The NHS 111 telephone advice service is sending growing numbers of people to A&E or calling an ambulance because its staff are too risk-averse when dealing with illness, a study has claimed.
Critics claim the trend is adding to the huge strain on hospitals and ambulances that have left them struggling to keep up with rising demand for care.
NHS 111 now either sends an ambulance or recommends someone goes to A&E in about one in five (20%-22%) cases of the 1.1 million people a month who ring seeking help, according to the Nuffield Trust.
That is up from an average of 18%-19% over the three years since the service was introduced, research by the health thinktank has found.
NHS 111 replaced NHS Direct across England in late 2013 as part of the coalition’s shake-up of the NHS.
Nuffield Trust’s analysis of the health service’s performance statistics shows that during the course of 2016 a total of 1.46 million of the 11.8 million people who rang 111 seeking help were sent a blue light ambulance. Another 1 million were advised to go to A&E. Taken together, that meant that almost 21% of calls overall were disposed of in one of those two ways.
“This report is further evidence that the NHS crisis this winter, and in particular the record A&E attendances, are the result of a catalogue of bad choices by the government,” said shadow health secretary Jonathan Ashworth.
“The decision to scrap NHS Direct and replace it with the NHS 111 was strongly criticised by health professionals, and today we have learned that NHS 111 is sending more callers, and a higher proportion, to A&E than in previous years, with great variations in performance across different regions.”
The thinktank has also uncovered “great variability between different areas in how likely NHS 111 is to send people to A&E or to the ambulance service”. The report says: “This might suggest that some areas are to likely, or not likely enough, to send people to emergency services.”
For example, while 12.4% of callers in east London and the City were sent to an emergency department, the 111 covering Cornwall did that with just 5.7%.
“These numbers are yet another sign of the unbearable pressure our health system is under,” said Norman Lamb, the Liberal Democrat health spokesman. “Whichever part of the system you look at it’s now at breaking point.
“But it also appears the overly cautious algorithm used by 111 call handlers is increasing pressure on already overstretched ambulance services and A&Es.”
The Nuffield Trust points out that “NHS 111 is more likely to despatch an ambulance than to simply send people to A&E, which is the reverse of the usual pattern of NHS use”, adding: “This lends credence to claims that the service is too risk-averse in some cases.”
That echoes concerns raised privately by many of the 10 NHS regional ambulance services that NHS 111 services too often practise “defensive medicine” and order an ambulance to take someone to hospital unnecessarily, which increases the pressure on them.
The 42 regional NHS 111 services are run by NHS ambulance trusts, groups of GPs and private firms such as Care UK, which has recently won more contracts. It uses far fewer nurses and many more call handlers than NHS did until then health secretary Andrew Lansley scrapped it.
However, the study also found that, paradoxically, NHS 111 is also reducing the pressure on A&E and ambulance services and successfully redirecting callers to GP surgeries and other services outside hospitals. While 45% of callers say they would have gone to A&E or dialled 999 if 111 had not been an option, call handlers send only around 20% of patients to them. Likewise, while a third of users said they would have gone to community-based services if 111 had not existed, the service itself sends about 60% to them.
NHS England said that NHS 111 is performing well amid rising demand for its advice. “The increased number of people referred to emergency care is proportionate to the higher number of calls being handled,” a spokesman said. “111 continues to do an important job helping patients to get the right care, at the right place and at the right time, and in protecting both A&E and ambulance services from unnecessary attendances and callouts.”
"Risk-averse" NHS 111 sends more callers to A&E than previous service
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