FINAL REPORT RECOMMENDATIONS
Foreword
No single action will remedy current difficulties and release the full potential of NHS 24 to play an important service provider role within a modern health care system. The recommendations below are intended to involve all the relevant parts of that system which, taken as a whole, can achieve the desired effect. They should also clarify the priority task of NHS 24 which is to provide telephone triage and consultation during out of hours periods for callers whose circumstances mean that they cannot wait for in-hours services to re-open. We hope the recommendations will support the elimination of some of the obstacles to gaining rapid access to appropriate health care while at the same time making best use of all available staff by matching the correct required skills to the needs of the users. The recommendations also clarify the responsibility of Health Boards in relation to unscheduled primary care out of hours and advocate maximum exploitation of modern technology to respond quickly and flexibly to the needs of people across the whole of Scotland.
Recommendations
1. Health Boards and NHS 24, in consultation with other appropriate NHS partners and with the active support of SEHD, must comprehensively plan how demand over the coming winter (with or without any kind of epidemic) will be met - particularly over the festive public holidays.
2. NHS 24 must be recognised as an important service provider working in partnership with all Health Boards, providing consultation and advice to telephone callers and facilitating the transfer of appropriate calls to other NHS partners.
3. NHS 24 must recognise that not only is the extensive, reactive and routine use of call-back to compensate for lack of the appropriate resources at peak times not the solution to handling high call volumes but it is the cause of many more problems.
4. NHS 24 should by 31 March 2006 produce a detailed plan, endorsed by Health Boards, of how call-back is to be reduced at least to a single figure percentage of all calls received by 31 March 2007. That plan should identify changes in the way calls are taken, different ways of working - both within NHS 24 and in partnership with Health Boards.
5. NHS 24 should by 1 March 2006, begin a radical review of the ways in which it delivers services and how processes and practices need to be changed to reflect the changes which have impacted on NHS 24 since its original design - even since it prepared a 5 year plan at the end of 2002. That review should be completed by 30 June 2006.
6. Before going live on any 'hub and satellite'-type models there should be well defined objectives, agreed by NHS 24 and the relevant Health Board, which are capable of being measured and monitored and the partners involved should be accountable accordingly.
7. NHS 24, in consultation, should review the role of call-handlers to consider the extent to, and the circumstances in which, some limited further discretion could safely speed up the flow of some calls.
8. Health Boards, in consultation with NHS 24, SEHD and other appropriate NHS partners, and the voluntary sector, should seek to change the understanding of the public in relation to the role of NHS 24 during out of hours to ensure that urgently needed advice from anxious callers is not unnecessarily blocked.
9. NHS 24, in consultation, should re-examine the role of the nurse adviser to consider whether the skills and expertise of these highly qualified and experienced nurses are being fully utilised.
10. NHS 24 must make further efforts to have sufficient appropriate staff available to cover shifts during which heavy volumes of calls are regularly predicted.
11. Health Boards and NHS 24, overseen by SEHD, should proceed by 31 March 2006, to more formal joint-working and partnership arrangements which include clear, agreed, monitorable and measurable targets for which they will be held accountable by SEHD and by Ministers.
12. NHS 24 should consider the findings of a consultants' report commissioned by the Review Team to assess the operational management of the 3 NHS 24 contact centres and to report how that compared with other contact and call centres in the UK.
13. NHS 24 and relevant Health Boards must recognise that the primary need of callers in remote and rural areas is speed of response followed by realisation of the peculiar difficulties presented by inaccessibility.
14. Health Boards and NHS 24 together should consider how nurse recruitment and retention might be improved by the promotion of posts which would allow experienced nurses to rotate between telephone triage and face-to-face care.
15. SEHD should, by 31 March 2006, complete a 'post implementation' review of the actual costs and measured benefits of those 'hub and satellite' models in relation to claims and expectations made of them - not least in providing nurse advisers within the local Health Board area to help cover peak call volume times.
16. NHS 24 should, as soon as possible, arrange easy access for people in Scotland to the healthcare website of NHS Direct - at least until some conclusion is reached on the original undertaking that NHS 24 would itself produce such a website in Scotland.
17. NHS 24, the Scottish Ambulance Service, relevant Health Boards and SEHD together should examine how current and imminent technology might particularly benefit patients and callers in remote and rural areas.
18. We recommend that NHS 24 consults with the important voluntary sector to explore how patient care organisations might be able to help in the response to some particular calls.
19. NHS 24 and Health Boards should improve mutual feedback mechanisms between NHS 24 front-line staff and clinicians in Health Boards.
20. NHS 24 and each Health Board, in consultation with other NHS partners, should together plan and develop the most appropriate mix of skills across the team required to deal with unscheduled primary care requirements in that particular area.
21. SEHD should review and revise the performance indicators on which NHS 24's performance is judged to better reflect the significant changes in the operations of NHS 24 and in the different ways it is being asked to deliver its services. Those statistics should, at least for the foreseeable future, separate Monday to Thursday and Friday to Sunday performance, replacing the average weekly statistics provided to date.
22. SEHD may wish to consider whether this report indicates a possible need for more detailed scrutiny of the actual performance of any new NHS organisation during the early years of its existence.