The Care Quality Commission has told South Western Ambulance Service NHS Foundation Trust that it must make significant improvements to protect the safety of people using its NHS 111 services for Devon, Dorset, Cornwall and the Isles of Scilly after rating the service as Inadequate.
A team of inspectors found the 111 service was Good for caring, but Inadequate for safety, effectiveness, responsiveness and being well-led. They found that there were often not enough staff to take calls, or to give clinical advice when needed.
Staff reported working long hours, many feeling high levels of stress and fatigue. There were high staff turnover and sickness rates. Too many calls were abandoned, and patients were waiting too long for their calls to be answered and to be assessed, or to receive a callback with appropriate advice.
Inspectors also found that calls were sometimes answered by staff who were not trained to assess patients' symptoms and there was a risk that patients needing urgent attention were not given priority or could be put into a long queue awaiting call back.
Following the inspection the CQC has issued a Warning Notice requiring the trust to ensure 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. The trust has been told that it must make significant improvements by 8 July 2016.
The CQC has also told the trust that it must make a number of improvements:
· The trust must 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.
· The trust must review the roles and responsibilities of Non Pathway Advisors (call handlers who are not trained to use the NHS Pathways triaging system) ensuring callers consistently receive the correct level of advice.
· The trust must 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.
Professor Sir Mike Richards, Chief Inspector of Hospitals, said:
"NHS 111 services are an important part of the urgent care system. 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.
"We found that patients were at risk of harm because the triaging system was not good enough. Too many people whose call was urgent were not being assessed in relation to their medical needs in a timely manner. A lot of people needing less urgent advice might have to wait all day for a call back.
"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.
"Since our inspection we have been working closely with NHS England, NHS Improvement and the local commissioners to ensure that our most urgent concerns around the triaging of calls are dealt with. The trust leadership has told us that they are well aware of the issues that we have raised. We expect them to take action – and we will be monitoring the service closely to ensure these improvements continue."