NHS 111 Service – our readers comment…

Breaking News (July 29th) - NHS Direct to pull out from all NHS 111 services. 

 “NHS Direct is seeking to withdraw from the NHS 111 contracts it entered into as these have proved to be financially unsustainable. The Trust will continue to providea range of we b, mobile and telephone services for patients which complement NHS 111 and support the NHS. These services are unaffected by the discussions currently taking place”.


Last week we published an article about the NHS 111 service (which you can read here), and received some interesting points in the comments, so we thought we’d take a look at some of them.

An anonymous commenter began to answer some of the questions we had raised in the article, with a few interesting figures:

“To answer your questions, 2/3rds of calls are diverted away from NHS direct 111 services to GP out of hours providers and old NHS Direct contingency … The call forecasts have actually been fairly good for a new service but as each call is taking twice as long staffing requirements go through the roof and the £7-£9 per call is not enough to cover costs. “

They also gave a link to an NHS Direct 111 ‘Go Live’ Review, which suggested that we shouldn’t be pointing our fingers at the commissioners. A second anonymous commenter, who claimed to have worked on one of the NHS 111 pilots for about 18 months (including procurement and implementation) agreed that the commissioners were not at fault, and instead thinks the Department of Health are to blame:

“In the real world the Commissioners may well have decided to scrap the whole thing and start again. But it was not the real world and the situation NHS 111 is in now is not the fault of commissioners or providers … like everyone else experiencing the new world order in health, the culprits were the Department of Health and their regional arms … Too little time, too little attention until too late – too often the narrative of change in the NHS.”

However, Trevor Black believes there was no hope for the service to begin with:

“There is a big difference between having a well-constructed and considered business case and a politically driven good idea. Those pointing out the potential failings in the political driven environment are side lined which places those with the professional abilities (who don’t speak up) having to consider carefully how they can survive in that arena. The NHS 111 project is doomed to failure as it is outside of the mind-set of the public and was just another of those ill thought out ideas.”

But defending the service, the first anonymous commenter also made an interesting point, that maybe this cause for concern really is just short-term:

“Can anyone else do it for that price? Maybe over time, but until the call scripts are shortened, systems and processes are tightened up everyone will be losing money.”

But then this also raises a good question which bitter and twisted asked:

“Why start from scratch, why not just improve the existing NHS direct service?”

To end on a slightly lighter note, bitter and twisted also amused us with his programming skills and this comment:

My IT skills are a bit rusty, but I’m sure this can be easily updated

10 Print ‘Welcome to 111′

20 Input ‘Are you really ill?’ X

30 IF X = ‘Yes’ then Go to 60

40 Print ‘Please contact your GP for an appointment. But if you’re really not sure, go to A&E.’

50 End

60 Input ‘Have you got chest pains, and/or a head injury, and/or a non-blanching rash, and/or a pre-existing life-threatening medical condition?’, x

70 If x = ‘yes’ go to 90

80 Go to 40

90 Print ‘Please go to A&E’

100 REM Copyright bitter and twisted medical solutions LLP, 2013

110 On Error print ‘All our lines are engaged. Please call again, or go to A&E’

And thanks as always to everyone who reads Spend Matters and particularly all our valued commentators!

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Voices (2)

  1. Dave Orr:


    “If it ain’t broke then don’t fix it” – Bitter and Twisted was right!

    The savings of NHS 111 over NHS Direct (who employed more people with actual medical qualifications) must be insignificant, compared to the costs being shunted on to A & E..

    The NHS 111 looks to be an assembly line “factory” answer, designed to undercut the costs of NHS Direct. Mechanised LEAN?

    Hire in generic call centre advisers without any formal medical training or qualification and rely on some whizzy IT with “intelligent” scripting and what could possibly go wrong? Lots is the answer.

    Key question is who was hired in to draw up the specification? Were they a bunch of accountants from one of the big consultancies or a large public sector outsourcing provider or a large multinational IT setup? We need you to find out Peter!

    NHS 111 shows that an early point of contact needs your best qualified staff for triage, not a generic call centre adviser with a script and some whizzy IT.


  2. Market Dojo e-Sourcing:

    Imagine if this contract had been agreed after a reverse auction process, there would be all hell breaking loose! Just goes to show that the reverse auction is just a red herring, it’s the way that the contract and commercials have been drawn up that are the crux of the issue. Surely a risk register should have been drawn up, exposing the sensitivity anaylsis to the length of a phone call and the number of staff required? Oh dear.

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