This service is rated as Good overall. The previous inspection of this service was completed in December 2016 and was rated Requires Improvement overall. (Safe- Good, Effective- Requires Improvement, Caring- Good, Responsive- Good and Well led- Requires Improvement)

At this inspection the key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

We carried out an announced focused inspection at South Western Ambulance Service NHS Foundation Trust (SWASFT) 111 on Wednesday 2 May 2018 to follow up on breaches of regulations in the Effective and Well led domains.

At this inspection we found:

• A clear management structure was in place with proactive engagement and involvement of front line staff to influence and participate in improvements and change.

• Continued positive feedback from patients.

• A continued low number of complaints and no outstanding adverse incident reports.

• An improved and a sustained improving trend of key metrics to demonstrate patients were accessing and receiving timely care and treatment.

• Evidence of appropriate support, auditing and monitoring of staff to demonstrate they had the necessary skills and knowledge to undertake their roles.

• A continued implementation of staff recruitment and induction

• An investment in equipment used at the hub; IT equipment had been replaced and repaired.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out a comprehensive follow up inspection of the NHS 111 service provided by South Western Ambulance Service NHS Foundation Trust (SWASFT) on 7, 8 and 20 December 2016. Overall following the December 2016 inspection, SWASFT NHS 111 service is rated as requires improvement.

The SWASFT NHS 111 service had previously been inspected in March 2016 and August 2016. The full reports for these inspections can be seen on our website www.cqc.org.uk

SWASFT NHS 111 service provides a telephone service to a diverse population for Dorset and Cornwall.

NHS 111 is a telephone-based service where callers are assessed, given advice and directed to a local service that most appropriately meets their needs. For example, this could be a GP service (in or out of hours), walk-in centre or urgent care centre, community nurse, emergency dentist, emergency department, emergency ambulance, pharmacy or home management

At the March 2016 inspection, the service was rated as inadequate overall. The main issues identified at the inspection included insufficient numbers of staff and NHS 111 calls were not responded to in a timely and effective manner.

At the inspection in August 2016 we found that positive steps had been taken to address the identified issues. The key finding following the August 2016 inspection was a significant improvement in the approach of the Trust’s the day to day and strategic running of the NHS 111 service that was not previously seen.

Our key findings were as follows:

• The Trust had significantly improved their systems in place to mitigate safety risks across the NHS 111 service and was now aligned to the SWASFT vision with safety and quality. We found that the Trust had recognised the need to improve the NHS 111 service. The NHS 111 service was monitored against the National Minimum Data Set for NHS 111 services and adapted National Quality Requirements. Performance against indicators was improving but still below national targets.

• Callers received a safer, more effective and responsive service than they had previously. However, patients were still at risk of potential harm as call answering performance and calls abandoned was still below national targets.

• Opportunities for learning from internal and external incidents were identified and discussed to support improvement. This included joint reviews with the NHS Pathways team for improvements in the assessment system.

• Staff took action to safeguard patients and were aware of the process to make safeguarding referrals. Safeguarding systems and processes were in place to safeguard both children and adults at risk of harm or abuse, including frequent callers to the service.
• Staff were trained to ensure they used the NHS Pathways safely and effectively. (NHS Pathways is a Department of Health approved computer based operating system that provides a suite of clinical assessments for triaging telephone calls from patients based on the symptoms they report when they call). Call audit activity had improved but still required further improvement to meet the NHS Pathways licence and to allow the service to identify areas of development and learning.
• The Trust developed the operational staff knowledge and skills and recognised the need to continue with the programme of staff support. The appraisal programme had been revised and delivered and operational staff received more frequent supervision, support and training to perform their roles.
• Staff commented that the service was safer and this had improved job satisfaction. There had been new staff recruitment at various levels although there was still a notable turnover of staff.
• Patients using the service were supported effectively during the telephone assessment process. Consent to the assessment was sought and their decisions were respected.
• The Trust responded effectively to complaints and to patient and staff feedback. Although there was still a large number still being investigated.
• Senior staff demonstrated a much improved understanding of governance and how to effectively run an NHS 111 service. This included identification and management to safely mitigate risks.
• The Trust demonstrated positive development of leadership and management systems to deliver significant progress in improving the NHS 111 service.

However improvements are still required.

There were areas of practice where the provider MUST make improvements.

The provider must:

• Ensure systems are effective for patients to always access timely care and treatment.

• Ensure that all staff have the necessary skills and knowledge to undertake their roles.

The area where the provider should make improvements:

• Continue with the implementation of the staff recruitment to ensure the service is staffed to full capacity.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice