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Exclusive: senior nurses who warned 111 service was unsafe were ignored

Senior nurses at NHS Direct warned colleagues and commissioners it was not safe to go live with the new 111 service in the West Midlands, but were over-ruled, Nursing Times has learnt.

A series of emails seen by Nursing Times reveal the views of senior figures at NHS Direct and NHS England involved in the decision to press ahead with the launch of the non-emergency phone service in the West Midlands area in March, which had been delayed since February.

They record NHS Direct director of nursing Tricia Hamilton saying the service was unsafe due to the high rate of predicted abandoned calls, and NHS Direct regional director for the West Midlands Pam Bradbury, a nurse by background, telling colleagues she was “very uncomfortable reassuring commissioners that we have the staffing levels right”.

The service was subsequently pulled in some parts of the region days after the launch on 19 March, as staff were unable to cope with demand.

In one of the emails, director of operational support Sean Flynn recollected the conference call during which the decision was taken to go live. He said: “Tricia Hamilton said something like: looking at the figures she thought it unsafe.

“[But director of strategy and business development Ruth Rankine] reminded her of the position we had created by not going live on time… Eventually a decision was made that we would go live.”

NHS England’s NHS 111 project director in the West Midlands, Wayne Bartlett, also took part in the phone discussion.

An NHS England spokeswoman said the decision to go live was taken “after very careful consideration of the balance of risk in the urgent care system across the region”. For example, she noted a planned reduction in call handlers at GP out-of-hours services was already underway even though 111’s launch had been delayed.

A spokeswoman for NHS Direct said: “The biggest single cause of the capacity shortfall at launch was the unexpected length of the calls – which reduced the number of calls that could be handled by the staff and led to the unacceptable waits for calls to be answered on that first weekend.”

Earlier this month NHS England said NHS 111 was “steadily improving” following its chaotic launch. It quoted data for April showing 92% of patients were “very” or “fairly” satisfied with their experience of using it.

However, 66,000 of the 514,000 calls answered in April took more than a minute to answer, and the service has still not gone live in several areas, including Great Manchester and Devon.

Readers' comments (6)

  • Debacle

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  • We used this service the other day for an elderly lady in the Nuneaton/Bedworth area. She was unable to move or get herself a drink. The operator would not actually talk to us, and we had a rigmarole of trying to get the lady to phone the service herself. The operator then repeatedly told her to go to the walk-in centre, which she was unable to do. In the end our own team of volunteers decided to sort it out themselves, and are taking it in turn to support this lady. As a nurse I am not encouraged by the lack of concern for an elderly lady who was in obvious distress, and I say well done to the Salvation Army for their valuable input in this matter.

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  • Zoe Cassidy | 20-Jun-2013 8:52 pm

    this lack of concern, expertise and listening to the needs of the caller is extremely worrying and especially as not everybody has the benefit of the intervention of nurses.

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  • tinkerbell

    well done Zoe. At least you made a difference for one person. The Big society? an army of volunteers picking up the slack?

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  • Working in A&E I am appalled by the huge volume of 'well' people who are sent in by 111. Examples include a child with a temperature of 37.8, a child with a cough for a week, a child with a splinter in his finger.
    The time taken up with children who should be cared for by parents [or at most by a GP] is delaying care for seriously ill children.

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  • I think that there should be a pilot trial of such a program as this one which seems to have been out of control since it became operational. There should be lots of public feedback before it can be expanded. It seems that their is a gap between the person making the decisions at the top who says that the data showed that the staffing levels were sufficient and the "boots on the ground" as I call health care workers and nurses who are left to deal with the tremendous workloads and lack of support from the top. This is pervasive in the NHS and I think that nurses should have a hot line or email your newspaper when they feel that they are caught up in a potentially dangerous situation for patients and thus putting their licenses at risk also.

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