NHS Direct - Out of Hours

01
NHS Direct:
Quarterly Stakeholder Report – July 2003
■ Introduction organisational review
■ Performance measures
■ Online e-Europe award
■ Accessing languages
■ Helplines
■ Health surveillance
■ Investing in quality
Introduction
Understanding NHS
Rapid expansion over the
past five years has made
NHS Direct the largest and
most successful
healthcare provider of its
kind in the world.
‘Developing NHS Direct
– a strategy document for the next three years’,
published by the Department of Health in April
this year, outlines the future for the service. From
next April, Primary Care Trusts will be responsible
for commissioning NHS Direct services and a
new special health authority will be set up to
manage the service. All NHS Direct staff will
transfer to the special health authority.
The strategy points out the need to deliver a
consistently high quality clinical service, which
helps to meet national performance targets and
offers value for money. There will also be a
requirement for NHS Direct to contribute to local
health agendas through a network of local
managers, empowered to work with
stakeholders to agree local priorities.
Three national task forces – commissioning,
provider and human resources – have been
established as part of an overall programme to
manage the changes between now and 1 April
2004, when the new authority becomes
operational.
NHS Direct looks forward to the challenges
that lie ahead, and is keen to continue to
preserve and build on its local relationships. In
future the relationship between NHS Direct’s
local managers and the local health economy
will be crucial in ensuring this relationship
continues and that NHS Direct services are both
relevant and appropriate for local people.
The publication of this quarterly report is the
first step in keeping you informed of
developments and progress within NHS Direct.
We hope you find it useful. Should you wish to
feedback or suggest other items that would be
of interest in the future, contact details are
provided on the back page.
I look forward to NHS Direct forging
successful partnerships with all the agencies we
will be working with in the future.
NHS Direct aims to provide the best possible service for its
patients and therefore places a high emphasis on its
performance measures.
To date, it has a good track record of clinical safety,
customer satisfaction ratings of 98% and a public
awareness rate of 73%.
Here we aim to share information relating to our
service performance in order to improve understanding.
Our performance is measured against eight measures
known as service delivery targets. We also show
information on the final recommended outcomes
suggested to patients.
Over the past five years, NHS Direct has dealt with more
than 18 million calls and continually looks for ways in
which patient services can be improved. Part of this
includes collecting age and gender data, a breakdown of
which is also shown.
Paul Jenkins
Acting National Director, NHS Direct
Calls answered
The trend line in
chart 1 below has
been smoothed to
remove daily
fluctuations and
shows the trend
on a monthly basis
Demand for NHS Direct is growing. Chart 1 below shows
the number of calls answered by the NHS Direct telephone
service and the number of visits to the NHS Direct website
over the last 13 months, up until June 2003.
In 2002/3 call volumes rose by 14.5% and performance
levels for patients also rose. Staffing levels were relatively
stable and increases in performance were achieved largely
by a 22% reduction in call length. The focus on capacity
and performance improvement has continued this year.
This year has seen an increase in demand for the service.
From April – June 2003, the service answered more than 1.5
million calls (1,656,740). This is an increase of 15% against
the same period last year. Of these calls, 16.3% were calls
from people ringing their GP out-of-hours service, where
NHS Direct takes the call and provides nurse assessment as
part of an integrated out-of-hours service.
Visits to NHS Direct Online increased by 106% for
April – June 2003 compared with the same period for the
previous year.
NHS Direct contacts
Number of calls (thousand)
600
calls answered on
telephone service
400
number of visits
to website
200
Jun02
Sep02
Dec02
Mar03
Jun03
Source: Health Intelligence Unit, June 2003
Chart 1
Direct performance measures
NHS Direct call sorting
Percentage of symptom calls referred for urgent care
30
Number of calls (%)
Calls answered within 30 seconds – our current
performance level is 60%.
Abandonment rate – (the number of callers who
abandon before being answered). Our current
performance level is 11%.
Clinical calls dealt with within 20 minutes –
our current performance level is 43%.
Awareness levels – these are measured
through independent market research
commissioned by the Department of Health. This
currently stands at 73%.
NHS Direct Online website – www.nhsdirect.co.uk
– 99.7% of enquiries through the website enquiry
service were responded to within five days.
Calls receiving an engaged tone – performance
level is 0.03%.
Health information calls assessed – 92% of all
health information calls are dealt with within
three hours.
Satisfied or very satisfied callers to NHS
Direct – a sample of NHS Direct callers are
surveyed in the monthly Satisfaction Report
produced by the Department of Health. This level
stands at 97.8%.
A range of action plans are in place to secure
gains in service delivery target performance during
2003/4 based on underlying improvements in
capacity and process.
Chart 2 shows the
monthly trend in the
percentage of calls given
urgent outcomes – these
are referrals to 999, A&E
department, GP within
the next four hours or
within the next 12 hours.
