NHS 111 'unlikely to lead to emergency care savings'
There is only a one in five chance of NHS 111 saving the NHS money on urgent and emergency care and a likelihood it will drive up demand for ambulance services, an evaluation has found.
Researchers from Sheffield University’s School of Health and Related Research analysed performance in the first four sites to pilot the non-emergency telephone number to calculate the NHS was likely to face additional costs of £3.7m a year.
Across the four sites studied – Durham and Darlington, Nottingham, Luton and Lincolnshire – the monthly financial impact ranged from a saving of £118,000 to an additional cost of £733,000.
Researchers also found a statistically significant increase in emergency incidents attended by ambulances in the pilot areas
There was no statistically significant impact on other parts of the urgent care system when compared with control areas. However most areas in the pilot saw an increase in attendances at emergency departments, GP out of hours systems and 999 calls.
Unison national officer for NHS Direct Michael Walker told Nursing Times the report was a “complete vindication” of the concerns expressed by the union about the impact of replacing NHS Direct’s 0845 number with a service using fewer nurses.
Former health secretary Andrew Lansley’s decision to roll out NHS 111 nationwide by April 2013 has been criticised by unions and professional bodies for being rushed.
British Medical Association NHS 111 lead Peter Holden said: “I remain very concerned that we are rolling out a new national programme which, in the words of [NHS chief executive Sir] David Nicholson is mission critical, when we have no idea whether it will cost us money or not.”
Matthew Cooke, DH national clinical director of emergency medicine, told Nursing Times it was difficult to draw definitive conclusions early on in a new service.
He said the national rollout would increase use of NHS 111 through a national marketing campaign advising people to call the number rather than going to A&E.
“It’s a catch 22: if we don’t roll it out nationally we won’t get the full effect of it,” he said.
An economic forecast by the Sheffield researchers found a national rollout coupled with savings from decommissioning NHS Direct’s 0845 number had the potential to lead to savings. However, it warned this analysis was based on “considerable assumptions and limited cost data”.
For example, start up costs for NHS 111 were not available to researchers due to the procurement processes ongoing at the time of writing while decommisioning 0845 would mean NHS 111 receiving a more varied type of call.
Professor Cooke said the service was providing other benefits through identifying gaps in provision through the directory of services and providing a “catalyst” for the creation of local urgent and emergency care networks.
The report was originally due to be published in July, which would have been before a number of contracts were awarded. Professor Cooke said the delay was caused by the steering group set up by the Department of Health to oversee the research asking researchers for more information but interim reports were available.