111 causing more trouble than it's worth

Teetime NHS Direct wasn't abandoned because it was "sending everyone to A&E". It was abandoned in an attempt to save costs by reducing staffing costs. According to an article in the Guardian in August 2010, "forty per cent of NHS Direct's staff are trained nurses, but anyone dialling 111 will speak to non-specialist "call advisers" who have completed a 60-hour course rather than a degree...."

In September 2013 a report - "Impact of the urgent care telephone service NHS 111 Pilot Sites on a controlled before and after study" was released:

"Conclusions In its first year of operation in four pilot sites NHS 111 did not deliver the expected system benefits of reducing calls to the 999 ambulance service or shifting patients to urgent rather than emergency care. There is potential that this type of service increases overall demand for urgent care."

There is now strong anecdotal evidence (two examples are given above) and also, I believe, statistical evidence to support the contention that NHS 111 bears some responsibility for the inappropriate use of the emergency services.

While DD was here over xmas she called 111. She had sprained her ankle a few days before coming up, and had developed pins and needles that wouldn't go away. She googled it and every site said 'go to A&E if you have persistent pins and needles'. So she rang 111 and after various calls, each giving her differing advice and ring-backs, a doctor called her - and told her to see her own doctor when she returned home! She must have spent two hours on the phone for that. As it was late on a Friday night by then, she didn't really want to go to A&E anyway, so we just strapped her and iced her and treated her ourselves.

She went to her own doctor, and even he couldn't explain the pins and needles phenomenon apart from her having perhaps trapped a nerve because of the swelling, but we did find the whole process rather unsettling and not at all reassuring.

At lunch in the village pub yesterday I overheard someone tell the others that one of the list of questions 111 operatives have to ask is "Are you conscious?"(now this may be apocryphal but never let that get in the way of a good story! )

That's the word I was searching for Mishap - an algorithm! NHS Direct used that as well, but with proper backup as I said.

This is why NHS direct was abandoned for sending everyone to A & E.; 111 was supposed to be better. In the bad old days if you were in difficulties you rang your GP surgery, were told the Dr on call number and you rang them, they advised first, asked you to meet them at the surgery second or if they thought it appropriate visited. Only rarely did they phone for ambulances. Now they are paid enormous salaries and cant be reached out of surgery hours. There are 14 GPs in our surgery surely they can get a rota together, they also have highly qualified Nurse Practitioners who could be on call - for a payment of course.

I used to work in the same building as NHS Direct and later the 111 service, while it was being piloted. NHS Direct calls were all taken by the same type of trained call handlers (unqualified) but there were Nurse Advisers available for follow up who could give self-care advice. The 111 service has far fewer nurses in service.

I believe the issue is not the staff, but the way the service was set up. NHS Direct was established with the clear aim of reducing A&E admissions, hence the emphasis on screening and self-care advice. I believe about half the calls taken were passed to a Nurse Adviser for a follow up call. The presence of these Nurse Advisers in the call centre also meant the call handlers could seek advice and were learning all the time.

The 111 service has no such aim, and far fewer nurses. The call handlers - who are trained to follow a computer system, just the same as NHS Direct - are therefore not under pressure to reduce referrals to A&E and they will inevitably play it safe for fear of getting it wrong. All of this was foreseen by the people I worked alongside in the very early days of 111. I'm afraid the government of the day got it wrong by taking a service that seemed to work quite well and changing it for one that is a mess.

On a personal note, I had a very good experience of 111 last summer. I had an insect bite that turned very nasty with my foot swelling like a balloon on Sunday afternoon. I phoned 111 and was given an appointment at the local treatment centre (community hospital), in and out with antibiotics within 30 minutes.

The absence of properly trained staff on the end of the phone seems to be the problem, but I guess that would be too costly - so we use up ambulance time and A&E time instead, which in itself is costly. The phone answerers just have an algorithm to follow and it seems that the end point is to send for an ambulance.

I gave up on them years ago. A shame really. But 111 staff are never doctors. They can miss things that are really important or over react.

I had a similar experience one Friday night. I am on Warfarin and a huge bruise appeared at the top of my leg. I wasn't particularly worried but the instructions told me to contact my GP.As it was after hours I rang 111 and was told I qualified for an emergency ambulance !! Within 30 minutes a young paramedic turned up followed by a big ambulance a few minutes later. The young man checked me over and said everything was fine. I said I felt very guilty about the 2 ambulances but he said it was quite common with 111. It is clerical staff who answer the phones. They have little or no medical knowledge and tend to panic .NHS Direct used to be answered by medical staff and was thus much more efficient. Talk about a false economy !

The 111 staff are probably afraid of being sued and are not qualified nurses.
If it's the Noro virus don't for heaven sake take the bug to a hospital, they don't want it either. 111 should be advising to take rehydration fluids instead and how to prepare them..

Recipes for rehydration fluids are all over the internet, or you can pay through the nose for them from your local phamacy. The right quantity of sugar and salt in the right amount of water is all it is,.

It's unpleasant yes but all anyone can do is to keep rehydrating themselves.