NHS 111, with Stephen Dixon on Sky News
On the record 111 month of August 2018: a good option inside a struggling system, the call-centre staff carrying it, and why the two emergency lines need to talk to each other.
A note before the recording. It refers to a death by suicide. If you are affected by anything here, Samaritans listen day and night, free, on 116 123 and at samaritans.org. Following safe-reporting guidance, the transcript does not name the person and carries no detail of method; the recording, preserved as it went out in 2018, does mention the method, so watch with care.
On the day
August 2018 was a record month for NHS 111: nearly 1.2 million calls in July, and the service was the story. I had been talking with call-centre staff only the night before, so when Stephen asked whether 111 was a good way into the health service, I wanted to answer about the whole system: the option is worth having, but the people staffing it were carrying an underfunded service, and the two emergency lines still did not talk to each other. It is the same thread that runs through everything I said on air in those years: look after the people delivering the service, and be honest about the system around them.
What I said
The presenter’s questions are paraphrased. My answers are my own words from the recording, lightly edited for reading clarity; the passage referring to a death is rendered per the note above.
Stephen Dixon paraphrased, from 0:00
Had you ever used 111, the NHS helpline? A record number had: very nearly 1.2 million calls answered in July, and NHS England said over half of calls received input from a professional clinical adviser, the highest proportion since the helpline was introduced. Was the service reducing pressure on the rest of the health service, and was it a good way in for people to get access to health advice?
Dr Kishan Rees from the recording, 0:32
It’s certainly proving popular. I think it’s a good option, but I think we have to look at it in the picture of the overall service. If people are struggling to get GP appointments, and they’re struggling for A&E, then that might be why there are a lot of calls going to NHS 111. So yes, it’s an option, but I think it’s part of an underfunded system that’s struggling, basically.
Stephen Dixon paraphrased, from 0:55
There was no political argument about the system struggling, because it is. But as an option, was it proving a sensible one: were people getting the correct advice, and the correct people getting through?
Dr Kishan Rees from the recording, 1:11
I think in some cases yes: some patients that use it get a good service. But equally, I’ve thought about this previously as an A&E doctor, and when I see patients, from those two perspectives. It was only last night that I was talking to some of the staff in the call centres, to find out the real struggle some of them have in terms of training. Absolutely horrific working conditions: you can imagine working in a call centre and getting shouted at when people’s health is on the line, and people having to wait hours for ambulances and getting really annoyed at that. So I think there are problems with the service. I’d say, over the weekend, if people ring the service and it helps and it works, that’s great, that’s fine. But if you’re ending up waiting hours for a callback, or hours for an ambulance, don’t delay: go to A&E, go and see a doctor.
Stephen Dixon paraphrased, from 1:59
But presumably that was the advice 111 itself was giving out: go through the checklist, and if there was any real concern about someone’s immediate condition, they would be told to go now.
Dr Kishan Rees from the recording, 2:16
Well, it’s interesting: some of the problems are around this checklist. I was speaking to some nurses, experienced nurses, and they’re not allowed to deviate from the algorithm. And you can have patients that phone 999, and 999 says no, you don’t need an ambulance; and in effect the same patient phones 111, and then the ambulance is dispatched from 111. So we need both systems to communicate with each other, and I think that’s really important, especially with this NHS app that’s coming. There’s a book, The Blunders of Our Governments, talking about how the NHS Direct service was scrapped and 111 was brought in without any evidence. And actually, going back to your first point, there were papers in the first year saying that it might drive use, it might drive people, to an already struggling service, which I would say is being failed by successive governments.
Stephen Dixon paraphrased, from 3:05
But there was no evidence of it driving use to A&E, was there?
Dr Kishan Rees from the recording, 3:09
There is, yeah. There were BMJ open-access papers, one year and two years after first use, saying that services like this may drive use to an A&E service.
Stephen Dixon paraphrased, from 3:23
So what was the alternative: scrap 111 and just let people cope?
Dr Kishan Rees from the recording, 3:30
Definitely not. Have it as an option, of course. But we need an appropriately funded GP service, where GPs are working in conditions where they are living healthy lives themselves, and the same for the A&E doctors and the call-centre staff in NHS 111. Some of the stories I’ve heard, in terms of managers shouting at them, supervisors just being interested in statistics. There was a tragic case in January of a call-centre worker who died by suicide in the middle of a shift, after four 12-hour shifts. That is just absolutely horrific. So if we’re putting call-centre staff under that much pressure, and experienced nurses are struggling to use their clinical acumen with these algorithms, then I think we need to think about how the service is run.
Broadcast by Sky News, 25 August 2018; this copy from the WatMed Media archive, my own upload. Words verbatim from the recording, presenter questions paraphrased; happy to amend or remove on request.