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NHS: 111 Telephone Service

Volume 745: debated on Monday 13 May 2013


Asked by

To ask Her Majesty’s Government what steps they are taking to improve the implementation of the NHS 111 service.

My Lords, I beg leave to ask the Question standing in my name on the Order Paper and refer noble Lords to my health interests in the register.

My Lords, we recognise that the NHS 111 launches in March did not go as smoothly as planned and that a number of providers have delivered an unacceptable service, especially at weekends. NHS England is working closely with clinical commissioning groups to stabilise providers who have failed to deliver an effective service and to ensure that areas yet to go live are in a safe and fit state to do so.

My Lords, I am grateful to the noble Earl for that response, but on what grounds was the decision made to go ahead with the national rollout in the light of the results from the pilots, which showed problems with the scheme, and the fact that many people in the NHS advised Ministers and NHS England not to roll it out because it was not ready?

My Lords, the University of Sheffield did work for the department reporting on the first four NHS 111 pilots. That showed that 92% of patients were satisfied with the service and that 93% felt that the advice given was helpful. It also found that, overall, the service was meeting its objective of getting people to the right place first time. On that basis, it was considered safe to go ahead with a rollout. Unfortunately, in particular areas of the country, the resources deployed to meet the demand have not been accurately assessed, but I stress that that is in a minority of locations.

My Lords, does my noble friend accept that if the Government were to take firm action and turn back the clock to require general practitioners to provide seven days a week, 24 hours a day comprehensive and efficient service, demands on 111 would greatly decrease?

My noble friend, with his experience, is very wise on these matters. I think it would be quite difficult to turn the clock back completely, but I take his point. There is enormous scope for GPs to contribute to the drive to keep elderly, frail people in particular out of hospital. Too many people are landing up in hospital with chronic diseases who should never have been allowed to get there.

My Lords, the Minister has just stolen my thunder in his response to the noble Lord. Does the Minister have any idea when the failings in the system will be sorted? At the Barnet and Chase Farm Hospitals NHS Trust, of which I declare an interest as chair, we see extra people coming into A&E who, as he has just said, are very poorly and should not really be in hospital because they need antibiotics or something like that and would get better much quicker either in their own home or in a nursing home.

On the issue of A&E, there is no doubt that the NHS has been under very heavy pressure over the past few weeks. I am pleased to say that over the past two weeks the NHS as a whole has met the 95% standard, but obviously that statistic masks difficulties that are still being experienced in particular locations. The challenge now is to ensure that we are ready for next winter, and all the work that is now being done in NHS England, by clinical commissioning groups and within providers is designed to ensure that we are much readier for the pressures to come.

My Lords, does the Minister accept that, although we refer to “primary care services”, they are not primary in that they are available for the shortest number of hours per week of any part of the health service? Unless things change dramatically, it is inevitable that accident and emergency will be seen as the first point of call for more and more people, especially in out of office hours.

I take the noble Lord’s point. That is why the 111 service has been created; there is no doubt that there was a very confusing landscape in which people did not know who to call out of hours, and they did not necessarily have the telephone number of the out of hours provider in their area. The 111 service is designed to simplify all that, and across the vast bulk of England people are getting a good, if not fantastic, service. Unfortunately, in two areas of the country, the south-east and the south-west, we are still seeing problems arising, and those are being gripped.

My Lords, the out of hours services, the ambulance services, A&E and these 111 services need to work in a harmonious and co-ordinated way for the good not only of the patient but of the service as a whole. Will the Minister reassure the House that the 111 service will be part of the review of urgent and emergency services being led by Sir Bruce Keogh?

I am very glad that my noble friend has raised that issue. Sir Bruce Keogh is indeed looking across the piece at urgent and emergency care services, and that will include the way in which 111 is working.

Does the Minister accept that Sir Bruce looking at these questions is not necessarily a comfort? Sir Bruce looked at accident and emergency services in south London but, based on what the Minister has said today about the pressure on accident and emergency services, Sir Bruce came to the wrong conclusion about Lewisham accident and emergency.

My Lords, I hope the noble Lord will understand that I cannot comment on Lewisham because it is sub judice. I do not accept that the advice that Sir Bruce gave was ill founded.

The Minister said that there had been confusion in the past. There is even more confusion now. Does he not agree that there should be some publicity for the general public so that they know where to go?

I agree. NHS England and clinical commissioning groups are engaged in that publicity. I think it will be a while before the general public are fully aware of what NHS 111 has to offer, but I have in my brief a series of very complimentary testimonials about 111 that show that many members of the public are already enjoying its benefits.

My Lords, would the Minister accept that many people who are not directly involved in the health services find it quite hard to understand why NHS Direct was dismantled in favour of the 111 service, which has clearly not been working terribly well? Does he agree that the fact that this change has not succeeded tremendously well does not give one great confidence that other changes that appear to have been relatively unnecessary will go through successfully?

I agree. It is unfortunate that the launch of this service was not nearly as satisfactory as was planned. The adverse performance in certain areas of the country has rather overshadowed the very good, if not excellent, performance in other areas, so while not belittling the issue the noble Baroness raises, I think we have to get it in proportion.