REPORT BY EXTERNAL CALL-CENTRE CONSULTANTS
The independent review team realised quite early on that we needed to assess the running of NHS 24 contact centres and compare/contrast that with the running of commercial call centres. We appreciated, of course, that the clinical nature of activities would inevitably influence the operational management of NHS 24 but we wondered if there were still some aspects of "technical" call-centre work that might be worth considering. Were the centres well designed, well laid out, fully fit for purpose etc? Is the proper technology and telephony in place to provide maximum help and assistance - to call handlers, to nurse advisers, to the public calling in? What is the expert view on current NHS 24/Health Boards' thinking on "hub and satellite" linkages? Not least, how does the general management of the telephonic side of the business compare with the management of a commercial call centre?
We commissioned an expert call centre consultancy company to do a short review (6 weeks) and we have received a very comprehensive report. We are passing a copy to NHS 24 senior management for consideration in detail. The report suggests that:
- while appreciating the necessary higher levels of medical and clinical management of the centres, there was concern that some of the fundamental practices of managing and handling calls are not always followed;
- although demand peaks are generally pronounced and predictable, staff are not always available when they are most required;
- NHS 24 may not always be getting the best service from its suppliers and contractors;
- the consultants have a degree of concern that over-concentration on "hub and satellite" work for Health Boards (beyond the NHS Highland project) could possibly prejudice internal NHS 24 preparation for the oncoming winter;
- while NHS 24 centres were designed, built and equipped to receive calls, around 50% of call time is now taken up with making calls because of the impact of call-back;
- that in turn can mean that up to 25% of a highly qualified nurse adviser's call time is taken up in the manual mechanics of making contact with a patient who has called in earlier;
- it may be possible to use NHS Direct's internet facilities to help reduce the volume of calls to NHS 24 - particularly at peak times. The NHS Direct internet could be used by callers to find out about illnesses, operations, tests and treatments; to get advice on common health problems from the self-help guide; to visit the "Best Treatments" web site for the latest treatment options;
- it would be beneficial to separate the "call centre" operational management responsibilities from the management of clinical services to allow exploitation of commercial 'call centre' management techniques and best practices - while continuing to acknowledge the importance of clinical standards;
- because of the mechanism used by the service provider to route calls to one or other of the 3 NHS 24 contact centres, calls made to NHS 24's telephone number from a mobile phone, from wherever, have to be automatically re-directed solely to the West Centre. This is not any fault of NHS 24 but it does mean that even at times when the North and/or the East Centres are relatively quiet, they simply cannot take the calls. It would be possible to adapt the telephone routing system used by the service provider to allow calls to the other 2 centres - but perhaps at considerable cost.