If anyone thought the problems with the NHS 111 free telephone advice service – the coalition government’s idea for a cheaper NHS Direct – had all been solved, we now have evidence that they are simply being covered up with gobbledygook and pretty drawings of flowers and heart shapes.
The report on the last six month’s NHS 111 service for Wiltshire by the private provider Care UK is before Wiltshire Council’s Heath Select Committee tomorrow (September 22.) The government’s plan for NHS 111 was published in August 2010 and Wiltshire’s service is commissioned by the Wiltshire Clinical Commissioning Group.
The presentation reads as if it is based on spin, convenient comparisons and excuses. The table at the end gives the true picture – especially when it comes to the timely transfer of callers for clinical advice.
This shows that the NHS 111 service for Wiltshire is performing very badly indeed on this most important part of its service – the transfer of callers directly from the person who answers the ‘phone call (known as a ‘Health Advisor’) to a clinician for expert advice – if that is needed. This is supposed to be done in 98 per cent of cases without having to put the caller in a queue for a call back – in the jargon these are known as ‘warm transfers’.
The target is for 98 per cent of callers who need to speak to a clinician to be passed to one immediately. Between March and August 2015, the Care UK service for this county achieved between 31 and 45 per cent.
It was not much better at reaching the 95 per cent target for calling people back (when they could not speak immediately to a clinician) within ten minutes: over the six months monthly averages ranged between 25 and 48 per cent.
The presentation’s overall implication is that Care UK believe some of these targets are inconvenient and some not necessarily achievable.
A serious problem with this NHS 111 service is revealed as being recruitment of staff. Once again NHS planners have accepted from politicians a new scheme without making a proper audit of the available staff with appropriate skills at wage levels that fit the ‘business plan’: “Care UK NHS 111 has struggled to recruit clinical resource into the NHS 11 service for the past 12 months” – where ‘resource’ means ‘staff’.
Care UK say changes to their recruitment and advertising has increased ‘…clinical advisor applications from seven per month to seven per week’: “We are around 20 per cent above our forecast recruitment trajectory and hope to have over 75 per cent clinical establishment by November 2015 which is a huge improvement.” Can this really mean that by November they will still be short of 25 per cent of their full establishment of those vital clinical staff?
The report is, of course, mainly about ‘KPIs’ (key performance indicators) – known to many as targets. One of the most significant of these for the wider NHS is the number of patients/callers referred by NHS 111 staff to A&E (or hospital emergency departments – EDs.) This impacts directly on the A&E waiting time crisis that has been hitting hospitals across England.
The nationally set KPI is for less than five per cent of callers to be referred to A&E: “Although we often achieve this KPI at the weekend, the weekdays prove more difficult.” Care UK’s spin is that they are doing better than the national averages.
For the six months March-August 2015, Care UK’s monthly averages ranged between 5.5 per cent and 6.9 per cent of callers being referred to EDs. That 6.9 per cent equated to 3,608 patients being told to go to A&E or EDs. Here lies one root cause of the A&E waiting times crisis.
The basic KPI for ‘calls warm transferred to a clinician’ has been explained above. This report says care UK want to change this KPI to make it more ‘realistic and accurate’ – or easier to achieve?
“This KPI is a notoriously difficult KPI to achieve and has been for many providers since NHS 11 service inception. In the first week of September only one out of the 45 NHS 111 service providers in England met this KPI of 98 per cent.”
It must be especially hard to meet this KPI if you do not employ enough Clinical Advisors.
However, help is at hand. NHS England is planning an ‘Integrated Clinical Hub’ model. This “will see clinicians from different services come together to staff a clinical hub which will allow patients access to the right practitioner, faster.” We can only hope so.
This report show again that the NHS 111 model was faulty from the outset and in Wiltshire at least, they are still applying not just sticking plaster, but life support lines. It also shows that when writing reports which are available to and important to the public, providers can resort to a shroud of jargon.
The full Care UK report can be found here.
Queens and Minions entertain the crowds at Pewsey Carnival
