stressed and fatigued; staff turnover and sickness rates were both high. It said there were often too few staff to take calls or to give clinical advice when it was needed. As a result, too many patients abandoned calls, or waited too long for calls to be answered initially and for urgent callbacks with appropriate advice. Sometimes, patients were answered by staff not trained to assess their symptoms, which meant there was a risk that those who needed urgent attention were not prioritised, or were put in a long queue waiting for a callback.

Inspectors also saw calls being answered but then being placed on hold, so although the initial 60-second target was met, patients were not spoken with immediately to assess their clinical needs.
The CQC has issued a warning notice to the trust, requiring it to make significant improvements by 8 July including ensuring that calls are responded to in a timely and effective manner, with enough suitably qualified staff on duty who are supported to deal with the volume of calls. It also told the trust to:

  • continue to review staff numbers to ensure patients can access timely care and treatment when first calling the service and when receiving a call back
  • review the roles and responsibilities of Non Pathway Advisors (call handlers not trained to use the NHS Pathways triaging system) ensuring that callers consistently receive the correct level of advice
  • ensure that the call queues awaiting initial assessment and callback are robustly monitored and managed by staff with clinical authority to intervene and allocate resources.

The CQC’s chief inspector of hospitals Professor Sir Mike Richards said: “If patients needing help can’t get a reply, if they are dealt with by someone who doesn’t understand their immediate needs, or if they have to wait too long for a nurse or paramedic to call them back for an assessment before they are referred to the out-of-hours GP, it can have potentially serious consequences.”

He went on: “Despite the best efforts of staff – the service was not doing enough to identify why this was happening or what needed to be done to improve. The trust had known of these concerns but it took the staff to bring them out into the open to ensure that something was done.”

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