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 needed.  

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.

 111 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 need it.


Why are ambulance services better at delivering 111 than others?

 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 operational experience.

 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 standards.

 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 patients understand.

 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.

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