Integrated Care 24

Social Impact Statements

The Social Enterprise Mark criteria includes a requirement that the applicant can demonstrate that social and/or environmental objectives are being achieved.

In support of this, new applicants and renewing Mark holders are asked to respond to a set of social impact questions, which are designed to help them think about the social impact they create, and to articulate this clearly and succinctly.

 

Updated June 2021

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1) What social differences and changes have you aimed to create (or supported)?

We aim to provide 24/7/365 care for people to ensure that they have access to urgent care advice/support/treatment at any time, and particularly in the ‘out of hours’ period when GP surgeries are closed.

A key facet of our services is helping to reduce the pressure on other health services, such as A&E departments and ambulance services. By ensuring that people get the right help in the right place at the right time via our services, it will reduce the likelihood of patients defaulting to A&E for care, or unnecessarily calling an ambulance for a need that could have been appropriately treated in a lower acuity setting.

 

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2) What actions have you taken to address the above social aims?

We provide integrated urgent care services such as NHS 111, out of hours urgent and primary care, as well as prison healthcare services on the Isle of Sheppey in Kent, and of course of technological solutions details earlier in this assessment.

Within our NHS 111 services patients are given a ‘disposition’ following their assessment, and this disposition indicates the level of onward care they require. For patients whose disposition is a non-urgent ambulance, we ‘validate’ that disposition, using senior clinical input to review the call to ensure that an ambulance is the most appropriate response.

Between April-June 2020 alone we conducted 20,018 NHS Pathways assessments which resulted in a category 3 or 4 ambulance. With the added clinical input 11,719 of those calls were downgraded to a lower, more appropriate level or response, meaning that 11,719 ambulance dispatches were prevented in three months alone. This not only allows ambulance crews to focus on the most life threatening of cases, but also ensures that our patients get a faster and more positive conclusion to their experience of using our service.

We are also taking part in the paediatric project referenced earlier in this document, and are the only provider taking part in the pilot who are actively collecting patient experience data as part of the project. We are achieving this through the use of a member of the team calling parents who have used the service to get specific feedback into their experience of this pilot, rather than the service as a whole.

 

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3) What has changed and what benefits have been realised as a result of your actions?

Individuals benefit from our services by having access to medical support outside of their usual doctor’s working hours. Our services ensure that patients have 24/7 access to medical support.

Through our service design other healthcare providers benefit from our services through ensuring that patients are directed to the right service at the right time. Our service helps reduce unnecessary attendances at A&E, and when the national NHS Pathways system (which we accept is risk averse) identifies that a patient is in need of a ‘non urgent’ ambulance, we ‘validate’ these calls, using clinical expertise to further assess the call.

In many thousands of cases, as explained above, this validation supports the downgrading of the call to a lower level of response (such as a home visit from the out of hours service) which reduces pressure on the ambulance service. Equally, there will be occasions when the clinician actually upgrades the call instead, which further ensures that a patient gets the right level of response.

 

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4) How do you and other people know your aims are being achieved? Or how will you know?

We use our patient experience data to review the quality of the services that we are providing and use feedback to further enhance our services. In our latest data submission, all our NHS 111 services are above the national average for patient satisfaction, and we also reflect on the wider performance of each of our services through our contract meetings with our commissioners who scrutinise the service that we provide.

We subsequently report on our successes through communications to our employees, stakeholders, and through our annual reports such as our social impact report and our annual report.

 

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Supplementary details

The below questions are not mandatory, but Mark holders are encouraged to answer them where possible, to provide a fuller account of their social outcomes and the social value they create.

5) How many people have benefitted from your actions?

In our latest full financial year figures we:

• Answered 961,264 calls for help to our NHS 111 services across Norfolk and Waveney, East Kent and Mid and South Essex.
• Provided 529,208 out of hours consultations to our patients, which included 51,517 visits to patients in their own homes across Norfolk and Waveney, Mid and South Essex, Sussex and Kent.
• Provided healthcare services to over 2,500 prisoners at the HMP Sheppey Cluster of prisons on the Isle of Sheppey in Kent.

What this means for patients is that they can access healthcare support at the touch of a button, 24/7/365 and even when that patient’s GP surgery is closed they will still have access to an appointment with a clinician if they need one.

What this means for the wider healthcare service is to reduce the pressure on those services. By providing out of hours care this reduces the burden on GP practices during the week because anyone who needed support over the weekend or in the evening can access it during that period rather than waiting until their surgery is open to contact them.

Our services also reduce the burden on ambulance and A&E services. There’s a national drive for patients to ‘think NHS 111 first’ and to call 111 before simply attending A&E and the 111 service can support patients to get the right care in the right setting. We also reduce the burden on ambulances by providing a service that they can use without calling 999 as a first resort.

When the NHS Pathways system suggests a patient needs an urgent or less urgent ambulance response we get a clinician to ‘validate’ those calls and review whether there is a more appropriate outcome than an ambulance. For example, between April and June 2020 we successfully prevented 11,719 ambulances from being dispatched using this process. In 2015-16 a National Audit Office report estimated a face to face response from an ambulance crew costs £265.

 

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6) What examples can you provide of a typical service user experience, that helps illustrate the benefits they have experienced as a result of your actions?

An abridged version of a service user experience of our services could be summarised as follows:

A patient wakes at 8am on a Saturday morning feeling distinctly unwell. It is a bank holiday weekend, so their GP practice will not be open until Tuesday. A full 48 hours away.

The patient dials NHS 111 and is taken through a Pathways assessment, which assesses the patient as requiring a ‘non urgent’ ambulance.

A senior clinician within the clinical assessment service reviews the case, and asks further questions of the patient. Following this the clinician downgrades the call to a home visit from IC24’s home visiting service. An ambulance is no longer required.

A clinician visits the patient in their home, and prescribes them medication, sending the prescription electronically to a pharmacy of the patient’s choice.

Key benefits here are the patient’s access to ‘out of hours’ care; preventing an unnecessary ambulance being dispatched; the patient receiving a visit in their own home; the patient benefitting from our electronic prescribing solution.

In Eastbourne we recently ran (for the second time) flu outreach clinics to support the local homeless population. We know from experience that they do not always keep appointments due to a more chaotic lifestyle so we worked in partnership with the local Salvation Army, who run a regular ‘hot meal’ service for the homeless community. We attended this and provided vaccinations on site as we knew that we would be able to capture a greater audience that through trying to get them to attend our surgery. This partnership resulted in an effort from the Eastbourne team to donate money to the Salvation Army.

Each year IC24 provides teams with a fund to buy treats for the teams who are working over Christmas the Eastbourne team chose to donate theirs to their local charity.  The team also provides support to other surgeries when they have shortfalls in capacity. In the last year the team saw 545 walk in patients for wound care who could not be seen at their own surgery, which amounted to 1,192 appointments. We also run a similar service in Hastings, which the local MP nominated for an NHS Parliamentary Award in 2019, and we are currently working with the commissioner on evolving the model of care that is provided in Hastings.

 

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7) What social and environmental benefits have you created from internal operational policies and actions?

As part of our health and wellbeing strategy we implemented the ‘Wellbeing Wednesday’ as the organisation got to grips with homeworking and the increased pressures of covid19. We have also developed and inclusiveness and belonging strategy, which includes the development of an employee support network as we seek to further support our people and provide a safe space for mutual support, shared learning and exploration of ideas for tackling discrimination and inequality. We have also recently signed off our wellbeing strategy for the coming three year period.