‘Experience to date of the transition from NHS Direct to the NHS 111 service 24.
The Unite experience of the 111 service is that it has been a disaster.
It is an example of exactly how the NHS is being fragmented and damaged by the government’s ideological obsession with markets and commissioning.
NHS direct was a functioning service and it has been replaced with one that has been widely reported to be failing in different areas of the country.
The service further fails service users with the call centre staff not having sufficient training and medical knowledge.
Unite ambulance members are reporting that on weekends the majority of 999 calls are now referrals from 111.
When the crews then try and refer patients to urgent care facilities or GPs they are then referred back to the 111 service or may wait 3-4 hours on scene for a callback from a GP.
The only option is simply to take patients into already overstretched A&E departments.
Unite ambulance crews have reported regularly receiving calls that are totally inappropriate while at other times they have been left idle due to failures to pass calls on.
The demise of NHS Walk In Centres or the prevention of ambulance clinicians being able to directly refer petients to these facilities has also added to the pressures.
Unite members in the ambulance service have said that they think it should be stopped with the funding being put back into ambulance services to develop better community based care and response teams.
The implications of the shift away from determining the success of ambulance services via indicators based on response time to the new measures designed to assess clinical effectiveness
Unite agrees that response time is a crude target for judging the success of ambulance services as it says nothing about the level of care received once the ambulance has arrived.
That stated, there needs to be a balance and caution with its design since if an ambulance does not respond in time then the quality of care becomes an academic concern.
Unite believes that all targets must be clinically led, agreed with health professionals and focused to avoid distorted outcomes.
The causes of delays in handover from ambulances services to A&E or transfer between different levels of urgent care, and actions required to eliminate them
Unite members report that this is usually caused by several issues; not enough staff in A&E to accept patients from crews, no beds available in the hospital and ultimately underfunding, closures, fragmentation and poor planning.
Trusts are not prepared to breach their A&E waiting times targets, so will not admit patients until they know that they will be able to move them on from A&E within 4 hours.
The shocking examples of tents being used to receive 999 patients illustrates this point. It has also been reported that some Trusts have had up to 20 ambulances queuing.
This also causes disharmony between the departments when considering who is responsible for patient’s welfare during extended waits.
The government needs to address these issues first and closing centres which can provide transitional care, such as ‘cottage’ hospitals is not going to help.
These were the staging post for discharged patients who needed that little bit of extra care or rehabilitation before they went home but have now been curtailed or taken away which has ended up in patients staying at main hospitals for longer and causing a bed block.
Finally, with the closure of some A&E departments, surrounding hospitals are finding the pressure of additional admissions difficult to manage.
If there was more advance skilled paramedics and facilities in the community and primary care then paramedics could keep more patients out of main DGH type hospitals but ambulance services need the funding to achieve this.
Unite believes that the funding would be easily recouped through admission avoidance.
Clinical evidence about outcomes achieved by specialist regional centres, taking account of associated travel times, compared with more generalist hospital based services
While there may be some evidence that specialist units can improve the standards of care, such evidence has to be weighed against the need for accessible care and access.
Particularly the most vulnerable and socially excluded patients will find it extremely difficult to get to specialist units unless there are sufficient transport systems in place.
Some emergencies should be dealt with at more local hospitals, as time critical admissions may not make it to the specialist emergency centres. The issues of health inequalities and of patients’ ability to self-diagnose are also of concern.
Aspects of care which are likely to improve by being located in regional specialist units and the risks associated with removing services from existing A&E provision.
Unite has mixed views on this issues. There are clear risks about separating general hospitals and regional specialism.
The patient will be unlikely to understand or know that they have a specialist problem, that a specialist hospital exists or they may have more than one problem that is unrecognised by the specialist units.
Again having proper access to GPs that know their patients would improve this and help guide patients through the system.
There could be a case for separating geriatric A&E issues from general
A&E in much the same way as is done for children. This could mean that specially trained geriatricians with wider A&E knowledge could handle these cases that may also involve serious chronic health issues that A&E might not pick up.
When A&Es close, there is an impact on the other clinical services provided by a Trust. The hospital can then be destabilised, and other services have to also be lost, thus downgrading the centre.
This then has an impact on access to local services.
More clinically evidenced work has to take place to model the right structure for hospitals to ensure that they are providing the safest levels of care. The current models are too simplistic.
The effectiveness of the existing consultation process for incorporating the views of local communities in to A&E service design
Current consultation processes are clearly failing as closures are taking place against the backdrop of large-scale public opposition.
As with so much of what is currently happening in the NHS, the system of planning and coordination has completely broken down, with service fragmentation, cost cutting and lack of accountability.
Unite is supporting a growing number of local campaigns about changes to local health services – the campaigns in Trafford, Redditch and Lewisham are all focusing on A&E closures and have begun mobilising large numbers of people, including 25,000 that marched for Lewisham.
The Health Committee should actively seek evidence from these campaigns on the consultation process in their areas.
If there are real clinical reasons to reorganise emergency services then these should be done in a planned, coordinated and evidence led way involving all the trusts and communities affected so that there is no loss of access, quality or coverage for that service.
The ability of local authorities to challenge local proposals for reconfiguration under the revised oversight and scrutiny powers included in the Health and Social Care Act 2012
The ability of the local authority to challenge decisions taking place in the health service is crucial and a vital avenue for members of the public to be able to take in order to save the services provided in their area.
This obviously depends a lot on the quality of the councillors running the local authority and how overview and scrutiny is organised in specific local authorities.
The flexibilities in the Act have fuelled further concerns about a postcode lottery due to this.
There is still a serious lack of clarity about how overview and scrutiny powers will be applied after the Health and Social Care Act 2012.
Health and Wellbeing Boards do not appear to have the power to police changes and this seems to be a toothless concession to partnership working.
Unite is also concerned that if local authorities start having a commissioning role this may compromise their ability to challenge health services in the future.
This evidence was submitted on behalf of Unite the Union by; Rachael Maskell Unite the Union, National Officer for Health.’’
