Agenda item

Geraint Davies (Director of Commercial Services, South East Coast Ambulance Service NHS Foundation Trust), Helen Medlock (Associate Partner, KMCS), Patricia Davies (Accountable Officer, NHS Swale CCG), Sally Allum (Director of Nursing and Quality (Kent and Medway), NHS England) and Dr John Allingham (Medical Secretary, Kent Local Medical Committee) were in attendance for this item.

(a)       The Chairman welcomed the Committee’s guests and asked them to introduce the item. A number of Members of the Committee had had the opportunity to visit one of the 111 call centres in the region, and this experience was remarked on positively. The offer was made during the meeting to extend the opportunity to visit to other Members.

(b)       Representatives from NHS Swale CCG explained that this organisation was the lead CCG for commissioning both 111 and 999 services across the South East area, covering 22 CCGs in total. On behalf on the South East Coast Ambulance Service NHS Foundation Trust (SECAmb) it was explained that there were three key questions to answer. These were whether the service was improving, whether it was meeting the requirements of providing access to the service and how was the service going to be improved in the future. It was further explained that SECAmb was meeting the targets in terms of call answering and responding to calls and was working to improve transfers between clinicians, or ‘warm transfers’ as they were referred to.

(c)        Members of the Committee commented positively on the way the NHS had been honest about the problems the service had faced and the way it had dealt with them to improve the service. In response to questions arising from this it was explained that the 111 service was not perfect nationally or locally. It was a national service, tendered locally, and this had been carried out by the Primary Care Trusts which preceded Clinical Commissioning Groups. Locally, contract penalties had been applied and the rectification of the service had been successful. The SECAmb representative stated that discussions with the CCG had begun on contract variation.

(d)       The broader point was raised that although the idea of commercial confidentiality was well understood, the Committee needed to think about how best to examine and scrutinise the use of public money. The Committee was informed that all the relevant financial information could be found in the SECAmb Board Papers and that these were publicly available on their website.

(e)       There was a discussion on the need to effectively promote and communicate the existence of the 111 service. Although many measures were being taken, it was explained that there were restrictions on local areas advertising the service ahead of a national campaign which had yet to take place.

(f)         The pressure on accident and emergency departments was raised. CCG representatives explained that Swale CCG and Dartford, Gravesham and Swanley CCG were working with the King’s Fund on this topic. Data from north Kent suggested that attendances at accident and emergency departments were flat and that the real challenge was the rate of people attending who were subsequently admitted. It was added that winter was coming, and there would be a change in the case mix, with more children and the elderly presenting at accident and emergency departments.

(g)       The role of technology was another area raised and discussed. The Ibis system used by SECAmb enabled GP systems to be connected with that of the ambulance service and that for calls relating to people with long term conditions or receiving end of life care, then the service would be able to view the appropriate information, including details of who should be contacted. The NHS Pathways programme, used by the 111 and 999 services for triage was also discussed. The representative from SECAmb explained that this system had been signed off by the Royal Colleges and expressed the hope that it could be used in accident and emergency departments as well to enhance consistency. More broadly, SECAmb wished to develop a single point of access service across the health economy. It was working with all 22 CCGs on how to access local urgent care boards and discuss the best ways of sharing information.

(h)        Although it was not related to the 111 service, the issue of the police being called to deal with mental health crises was discussed. Work was being done on this in Kent and pilot schemes were underway where a mental health professional accompanied police men and women.

(i)         On the topic of innovation and improving the service, it was explained that NHS 111 was a big national service and that there was the opportunity for different ideas to be piloted. One Member raised the idea of giving telephone access to 111 in accident and emergency departments and the response was given that a version of this was being trialled in Sussex. It was important to look at the processes carefully to avoid such situations as an ambulance being called and sent to a person already in an accident and emergency department. There was a pilot underway in Blackpool where the 111 system and accident and emergency department were closely connected.

(j)         The Chairman proposed the following recommendation:

§         That the Committee thanks its guests, notes the good progress made and looks forward to an update next year.

(k)        AGREED that the Committee thanks its guests, notes the good progress made and looks forward to an update next year.