It is not a good week for NHS 111 – the coalition government’s new 24-hour urgent care helpline for England. In Monday’s (July 29) Channel 4 Dispatches programme (‘NHS Undercover’) the call centre in Bristol which covers Wiltshire was one of two Harmoni centres targeted by undercover reporters.
The private health provider Harmoni has contracts for one third of the NHS 111 contracts across England – including the one for Wiltshire and for Bath and North East Somerset (BANES). The rollout of this contract was set for April 1 but has been postponed while the two Clinical Commissioning Groups (CCGs) responsible for the contract makes sure the service is safe for patients.
Following the Channel 4 programme Wiltshire and BANES CCGs have put out a strong statement about their contract with Harmoni.
It states “…we are disappointed that the NHS 111 service we have contracted from Harmoni is still not providing the safe, efficient and effective service for the people of Wiltshire and Bath and North East Somerset we expect”. [See below for the CCGs’ full statement.]
In addition to the Channel 4 programme, the headlines in Monday’s television news bulletins and Tuesday’s newspapers highlight the withdrawal of NHS Direct from its eleven contracts for NHS 111. This move had already been signalled by Marlborough News Online.
NHS Direct provided the previous free telephone triage service but seems to have under-estimated the costs of the new service. It now says the contracts are ‘financially unsustainable’.
One commentator, Roy Lilley, who writes for NHS Managers, has been told that NHS Direct have been in talks with CCGs and NHS England to try and increase the money it gets for each contract.
The service is designed to run with a ratio of four ‘call handlers’ – also known as ‘Health Advisors’ – to one clinician who will be a nurse or paramedic. The Channel 4 programme mentioned the shortage of clinicians at the Bristol centre as one of the problems.
Other problems have been that calls are not answered fast enough and patients can wait far too long when a call-back from a clinician is needed.
The call handlers (who are not medically trained) use a computer system that prompts them with a series of questions to judge the seriousness of the caller’s illness. If in doubt they hand the call over (known as a ‘warm transfer’) to one of the duty clinicians.
Delays in making these ‘warm transfers’ has been of the worries facing Wiltshire CCG.
Some doctors have criticised the algorithms used in the computer programme. And one of the key problems during the implantation of the NHS 111 service has been call handlers calling out ambulances unnecessarily.
Examples have been reported of ambulances called out for a man with a hangover, someone with a cat scratch, a patient with a cough and someone who could not sleep.
Harmoni have published on their website a robust and detailed, 1,300 word rebuttal of the Chanel 4 programme. Harmoni insists that “Contrary to Dispatches’ claims, the NHS 111 service [Harmoni provides] is not only safe but is also meeting many of its non-safety related targets.”
And Harmoni says “Both our training and the qualifications of our staff are carefully monitored and follow NHS standards.” Their statement also states that the Bristol call centre is “…answering around 95 per cent of calls within 60 seconds – the target level set by the NHS…”
However, following the Channel 4 programme, Wiltshire CCG have today (July 30) put out a very strong statement about the service Harmoni is providing. It is worth quoting in full:
“NHS Wiltshire and NHS Bath and North East Somerset Clinical Commissioning Groups recognise that the NHS 111 service for this area is not to the standard it should be for people and patients. Whilst we have put in place additional contingency services to manage calls from particularly vulnerable patient groups or those needing to directly access the Out Of Hours Service [OOH], we are disappointed that the NHS 111 service we have contracted from Harmoni is still not providing the safe, efficient and effective service for the people of Wiltshire and Bath and North East Somerset we expect.”
“Since April, we have invested significant effort and worked closely with Harmoni, and other local providers such as the OOH service and the ambulance service to manage improvements in performance; this includes Commissioners meeting weekly with Harmoni to review a range of performance measures and working with them to rectify problems they encounter. As a result there has been some steady improvement in performance. However, we acknowledge that there remains more work to be done.”
“As Commissioners we will be meeting with Harmoni to discuss how further improvements can be made quickly and safely so that patients who need the NHS 111 will receive the appropriate care in a safe and timely manner.”
If anyone thinks running an NHS 111 service is a simple task they should look at the ‘Service specification’ (February 2012 version) for the south-west of England. It is very long and is headed ‘Commercial in Confidence’, but can be found here.