25
GP under 4 hours
20
15
10
A+E
5
999
Feb03
Chart 3 shows the change
over time in the percentage
of callers not referred to
urgent care – these are
referrals to GP next day or
later, referrals to other
health professionals, and
home care, where the
patient is advised on how
they can care for
themselves without the
need to contact another
service.
GP within 12 hours
0
Mar03
Apr03
May03
Jun03
Source: Health Intelligence Unit, June 2003
Chart 2
Percentage of calls not referred for urgent care
16
14
Number of calls (%)
Performance Measures for
NHS Direct (April – June 2003)
12
GP over 12 hours
Home
10
8
6
4
2
0
Dentist
Pharmacist
Other Health Professional
Feb03
Mar03
Apr03
May03
Jun03
Source: Health Intelligence Unit, June 2003
Chart 3
Gender of NHS Direct patients by age group
Female Male Unknown
Not specified
Over 65
45-64
21-44
15-20
For April – June 2003, 63% of all callers received
6-14
assessment for symptoms and 25% received
detailed health information. The remaining 12% of
1-5
callers include those who received simple health
Under 1
information or made other enquiries in addition to
those who decided they did not require further
0%
20%
40%
60%
80%
100%
attention from the service.
Source: Health Intelligence Unit, June 2003
For the 63% of calls assessed
Chart 4
by a nurse, NHS Direct monitors
Breakdown of all calls to NHS Direct (Apr03 – Jun03)
the final recommended outcome
Chart 5
given to each patient. The
average percentage of
each outcome for the
Urgent referrals
Routine referrals
– 39%
– 16%
last quarter is shown
in chart 2 and 3.
Sixty-one per cent
Completed episodes
of all calls received
within NHS Direct
by NHS Direct were
– 45%
concluded without
referral to an urgent
clinical service during
April – June 2003,
chart 5 refers.
2
Source: Health Intelligence Unit, June 2003
Health alerts – key role for NHS Direct
Public health alerts requiring a responsible and
coherent response is one way in which NHS Direct
supports the wider NHS.
Such health alerts originate from many sources
and affect varying sections of the population. But
the need to let the public know what is happening
and advise them on the best course of action, if
they are at risk, runs through all health alerts.
With its national infrastructure of 24-hour call
centres, the web site and experienced nurses and
health information advisors, NHS Direct is well
placed to help respond.
Over the past four years, NHS Direct has worked
with the Department of Health to provide a public
helpline service in the event of health alerts. These
have ranged from local incidents, for example
chemical spills, to handling calls during a multiregional hepatitis C look-back exercise, as well as
the Alder Hey Independent Inquiry.
NHS Direct has established itself as a routine
point of reference with health professionals and
the public, at a time when they may be anxious
about the consequences of a health story.
If you would like more information please
contact Lee Johnson on 01924 889889 or via
[email protected]
NHS Direct is well placed to deal with any type or scale of health alert
In the past NHS Direct has played a key role in providing the
NHS with support by setting up helplines – some of which
have been on a massive national scale whilst others, equally
as important, at a local level.
The infrastructure of NHS Direct ensures that it is both
flexible and timely in issuing the public with appropriate
information when they most need it.
At the time of going to press, NHS Direct was running the
Elstree and Hillsborough Advice Line as a result of a doctor
at a private clinic in Hillsborough and Elstree, who had been
administering single vaccines to around 40,000 patients over
Number of health alerts to NHS Direct (Apr03 – Jun03)
Jun03
May03
Apr03
0
Chemical
incident
5
Communicable
disease
10
Drug
alert
15
Food
safety
General
20
Lookback
25
Medical
device
Source: Health Intelligence Unit, June 2003
a 10-year period. The effectiveness of the vaccine had been
called into question, and resulted in national media
coverage.
NHS Direct set up a helpline to answer patient queries. A
call plan for 10 of the 22 NHS Direct call centres was drawn
up to run alongside the usual 0845 4647 number so that
specialist advice could be provided During the first four days,
this advice line handled 1,243 calls.
At a more local level, NHS Direct Avon Gloucester and
Wiltshire, have been running a helpline for the Bristol Eye
Hospital in response to a Select Committee report which
raised concerns about waiting times for patients with eye
conditions. The helpline has been collating patient concerns
following cancelled hospital appointments and then faxing
the details to the hospital for follow up. The helpline covers
the immediate Bristol area as well as some neighbouring
parts of the area.
During the first three days of the helpline, which started
on Tuesday 22 July 2003, more than 120 calls were taken.
Lee Johnson, Manager of the Health Intelligence Unit at
NHS Direct, said: “This helpline is a good example of
integration with the local health communites. NHS Direct is
always pleased to be able to assist in resolving local issues
that have an impact on local patients.”
European award for NHS Direct Online
Breaking
down the
language
barrier
NHS Direct call
centres offer a
24-hour interpreting
service to patients
through Language
Line and in whatever
language they may
require.
