The case for the defence of NHS 111
The case for the defence of NHS 111
The oxygen of publicity yet again favoured the critics of the
new NHS 111 service as two reports were featured in news.
The first was the announcement that NHS Direct wants to end its 111 contracts in
all 11 of the areas where it successfully bid to win the contract
so recently. This will not affect the North East region.
The second was an undercover investigation by Channel Four's
Dispatches programme at two 111 contact centres in the
south of England. Both contact centres are run by a company called
Harmoni and they are operating under a performance notice at the
moment due to failings already identified by the NHS and
highlighted in last night's programme.
Anyone who saw last night's programme would have been shocked at
the lack of clinicians supporting the call-handlers; the numbers of
staff available to answer the volume of calls and the anecdotes of
ambulances being unnecessarily sent to cases where they were not
Why should we keep 111?
All of the issues raised in the Channel Four film are not ones
that we recognise in the North East for the 50,000 callers who ring
111 every month and receive an outstanding service. We know this
because 98% of patients said they were happy with service we
provided in a recent survey submitted to the
Department of Health.
We could not deliver such a great patient survey result
without the hard work and effort of everyone in the contact
centres. Their flexibility and great attitudes are a key part of
the success we are achieving. This is even more incredible when you
consider that the continual onslaught of negative media coverage of
NHS 111 that has battered morale for several months.
was never intended to reduce demand on NHS services and this is
an important point to remember as our region has a history and
culture of patients who present with serious conditions at a very
late stage. Our history of disease and mortality demonstrates that
patients are reluctant to seek medical help. A free-to-call number
like 111 gives these patients assurance to seek that help when they
Why are ambulance services better at delivering 111 than
We should all be rightfully proud of the 111 and 999
services we are delivering. While there are some who will criticize
111, there are many other doctors, GPs and nurses who support and
believe in what we are achieving. The commitment of everyone within
NEAS is a credit to the service and a beacon of light to the rest
of the NHS in showing how 111 should be delivered.
111 was developed here in the North East through our
conviction in NEAS that there was a way to redress the imbalance
between emergency and urgent care pathways and reduce the pressure
this was putting on colleagues in the acute and emergency care
sector. Efforts in the past to educate the public about the health
services available and when they should be used have failed and
this new approach has instead created a system that responds
rationally to patients' need for help. It directs them to the care
they need at the first point of contact.
Our core skill is expert call handling and telephone
triage of complex calls. Ambulance services are also well placed
within the NHS to understand the relationships and dependence
between urgent and emergency care. We have a vested interest in
ensuring patients receive the right care, in the right place and in
the right time. Developing a system that significantly increases
ambulance activity would not be in our interests.
What have we done to make 111 a success?
In NEAS contact centres, the training for 999 and 111 is very
similar and the system used is identical. Only when all of this is
completed successfully to the required high standards are staff
certified to take calls. The training was developed by NHS clinical
training experts and has been consistently refined and enhanced
based on active feedback from call handlers, clinicians and
All call-handlers and clinical advisors are subject to an
audit every month, in the same way as our paramedic crews are
audited. These are formally scored and evaluated to ensure the
highest standards at all times and to give early indication of any
areas where additional support will ensure the highest
Call handlers are provided with extra support within the
control room should they require clarification or support during a
call. That is the same support that our paramedic crews can call
upon if they need additional advice when treating a patient.
All of this adds up to supporting our mission of "right
care, right place, right time." We believe that this model of
integrating 999 and 111 services on the same platform, supported by
a capacity management system and well-populated directory of
services, best delivers a "whole-systems" approach around what
There is still work to be done, particularly in keeping
the directory of services well-populated, but until NHS England
bring some stability into the 111 system across the country, we
will undoubtedly continue to hear from the critics. It is
unacceptable when there is evidence of poor service delivery and
our hope is that Channel Four's Dispatches programme will
go some way towards putting an end to those providers who cannot
deliver a safe service to patients.