A radical review of Scotland’s health helpline NHS 24 has recommended using the new volume predictive technology to ensure the best possible match of supply to demand as one of a raft of measures to improve the troubled service.
The report – which is highly critical of NHS 24’s board – also says that more efficient management in the technological and telephonic aspects of the operational handling of calls is also needed in NHS 24’s three contact centres.
Key issues identified when the review was set up in February this year included: difficulties in recruitment and retention of nurses; the way calls were taken and subsequently handled – particularly the number of ‘call-backs’ used; problems facing patients transferring from NHS 24 to other parts of the NHS in Scotland and particular problems for people in remote and rural areas.
The review also highlighted that NHS 24, in enthusiastically promoting its existence, had probably failed to explain to the public that during out-of-hours times the service was intended primarily for callers who felt they had an urgent need for help or advice.
The review team, chaired by Owen Clarke, concluded that the cumulative effect of most of the issues identified had, at times, rather overwhelmed NHS 24.
The report advises: “Once NHSScotland has got through whatever this winter brings, there should be a quite radical review and overhaul of the ways in which NHS 24 contributes to unscheduled care particularly out-of-hours.”
“There are two main reasons for that; firstly, the actual role has changed fairly dramatically since the original design blueprint of 2001-2002; secondly, some of the operational processes and procedures in place since those early days have simply not stood up to some pressures that have certainly been significant but which were generally not unpredictable,”
The review goes on to deliver a damning assessment of NHS 24’s handling of these issues at the highest level. “The Board’s failure to acknowledge some of those weak spots (to continue, for example, to believe that rising numbers of calls-back were simply an inexorable, and integral, consequence of increased call volumes) meant that there was no critical review of the process of performance delivery; no obvious consideration that if a process needs a specific level of human resource and that level, continuously, cannot be reached it is then necessary to review the process.”
Call-back, the review says, is by far the most problematic issue and that in turn causes difficulties in a number of different ways.
“It was not designed to be used other than as an exceptional, temporary, planned method of dealing with low-priority calls. In fact it was soon – as early as 2002 – accepted as an integral part of the day-to-day service.”
The review lists the problems this created – first and foremost for anxious callers; for Health Boards arranging local out-of-hours clinical services; for nurses called away from dealing with live incoming calls to make return calls; for the contact centres themselves that were designed quintessentially to receive and not to make calls.
“The only practical way to manage down call-back to the minimum is to change, always in consultation and always following rigorous assessment of risk, the ways in which the job is done,” says the review.
In addition to the technological changes suggested, the review also recommends:
• limited and monitored empowerment of experienced call-handlers;
• encouraging highly experienced qualified nurses and experienced call-handlers to break away from an almost pre-determined length of call time and to take the time appropriate for each call;
• encouraging experienced nurses to use the extensive clinical software as they themselves require on a call by call basis and not comprehensively as a matter of course;
• giving response priority to callers from remote and rural parts of Scotland.
Dr David Love, joint chairman of the BMA’s Scottish GP Committee, said: "The BMA welcomes this report and is pleased that many of the concerns expressed by GPs have been recognised by the review group. Overall this is a fair reflection of the problems and challenges facing NHS24 and offers a positive way forward for the service.”