This service can be
accessed at any
stage of the call by
all frontline staff. An
average of 360 calls
a month use the
interpretation service
for between 35 to
40 different
languages. The
London area
accounted for 53%
of all interpreted
calls, with an
additional 14%
recorded for the East
Midlands area.
The graph below
shows the 10 most
frequently requested
languages for the
three-month period
April to June 2003.
NHS Direct Online beat stiff
European competition to win
one of the first ever e-Europe,
e-Health awards – in this case
for Empowering Citizens in the
Management of Health and
Wellbeing.
The service competed for the
award in May this year, against
200 applicants from 23
European countries. The judging
criteria included economic
benefit, accessibility, quality
assurance, technical standards
and European applicability.
The award was presented to
Bob Gann, Director of NHS
Direct Online in Brussels and was
attended by European
Commissioners and 33 Ministers
from across the member states.
David Byrne, European Union Commissioner for Health and Consumer Protection presents
Bob Gann, Director of NHS Direct Online with the 2003 e-Europe e-Health Award for
Empowering Citizens in the Management of Health and Wellbeing.
Communicable disease watch
NHS Direct call data has now been added to the
United Kingdom’s range of surveillance methods
used to detect communicable diseases.
In the event of a deliberate release of a biological
or chemical agent, people who become unwell
might call NHS Direct for advice on their symptoms,
especially during the early stages of illness.
An identified rise in the use of a particular
algorithm on the electronic NHS CAS system used
by NHS Direct staff, may provide an opportunity for
early identification of an illness outbreak in advance
of other surveillance systems, which currently
include clinical reporting and laboratory data.
Top 10 languages using Language Line
Punjabi
Urdu
French
Bengali
Portuguese
Arabic
Farsi
Ukranian
Gujarati
Hindi
0
1
2
3
4
5
% of total Language Line calls
6
7
8
9
10
Source: Health Intelligence Unit, June 2003
Duncan Cooper, an NHS Direct Scientist with
the Health Protection Agency, said: “It was the
deliberate release of anthrax in the United States
and heightened fears over the possibility of
biological terrorism which led to us stepping up
the joint surveillance project between the Health
Protection Agency and NHS Direct.
“The main aim here is to detect local or national
increases in symptoms which may be reported by
people during the early stages of illness caused by
a deliberate release of a biological or chemical
agent, or the more common infectious diseases.”
The NHS Direct symptom surveillance system
does this by collating electronic call data relating to
10 key symptoms or syndromes, which are mainly
respiratory, gastrointestinal or skin related, from 23
NHS Direct sites across England and Wales. Results
are analysed on a daily basis and any significant
statistical increase in calls for any of the 10 key
symptoms are automatically highlighted and
assessed by a multi-disciplinary team.
If appropriate, the information is passed on to the
relevant Regional Epidemiologist to enable further
follow-ups by other public health mechanisms.
Regular electronic bulletins are also
disseminated to the Health Protection Agency,
Consultants in Communicable Disease Control
and all NHS Direct sites.
Investing in quality
© Crown Copyright
31877.1P.1k.May 03 (Cherryprint)
NHS Direct aims to make lifelong learning,
innovation, achievement and investment the
hallmarks of the service’s training and
development programme.
All frontline staff joining the service undergo a
competency based preparation programme,
initially for up to six weeks, and thereafter as and
when required.
Initial training prepares new staff with the
necessary skills to work with people over the
telephone. It includes essential information
technology and telephone skills, communication
and customer service skills, in addition to courses
aimed at enhancing their knowledge for specific
roles. For example, it includes learning how to
use information resources and decision support
systems effectively.
Through the course of their work NHS Direct
staff need to deal with patients who are anxious,
emotional or experiencing mental health problems.
To help them deal with such calls, they are given
specialist mental health training and have access to
a mental health advisor at their local site.
All training continues beyond the six-week
period. Through information gleaned from quality
improvement tools and clinical outcomes for
individual members of staff, gaps are identified
and further training implemented.
Ros Moore, who leads on lifelong learning,
said: “NHS Direct is committed to ongoing
education, training and development for all
groups of staff and therefore provision for
training is built into both the funding and
capacity plans for the service. All our sites have a
dedicated staff development lead and a training
team, all of whom work collaboratively to ensure
that good practice is shared at both local and
national level.”
NHS Direct’s commitment to quality
improvement and staff development is reflected
through its commitment to training of 21, 16,
and 11 days respectively for nurses, health
information advisors and call handlers.
NHS Direct’s local and national training leads
work closely together to ensure training needs
are met so that all staff are equipped to carry out
their roles at the highest level.
NHS Direct contact details:
Kit Tsang, NHS Direct, Quarry House,
Quarry Hill, Leeds LS2 7UE
Tel: 0113 254 6456
Email: [email protected]
Local NHS Direct contact details: