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NHS: 111 Service

Volume 769: debated on Monday 21 March 2016


Asked by

To ask Her Majesty’s Government what assessment they have made of the safety and reliability of the National Health Service 111 service.

My Lords, NHS 111 is a vital service helping people to get medical advice quickly and easily. It has received more calls this year than in the same period in 2014-15 but continues to perform well overall. The Care Quality Commission has announced that it will inspect all NHS 111 providers by September 2016. The CQC will assess whether the services are safe, caring, effective, responsive to people’s needs and well led.

My Lords, is not the problem that when the excellent NHS Direct service was replaced, very many experienced nurses ceased to work for the new 111 service and were replaced by call handlers with a few weeks’ training who have to follow instructions on a computer rigidly? The evidence is that there have consequently been misdiagnoses. One ambulance trust fiddled the response time for 999 calls routed through 111 to meet the targets. There have been a number of personal tragedies as a result. Therefore, in addition to the CQC’s inspection, will the noble Lord institute a review of the safety of 111 and return to having qualified nurses handling the calls?

My Lords, the decision to stop NHS Direct was, of course, taken in 2008, when I think the noble Lord was in post. He shakes his head, so perhaps he was not, but the decision was taken in 2008, before this Government were in charge, if you like. The new system uses the NHS Pathways algorithms developed by the Royal College of GPs, on which the BMA and the Royal College of Paediatrics and Child Health sit, so we have considerable confidence in the algorithms used. We will also increase the number of clinicians. I accept the noble Lord’s point that we need to have more clinicians answering these calls rather than call handlers, as he puts it. It is our intention progressively to increase the number of clinicians in these 111 hubs.

My Lords, I declare my interest as chairman of University College London Partners. What assessment did the Government make of the training needs of the individuals who were to deliver the 111 service prior to its introduction, and what determination have the Government made subsequently of the appropriateness of that training?

My Lords, as I said, the decision to set up 111 was made back in 2008. The operation of 111, which includes the training and the capabilities of the people working in it, is carefully monitored by the CCGs—which commission 111 services by the licence under which 111 operates the NHS Pathways algorithms—and, of course, by the CQC.

My Lords, is the Minister confident that the NHS England workforce development plan will ensure that no chief executive or senior NHS staff can support covert operations, as we saw with South East Coast Ambulance Service, which affected up to 20,000 people? Is the Minister confident that this will be put in place?

My Lords, the noble Lord will be aware of the very severe problems at South East Coast Ambulance Service. The chairman has resigned. The chief executive is, I think, on gardening leave at the moment. NHS Improvement is very clear that it needs to sort out the management structure in that ambulance service.

Will the Minister explain how the 111 service will be improved to ensure that ambulances for life-threatening conditions arrive in a timely fashion and are not delayed or cancelled by 111 call handlers?

My Lords, the 999 service runs in parallel with the 111 service. If you have an emergency, you should ring 999; if you have an urgent request you should ring 111 and a decision will be made then on whether to call an ambulance. Interestingly, of the 27% of people who ring 111 who would otherwise have gone to A&E, only 8% are actually referred to A&E.

My Lords, the Minister’s response is astonishing. Has he not been reading in the national media the repeated reports of a breakdown in the service all over the country? Has he not read these reports? I am astonished by his responses.

There have been a number of terrible tragedies. The most recent of these was William Mead, a very young baby who died as a consequence of not getting the right treatment quickly enough. NHS England has done a root-cause analysis. Some of the problems lay within 111 but others were with the out-of-hours service and with diagnosis by the GPs concerned. The noble Lord is wrong to say that the 111 service is not operating well throughout the country. Some 90% of all those who use 111 believe they get a good service from it.

My Lords, what suggestions does the Minister have for improving the performance of the 111 service?

My Lords, there are two things which we need to do to improve the 111 service. First—and this is in response to part of the Question asked by the noble Lord, Lord Hunt—we need to have more clinicians within the 111 hubs. Secondly, people need to have access to the patient’s electronic summary care record so that they can see what has gone on before coming to a final judgment.

My Lords, the Minister referred to 90% satisfaction. How many people are involved in the other 10%? It does not strike me that 90% is acceptable.

My Lords, 100% is clearly the only acceptable level but, realistically, it would be extremely difficult to get to that. Referring back to the charge of complacency, we recognise that significant improvements need to be made to the 111 service, but it can be a vital part of the way that we deliver urgent care in Britain.

My Lords, we all accept the Minister’s commitment to the NHS. He has just stated that improvements to the service need to be made. When are they going to be made?

My Lords, it may sound trite, but we need to make continuous improvement in all aspects of the NHS. We can never be satisfied with where we have got to. Interestingly, the licensing arrangement which underpins the NHS Pathways—the algorithm developed by the Royal College of GPs—has within it an audit to ensure that continuous improvement is being made.