NHS Wayfinder clinical escalation process

Due to there being a wide variety of services/stakeholders/third party portal providers involved in the provision of the NHS Wayfinder Service, it may be unclear upon the identification of a major Incident which organisation’s clinical team are responsible for owning and managing the risk. It is therefore a requirement for the clinical risk ownership to be established between all parties before any CSA tasks are assigned.

This is not in line with the standard High Severity Service Incident Management Process that is used by Service Bridge and as such this bespoke clinical escalation process will be in place until the High Severity Service Incident Management Process has been reviewed.

The agreed process for managing NHS Wayfinder major Incidents that have an associated clinical risk going forward is as follows:

Any major Incident/HSSI that may have a clinical impact must be immediately reported to the NHS England Service Bridge.

The NHS England Service Bridge will set up a Teams conference call requesting the attendance of the relevant NHS England stakeholders (as confirmed in the Service Bridge SAC document) and a representative of the NHS England Clinical Safety Team (this will also be followed up with a phone call to ensure the request has been received). The Service Bridge will also contact any other relevant third party Portal provider/supplier (as confirmed below and in the Service Bridge SAC document) requesting that they ensure there is both a major Incident manager and clinical safety officer available on the call from their area.

Out of hours the clinically impacting Major Incident’s/HSSIs will be escalated to the NHS England Escalation and Deployment Manager (EDM) (the process remains the same for informing the Service Bridge, and the first line will escalate to the EDM). For NHS England clinical representation, the Clinical Safety Team on call Safety Engineer resource will be contacted. The contact details for the Clinical Safety Team are in the NHS England Service Bridge Contact Sheet and on the NHS England Escalation and Deployment Manager rota.

When the call is convened, the Service Bridge will relay all current findings / the impact and timeline so far and all parties will agree if the major incident is in fact a clinical safety issue or whether it is a standard major Incident. If it is defined as a non-Clinically impacting Major Incident the Major Incident management process will be followed and clinical representation will no longer be required. If it is defined as a Major Incident with clinical risk then all parties will agree which organisation will own the Clinical Risk.

The clinical safety flag will be ticked within the SM Toolset incident record and the additional clinical minimum dataset (MDS) information will be completed by NHS England Service Bridge. The CSA Task will then be assigned via the toolset to the NHS Wayfinder Clinical Safety Team. If it is agreed that the NHS Wayfinder Clinical Safety Team are not responsible the task will be updated with a note that reflects this.

The responsible Clinical Safety Team will then own the risk, taking full responsibility for the management of the clinical risk until it is deemed safe and the NHS England Service Bridge will maintain ownership of the incident record.

The responsible Clinical Safety Team will update the NHS England Service Bridge or NHS England Escalation and Deployment Manager where appropriate and let them know when support is required.

The NHS England Service Bridge and NHS England Escalation and Deployment Managers have the responsibility to ensure all information that is available is provided within the incident record.

Clinical Safety Major Incidents/HSSI will be communicated by the NHS England Service Bridge if it falls in line with the Major Incident Process. As standard, the Service Bridge do not communicate Clinical incidents, however, if there is a technical degradation or outage, this will be communicated without making reference to any clinical impact.

If a Major Incident/HSSI is raised and a patient(s) may have already come to some harm then the Service Bridge may request NHS England Clinical representation to assist when drafting communications.

All actions will be recorded and shared by Service Bridge as part of the Major Incident Process.

Following resolution of the Incident, the Service Bridge will issue a Major Incident Report (MIR) within 2 working days, which will be followed by the hosting of a Post Incident Review (PIR) if deemed necessary within 10 working days. Any actions as a result of the PIR will be documented and assigned, following which the respective owner will ensure progress is being made.