Minutes:
The Chairman welcomed those present to the meeting.
Ms Helen Delaitre, Lead for Unscheduled Care at NHS Hillingdon, advised that Harmoni had been contracted to provide the NHS 111 service in Hillingdon.
Mr David Penfold, Director of Operations for Harmoni, advised Members that research had shown that the public found it difficult to access NHS services when they developed unexpected health care needs. The introduction of new services such as Walk In Centres and Urgent Care Centres had added to the complexity of the unscheduled health care system which meant that many individuals were unclear about the services that were available to meet their needs and how these could be accessed (particularly outside normal working hours).
It was proposed that NHS 111 would not be a replacement for the NHS Direct service or the 999 service and that it would provide access to unscheduled non-urgent care. The service would be available 24 hours a day, 7 days a week, 365 days a year and would provide information about the services that were available at the time that the telephone call was made.
Members were advised that NHS 111 had already been piloted in County Durham and Darlington, Nottingham City, Lincolnshire and Luton and would now be rolled out in Hillingdon. A soft launch of the two year pilot in Hillingdon would take place on 25 October 2011 to ensure that any issues with the system were ironed out before the public launch in mid-November 2011. It was anticipated that the service would achieve pan-London coverage by 2013 but it was unclear whether it would ultimately be commissioned as a pan-London or local service.
A recent survey undertaken by Healthcare for London had identified that 88% of respondents would use the new service. In addition to this public support, NHS 111 was supported by professional bodies such as the British Medical Association (BMA) and the Royal College of General Practitioners (RCGP). Hillingdon LINk had also been involved with the Hillingdon 111 Project Team in the development of the Communications and Engagements Plan.
It was anticipated that the service, which was locally driven by GPs, PCTs, local authorities and other stakeholders, would make it easier for individuals to access unscheduled health care and would drive improvements in the way that the NHS delivered care. The service would also enable call handlers to direct patients to the right local service first time and would be used by patients when they:
- thought they needed Accident & Emergency (A&E) or urgent care;
- thought they couldn’t wait for a GP appointment; or
- didn’t know who to call for medical help.
The NHS 111 call handlers would receive two weeks intensive training and would be based in Southall so would have local knowledge – they would be based at the site of the existing out-of-hours call handling centre. However, Mr Penfold stressed that the handlers were not clinicians and that the service would assess the needs of a patient but not give a diagnosis.
It was anticipated that NHS 111 would reduce the number of non-emergency 999 calls, avoidable ambulance journeys and unnecessary hospital referrals. It would also improve access to unscheduled health care services by providing a simple, free to call, easy to remember three-digit number that was available all day, every day. Furthermore, the service would enable the commissioning of more effective healthcare services by:
- identifying those services that were under or over utilised;
- providing information about an individual’s needs and the services that they were directed to; and
- increasing the understanding of the demand for each service.
Mr Penfold explained that NHS 111 would be operated in conjunction with NHS Pathways and the London Directory of Services database (DoS). NHS Pathways was a clinical decision support tool (software) for triaging telephone calls from the public (based on the symptoms that they reported when they called) and had been in use elsewhere in the NHS for more than 4 years. A clinical assessment would be undertaken by the call handler which, as each call progressed, would give leads to a pre-determined level of care for the patient based on the information provided. Once the clinical assessment had been completed, an automatic search would be carried out using the web-based London DoS to locate an appropriate service in the patient’s local area that offered the specific clinical skills needed within the timeframe required.
Work was currently underway to populate the DoS database with information on the various health care services currently commissioned locally in the Borough.
It was anticipated that, as well as providing a more comprehensive and timely service to the public, NHS 111 had the potential to save millions of pounds. Future developments included:
- the potential for call handlers to make GP appointments for callers, which would increase the number of patients attending the surgery and reduce the number of hospital attendances;
- the creation of speed dial transfers so that callers who needed one of the emergency services could be immediately transferred to the correct service; and
- the London Ambulance Service using NHS 111 for triage following the Olympics in 2012.
Members were reassured that at the end of an assessment, if the caller was not happy with the outcome, they would be able to speak to a doctor or nurse (whichever was most appropriate). There would also be systems in place to identify repeat callers and, if the caller chose not to be anonymous, their GP would receive an automatic feedback message about the outcome of the call.
As this pilot service was directed at Hillingdon residents, callers from outside of the Borough would be advised that the service did not operate in their area.
It was noted that the Hillingdon 111 Project Team was working with NHS London to ensure that publicity for the service was produced centrally in a joined up way with the three other pilot London boroughs. This awareness raising campaign would include posters and would be done in consultation with the LINk and other stakeholders. Members were asked to contact Dr Johal with suggestions for publicity to raise awareness of the service locally.
Ms Linda Sanders, the Council’s Director of Social Care, Health and Housing, suggested that the pilot was arguably a missed opportunity to provide a whole system approach to health and social care. For example, it could have been useful for the call handlers to have been based at the Civic Centre which was open 24/7 and from where all out of hours LBH Housing were to be based, e.g., TelCareLine Repairs Management Services, out of hours Emergency Duty Team, Home Carers, etc. In the absence of co-location, Ms Sanders advised that work would need to be undertaken to ensure that there was a seamless out-of-hours service provided that included referral to these Council teams. Ms Delaitre advised that the incorporation of these local services into DoS could be included as the next step. Ms Sanders advised that it would be better for the DoS to only cover NHS provision as other directories existed and should not be duplicated.
Mr Penfold offered to attend a future External Services Scrutiny Committee meeting to update Members on NHS 111 following its launch in Hillingdon in November 2011. In the meantime, he advised that the Hillingdon 111 Project Team would continue to work closely with the Hillingdon LINk.
RESOLVED: That:
- the report be noted; and
- Ms Delaitre, Dr Johal and Mr Penfold be invited attend a future Committee meeting to give an update on NHS 111 following its launch in Hillingdon in November 2011.
Supporting documents:
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