The Acting Chief Officer for West Midlands Integrated Urgent and Emergency Care Service introduced the item and drew Members attention to:
· The NHS 111 offer continues to be delivered by West Midlands Ambulance Service (WMAS) in Dudley. It has developed into a frontline patient service, with a number of clinicians to support the calls.
· It was noted that 999 and 111 call handlers within the West Midlands would soon be integrated seamlessly. This would enable 999 calls to benefit from the expertise of 111 clinicians and reduce ambulance conveyance.
· Since the COVID-19 pandemic, there had been increased demand on the service, as the public had been encouraged to use the 111 service. This had not significantly impacted on regional performance against KPIs. Other factors which increased demand included:
o The introduction of NHS 111 First in December 2020.
o Staff sickness and absence rates.
o National contingency support to other 111 providers in England.
The Integrated Emergency and Urgent Care Director, WMAS highlighted the following points to Members:
· WMAS took over as the NHS 111 provider for the Greater West Midlands region in November 2019. A considerable amount of work had been undertaken to improve the service. From March 2020, there were significant changes in the activity of the service and how users accessed the health service. This was unlikely to ease in the immediate future.
· There appeared to be less of a reliance to contact GP surgeries and instead residents would choose to contact NHS 111.
· They continued to try to reduce the number of people who unnecessarily contacted 999 or attended Emergency Departments. This was part of a shift to support patients in their own home, and for them to access the most appropriate local service.
· They aimed to completely integrate the 999 and 111 service into a single call queue. This would improve outcomes for patients as they would be able to seamlessly access alternative pathways when appropriate.
Members made comments and asked the following questions:
· A Member asked about which services NHS 111 users attended instead of Emergency Departments. The Integrated Emergency and Urgent Care Director confirmed that the information was available and this highlighted that patients would primarily be directed to Primary Care services, local pharmacies and other similar provision. In response, the Member sought clarity whether this created an additional burden on Primary Care services, and whether there was additional funding to support this. It was stated that the data would not support this, and less patients were sent through to their own GPs.
· A Member queried whether there was information to show that fewer people would attend Emergency Departments if they contacted NHS 111. The Integrated Emergency and Urgent Care Director explained there were not larger numbers of patients referred to Emergency Departments after they contacted NHS 111. They worked closely with partners to make sure referrals were followed up; as they were able to book appointments.
· A Member asked whether there had been any significant events as a result of residents who had contacted 111 instead of going to an Emergency Department, and if residents were still able to turn up to these sites to be treated without a booking. It was confirmed there had not been any events and they were able to turn up to these sites.
· A Member enquired what the longest time taken to answer a call was. The Integrated Emergency and Urgent Care Director explained that in the early stages of the pandemic there was activity which far exceeded predicted call volumes, as a direct result of the lockdown. A large number of these people were the “worried well”, who were people concerned about the implications of the lockdown. It was unlikely that this volume of activity would be replicated.
· A Member probed about the equality impact assessment in reference to the safe discharge measures, especially for those who were vulnerable, and what steps were in place to support these people. The Associate Director of Integration, Birmingham and Solihull CCG explained that there was an integrated discharge hub with health and social care partners to ensure that people were on the correct discharge process and were discharged safely. The Member also asked whether a consultation and monitoring plan mentioned in the equality impact assessment had been produced. The Associate Director of Integration confirmed this had been produced and could be shared.
· A Member asked how the triage process was assessed to ensure that the correct pathway for patients had been taken, and how this information was used. The Integrated Emergency and Urgent Care Director responded that they evaluated and audited call assessors and handlers. They aimed to stick to the same care pathway, but it was noted that there could be some exceptions, such as to prevent patients being sent to Emergency Departments unless absolutely necessary. Alongside this, they linked in with other areas to ensure that the outcomes for patients were effective.
· A Member requested further information whether if a patient contacted NHS 111 it would be included on their records. It was confirmed that the details would be passed through to their GP and attached to their records. Call handlers were able to access some patient information.
· A Member sought clarification about the geographical and demographics of the patients who accessed the service. The Acting Chief Officer confirmed there was performance and service level data which could be shared with the Board.
· A Member also enquired about whether this service acted as a displacement from a GP call and if this was funded by NHS England. The Acting Chief Officer confirmed that it was a national mandated service which had local considerations factored in and was consolidated by the Black Country CCG for the West Midlands. They also explained that there had not been displacement.
· A Member asked if it was clear to call handlers if the patient had dialled 999 or 111. The Integrated Emergency and Urgent Care Director reassured Members that the call takers were aware where the call stemmed from and would respond appropriately. Another Member queried whether that there could be detrimental outcomes if services were streamlined for those with communication difficulties. The Director explained there were a number of tools in place to support these patients, which included a triage system called NHS Pathways.
· A Member questioned whether this service would lead to increased demands on paramedics. The Integrated Emergency and Urgent Care Director highlighted that activity on both 999 and 111 continued to increase. This had not explicitly translated to increased demands on paramedics.
· A Member stated that there needed to be clinical excellence to support the integration of 111 and 999. The Integrated Emergency and Urgent Care Director responded that there had been significant developments in 111, which would make the service better and more accessible.
The Board NOTED the presentation.