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Michael White: Hanging up on NHS 111

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Can a TV documentary like Monday night’s NHS Undercover in Channel 4’s Dispatches spot still sink a government service like the 111 helpline in such a distracted age of multifaceted digitalised media?

 

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Not on its own. But with the health service already under siege and Fleet Street whipping up a storm of public disquiet anything can happen. It’s the silly season too.

‘Peers were still around and Lord Phil Hunt led a 111 charge against Lord Howe on Monday afternoon’

So the timing of NHS Direct’s decision to abandon all 11 of the contracts it won to run great chunks of the new helpline − underpricing its bids in a panic attempt to rescue some of its previously successful service from Whitehall meddling − couldn’t be much worse. It came on the very day that Dispatches targeted failings (“we are unsafe”) by rival contractor Harmoni. Do I hear a fresh patient stampede towards A&E?

Busy signal

At least MPs are safely away from Westminster, ministers must have murmured. Whoops! Peers were still around and Lord Phil Hunt led a 111 charge against Lord Howe on Monday afternoon. “We warned you this would happen,” critics protested. “We listened to your warnings and offered contractors an extra six months to bed in NHS 111,” Lord Howe replied. But only two took up the offer.

“The NHS 111 service is not unsafe − it is a safe service. In the vast majority of the country it has been provided very well for patients,” the normally cautious peer boldly assured colleagues.

‘Freddie Howe did not play the Labour alibi card, as some Tory MPs have tried to do’

That claim may come to haunt Jeremy Hunt’s team if NHS Direct’s contracts are not quickly picked up and public confidence restored. It will not be easy.

This column’s acceptance of the need for greater diversity in the provision of healthcare services has always rested on the assumption that the private and voluntary sectors will sometimes fail − just as the public one does − but that we will learn from their failures as well as successes.

Serco, G4S, Sodex, Capita; the liberal media is now on the case of private providers of “outsourced” services − I prefer that term to “privatised” − that are better at bidding than providing and quick to plead “commercial confidentiality” to cover up their misdeeds and financial miscalculations. The Tory media favours outsourcing, but is a fair weather friend. The Melanie Phillips brigade sounds glib and unconvincing.

Call waiting

In fairness to Freddie Howe he did not play the Labour alibi card, as some Tory MPs have tried to do. Not guilty this time. Yes, in its 2010 manifesto Labour did promise to create an NHS 111 system, but as a mere call handling system designed to pass patients on to the right part of the system, usually to the clinical service offered by NHS Direct, possibly to their local GP or out of hours service.

‘There are good value for money ideas struggling towards the light here. But ministers should remember: markets have their limits too’

“The aim was to simplify out of hours care and stop inappropriate 999 calls,” Andy Burnham has been reminding colleagues. Urgent care patients would have two entry points: 999 or 111. “111 will not replace… NHS Direct” (Labour press release, 18 December 2009). But Andrew Lansley announced on 29 August 2010 − barely three months after taking over − that 111 “will eventually replace NHS Direct”.

But not very well if Dispatches findings about ill trained staff, poor auditing and rackety judgement proves correct. The programme sounded level headed to me. What else are ill equipped, non-clinical employees clutching a pathway script going to do under pressure from distressed patients but play it safe and dispatch an ambulance, often at needless extra cost to the NHS budget?

As with the reshaping of A&E into a more focused three tier service, there are good value for money ideas struggling towards the light here. But ministers should remember: markets have their limits too.

Michael White writes about politics for The Guardian

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