NHS 111 – Improving efficiency or destroying the ‘brand’?

In a recent post we talked about the push for patients to take responsibility for their health and their use of healthcare services, working in partnership with healthcare professionals to ensure that they receive good quality care.  As I discovered this weekend, however, that it is almost impossible to do this if you find yourself in the position of needing to access out of hours GP care, via the NHS 111.  Such is the state of crisis in the NHS, it is almost as if the vultures are circling, looking to pick over the corpse of a national healthcare system. That is not the intention of this post. Rather I want to draw attention to the poor performance of private sector providers, commissioned to provide services like NHS 111. These companies, often driven more by financial bottom-lines than patient care, rather than alleviating pressure on professionals, with poor levels of performance are actually creating additional burdens upon statutory providers. This is the real scandal of NHS 111.

Take what happened to us. When your child has a cochlear implant it is made clear that ear infections need to be treated immediately and aggressively with antibiotics because of an increased risk of the infection causing meningitis.  So when our son complained of ear pain on Sunday evening we decided, with some trepidation, to make an appointment to see the out of hours GP service.  (On a previous occasion we had attended the out of hours service, run by Harmoni, for the same reason and been asked by the doctor what the things on our son’s head were.  On explaining that they were cochlear implants we were asked what they were for…).

Out of hours care can be provided by the local GP service or through the area out of hours team.  Our area of the country is one of many where there is no longer any direct access to the out of hours care team, Harmoni, who can only be accessed now through NHS 111.  NHS 111 was introduced through the 2010 Department of Health White Paper “Equity and Excellence – Liberating the NHS” as part of plan to introduce a country wide number (111) to ‘improve and simplify access to non-emergency healthcare for patients by providing access to a full range of services including referrals into community, primary and secondary care services’.

In reality, this system is neither excellent nor liberating, patients no longer have direct access to an out of hours doctor and need to respond to a series of questions asked by call handlers who often have no more medical expertise than the patient themselves.  An internal review was launched in May last year when it emerged that serious failings may have led to three deaths, and a Harmoni manager in Surrey was quoted as saying “We had a very bad service. Realistically, on the weekends we still are unsafe. We don’t have the staff to deal with the calls that are coming in”.  NHS 111 was brought in to replace NHS Direct which was too expensive as it was staffed by nurses.  Now we have a service staffed largely by people with no medical qualifications at all.

I phoned 111 on Sunday evening at 10pm and explained that I needed an out of hours GP appointment as my son had an ear infection and cochlear implants. I was told that I needed to answer some questions so that I could be directed to the right service.  On explaining that I knew which service I required I was told that the GP service could only be accessed once the questions had been answered and if I wanted to be seen more quickly I could attend A&E.  I explained that I did not need A&E and did not want to waste their time and resources unnecessarily and duly answered the questions asked.  20 minutes later I was called back by a paramedic to discover that the fact that my son has cochlear implants (the whole reason for the urgency of the call) had not been recorded in the notes by the original call handler. We were booked in to be seen in the urgent slot – within 2 hours – and ensured we would receive a call within 20 minutes giving us an appointment time.  50 minutes I chased this up with a further call to 111 to be told by yet another call handler that we were still within our 2 hour slot and to go to A&E if we didn’t want to wait.   At 2am (4 hours after the original call) we received a call from the out of hours GP, by which time our son was asleep and we had, after extensive internet research, decided it would be quicker and safer to see our own GP in the 8am emergency walk in clinic.

The NHS 111 service was designed, amongst other things, to reduce pressure on ambulance and A&E services, and yet even after making clear that this was an urgent case but not an emergency, we were told twice if we wanted to be seen more quickly we should go to A&E.  This ties in with the findings of the Channel 4 Dispatches programme and extensive coverage of the increase in use of A&E services following the introduction of the privatised NHS 111, and Harmoni in particular, who have a third of the hotline contracts in England, as gatekeepers to out of hours services.

At a time when we are inundated with media stories about the crisis in the NHS, highlighting NHS failings, long waits, A&E services close to collapse and poor quality care, it is worth focusing in on who is providing and managing the services that are failing.  In the case of NHS 111 a mix of private companies and private/public partnerships, often with track records of poor quality care, are acting as gatekeepers to our NHS.  This raises yet more questions about the government’s agenda, privatisation by stealth and a strategy of destroying the publicly funded parts of NHS from within