Archived: Wellington House

Updated 26 February 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

Wellington House is part of Vocare Limited. This service provides a NHS 111 service for a population of approximately 540,000 patients in the Somerset region. Vocare deliver GP Out of Hours and urgent care services to more than 4.5 million patients nationally.

Wellington House Somerset NHS 111 is a telephone based service where people are assessed, given advice and directed to a local service that most appropriately meets their needs. It operates 24 hours, 365 days a year from Queen Street, Taunton, Somerset TA1 3UF. The location is registered with the Care Quality Commission under the Health and Social Care Act 2008 to provide the following regulated activity: Transport services, triage and medical advice provided remotely.

It is co-located with the NHS 111 service for Cornwall & the Isles of Scilly. The local management team also provide governance of NHS 111 for Devon, Wiltshire, Bath and NE Somerset and Swindon CCG areas.

Updated 26 February 2019

This service is rated as Good overall. (Previous inspection 05 2018 – Requires Improvement).

The key questions are rated as:

Are services well-led? – Requires Improvement

We carried out an announced focused inspection of the Somerset NHS 111 service at Wellington House on 10 January 2019. This was to review the quality of the service following four previous inspections carried out at the service in May 2018 and April, August and November 2017 where we issued warning notice’s as a result of finding significant areas of concerns.

On 16 May 2018 an announced focused follow-up inspection was carried out. We found the delivery of high-quality care was not assured by the leadership and governance in place at the service. Significant issues that threaten the delivery of safe and effective care were not adequately managed. There was limited evidence that actions to address previous CQC concerns had resulted in sustained improvement to the service. Insufficient improvements had been made such that there remained a rating of inadequate for well-led. Following that inspection, we issued a further warning notice in respect of:

• Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Good governance.

At this inspection we found:

• There was evidence that actions to address previous CQC concerns had resulted in improvement to the service.
• There was improvement and stability within the local and regional leadership team who demonstrated prioritisation of previous non-compliance.
• Significant issues that threatened the delivery of safe and effective care had been reviewed and managed. For example, overnight calls had been diverted to central call centres where sufficient staffing ensured the service delivery within the required call targets.
• There were improvements in national Minimum Data Set requirements with service performance in line with national averages although in some areas these remained below national target levels.
• Patients were mostly able to access care and treatment from the service within an appropriate timescale for their needs.
• There was evidence of continuous learning and improvement at all levels of the organisation. The service had processes in place to learn and share lessons from safety incidents. Reviewing learning to improve performance was limited to call-auditing and individual staff reviews.
• The provider had implemented new governance systems and processes to measure the quality of the service and to promote continued development and improvement of the service. At the time of our inspection this was new and therefore limited evidence to show effectiveness.
• Incidents and complaints were not always completed within provider policy timescales and processes to identify and manage these risks were not effective. This meant limited evidence that duty of candour had been applied in a timely manner.
• The provider had a planned audit programme and we saw some evidence of quality improvement work.

The area where the provider must make improvements as they are in breach of regulations:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

• Consider a formal system to demonstrate evidence of how learning from incidents and quality improvement work has been embedded and improved quality of care delivery.
• Continue to develop the programme of audits to identify impact on patient care.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice