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NHS 111 continues to miss national targets

NHS 111, the non-emergency medical helpline, has only been able to meet the national standard for answering calls in 60 seconds on four occasions in 2014, new figures reveal. 

The national standard of 95% was only achieved in the months of January, February, August and September. 

According to NHS England’s latest figures, in November 2014 only 90.6% of calls were answered within 60 seconds, significantly less than the 94.7% recorded in October. 

In a week where numerous hospitals have declared major or significant incidents, as they struggle to cope with severe demand for their services, NHS 111 and its referral process has come under fire. 

Dr Mark Porter, BMA council chair, when discussing the pressures put on A&E departments, said: “Calls to the NHS 111 line, which is intended to help those who want medical aid but do not need emergency response, too often result in ambulance response and admission to A&E.” 

He added that the NHS 111 number was designed to make sure that NHS resources are used effectively – however, without the appropriate information, it is not always possible for the operators to differentiate between what is and isn’t an emergency.  

The latest figures revealed that in November there were 1,084,219 calls to the NHS 111 service, equivalent to 36,100 per day, or 13 million per year, slightly more than the previous highest value of 36,000 per day in April 2014. 

Of the calls answered in November, 84% received triage, slightly less than the 85% recorded for each of the previous 10 months. Calls not triaged include when callers are referred on to another service, or are following up previous calls, or when callers abandon the call before triage could start. 

The calls that received triage in November comprised 10% where ambulances were dispatched, recommendations to primary care (54%), A&E (6%) or another service (3%), and 13% where no other service was recommended. For October 2014, these figures were 53% primary care, 7% A&E, 14% no service and otherwise the same. 

Professor Keith Willett, director of acute care at NHS England, said: “NHS 111 is currently delivering a high quality, robust and safe service across the country, in spite of experiencing an extraordinary level of demand. 

“Although there has been a massive surge in demand for NHS 111 services, every effort has been made to ensure that patients received appropriate clinical advice, improving the healthcare options for millions of people around the country.  The proportion of callers who were referred to A&E departments and ambulances actually fell during this period and NHS 111 number played a major part in addressing patients' needs and helping to reduce pressures on other parts of the national healthcare system. 

“We are carefully monitoring the pressure placed on NHS 111 service providers around the country and the significant increase in demand that the service is experiencing is testament to the success of the NHS 111 number as the first point of responding to  people's non-emergency healthcare needs.” 

But speaking to the BBC earlier this week, Dr Clifford Mann, president of the College of Emergency Medicine, said that part of the reason for the surge in A&E demand was the NHS non-emergency line 111 advising an increasing proportion of people to seek emergency care. 

The NHS 111 service, which is staffed by a team of trained advisers, supported by experienced nurses and paramedics, is aimed at making it easier for patients to access local NHS healthcare services in England. 

On average, 29% of call time was handled by clinical staff in November 2014, the same as October 2014. However, only 21 of the 45 sites provided this information in November. 

But Suzanne Mason, professor of emergency medicine at the University of Sheffield, told The Times newspaper that the number of patients sent to A&E at the weekend by NHS 111 is a “huge problem” and that parts of the country had been “brought to their knees” by it. 

“There are certain times of day and days of the week when call handlers get to the bottom of the algorithm and look at what services are available locally and there isn't anything there,” she said. 

In addition, the chair of Healthwatch England, Anna Bradley, stated that the latest A&E admissions figures highlighted that in Gloucestershire, for example, nearly one in three of those turning up are doing so with non-urgent needs. 

She said: “The question is why. Is it all down to problems getting a GP appointment, is NHS 111 simply referring too many cases to A&E that could be sent elsewhere? 

“It’s time NHS bosses stopped telling people they are going to the ‘wrong place’ and did more to understand why patients are resorting to A&E and address the underlying issues.” 

(Image: c. London Ambulance)

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