NHS Digital

“Our 111-service management team agree that this was a complex case and should have been transferred to a clinician. In order to ensure that call handlers fully understand the need to identify and refer such cases, the following actions have been taken: 1. Work has been undertaken on a focused area of learning known as a”

“Key skills is the name given to core training delivered to all members of staff quarterly. The content varies according to job role and is based upon required system updates, clinical updates and learning from incidents and events. The next key skills for Health Advisors and Emergency Medical Advisors will include a section on dealing with calls from or about patients who have a learning disability.”

“The handling of complex calls has been added to those core competencies and as such new Health Advisors and Emergency Medical Advisors will be required to demonstrate this as a competency moving forwards.”

“Our Head of Governance for 111 plans to publish a shared learning based on [the deceased]'s family's contacts with the 111 service before the end of January 2022.”

“It is for NHS Digital to address the issue of how NHS Pathways accommodates patients with underlying disabilities.”

“SECAmb does not specify a field of experience such as A&E or urgent care because the range of medical conditions and situations with which we deal on a daily basis is so wide. Experience in a wide range of disciplines in our clinical workforce in the 111 service is an advantage; a broad spectrum of experience in different clinical settings (e.g. cardiac, stroke, paediatrics, mental health) helps us to accommodate the extremely diverse needs of our patients.”

“The primary care registration management process within the NHS in England is managed through a range of different systems which, when operated correctly, ensure a patient's GP registration transfers from one GP practice to another. The successful registration of a patient with a new GP practice includes the appropriate generation of notifications to the different systems involved in the process.”

“We understand from the request that the discharge care plan was not followed, and this was not recognised. This is an issue of health and social care coordination and management.”

“Following Ms [name redacted] death, the Practice undertook an audit in October 2019 of all patients who were being prescribed Emerade to ensure that the dosage was in accordance with the BNF based on the respective patients' weight and age. Indeed, all patients who use AAI pens have had their doses reviewed. Patients have been contacted to ensure that they have the correct dose and appropriate knowledge about the use and storage of the pen. Letters were sent to patients on Emerade, which included”

“we will consider how best to make clear In CG134 the advice that 2 adrenaline auto-injectors should be prescribed, which patients should carry at 811 tfflls.”

“NHS Digital has developed an extensive audit framework that applies to providers using NHS Pathways. This was described in NHS Digital's: supplementary second witness statement dated 20th December 2019; submissions on conclusion dated 3 January 2020; and PFD submissions dated 17 January 2020.”

“NHS Digital also offers regular 'audit levelling' sessions to providers in order to achieve good and consistent practice.”

“The detailed requirements for auditing call handlers (including clinicians) establish audit frequencies, and standards against which audits should occur. These include criteria for auditing and requirements by way of qualification and training of those carrying out any audit.”

“Ensuring the proper operation of the audit system and management of failed call audits is the responsibility of the provider, within the framework provided by NHS Digital.”

“NHS Digital has since changed its categorisation.”

“Following the Ambulance Response Program, NHS England led (supported by NASMED and ECPAG) a "clinical coding review" in May 2019, reviewing the category 1 ambulance response definition. Consequently, it was decided that symptoms which may suggest life-threatening anaphylaxis should receive a category 1 ambulance response and the necessary changes were made by NHS Pathways. These were beta tested in September 2019 and deployed nationally from October 2019”

“Historically, a question about whether a child has cold hands and/or feet has not been included within NHS Pathways. This was a deliberate decision not to include it after consideration of the available evidence of its accuracy as a discriminator of severe illness in a remote assessment setting. According to the National Institute for Health and Care Excellence (NICE) guideline for sepsis NG51, published in July 2016, cold hands and/or feet in the context of an unwell child is a moderate to high”

“NHS Pathways is built on a clinical hierarchy of symptoms, meaning that life-threatening symptoms are prioritised and assessed through our initial set of questions (known as module 0). Within these algorithms we specifically look to identify the symptoms and signs of life-threatening conditions, including bleeding, by asking about conscious level, fitting and choking, breathlessness, cool, cold, clammy skin and pallor. Specific questions about the many individual conditions that could lead to”

“The EPS Enhancements survey took place in August 2017 and a”

“An improved reporting mechanism has been developed to record actions and results of the audit and support the ongoing maintenance of the changes which have been implemented.”