The 111 number fiasco

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How was that supposed to work? It wasn't a premium rate number, was it? That would be bad, obviously. So what was the business model?

I'm not trying to make a political point. I am just baffled. Can someone please explain it?

What is 111?

No, it just wasn't very good. NHS Direct by phone wasn't terribly good either (lots of criticism from HCP organisations), though the on-line version was praised. This version was an attempt to relaunch a better version of the phone service. It hasn't worked.

I never phoned NHS Direct. Presumably even if you were a HCP you'd probably end up telling lots of callers to go to A&E.

I don't understand how you can make money out of it.

Presumably you can, but how do you that while keeping it safe and sticking to the idea that the NHS is free at the point of delivery?

Sorry, this is making me look really thick or a troll.

I'm neither; just really confused.

How is it supposed to work?

FAQs on what NHS 111 was meant to be plus info on what the problems are.

You don't make money out of people dialling the number. You get awarded a contract to provide phone advice in your area and then you bill back to the NHS based on the number of calls taken. There may or may not have been 'outcome measures' (I genuinely don't know) about number of callers diverted to more appropriate services, i.e. kept out of A&E if appropriate.

NHS Direct was a good idea and a lifeline for me as the mum of a small baby. I've probably used it more than most as I also have a chronically ill DH - in general I found it useful, if slow.

I had good experiences with NHS Direct. So fairly peeved at the 111 mess. Friend worked for NHS-direct, she was a well trained experienced & qualified Nurse Practitioner. But I think (?) people staffing 111 don't have to have any medical experience or qualification, they just work to scripts.

oh no, i stand corrected, at last that link says that 111 calls have to be taken by nurses. But the ratio of callers to nurses is higher under 111.

the 111 contracts are just another example of the Tories setting the NHS up to fail, so they can 'show' how much better private providers are.

when will people realise that the Tories hate the NHS and want to destroy it.

I used NHS direct several times when the DC's were small, no problems at all. They always called back within a few minutes and generally sent us to the OOH GP within the hour.

111 was a PITA the one time I had to use them. And they've closed our drop in centre so the OOH service is swamped.

You can't actually blame the Tories for this, or at least not the concept or basic architecture. The pilots began in April 2010 - a month before the general election.

From what I understand, it was a cost-cutting measure that has failed because NHSDirect can't afford to run it.

When you cut costs the service gets worse. Happens all the time.

I am in the Scottish equivalent service and was at that Dispatches programme on the Englidh 111 - particularly the lavk of clinicians .

No, but I think the general fragmentation of the services that appears to have ensued doesn't bode well for the selling off of bits of the NHS - which is a Tory policy.

My last post was to Meditrina.

I meant to watch Dispatches tonight ...

What a crazy idea anyway, to try to make money out of it. It could be so simple. You ring up and ask for advice from experts when you don't want to bother the doctor. Those experts are NHS employees, qualified nurses and other professionals, paid for by the NHS. Why involve all these other companies?

It wasn't broken until they tried to make money from it.

You can't and shouldn't make money from the NHS. It's immoral.

Who is trying to make money out of it? Most of the providers are existing bits of NHS or rollovers to NHS Direct .

And both 111 and its predecessor were Labour initiatives (not part of fragmentation, and indeed one of the rationales for the change was to improve co-ordination. Unfortunately, neither phone line has (yet) worked as intended. But unless/until the changes to GP contracts which ruined out-ofahours services in the mid/late-00s are renegotiated, then the requirement for a properly functioning phone line is unlikely to go away.

Was no-one making money from it, then? I thought each time a call was made, the NHS was invoiced by the company who were taking the calls (according to Tribpot). Or was that company also part of the NHS?

I don't care who started it, btw. If it's a bad idea, it's a bad idea.

And I love the idea of people making money. Just not from other people's bad health.

Solo large numbers of people and companies make money from the NHS - ie all staff, drug companies, equipment suppliers, energy suppliers etc

In some places the service was run by parts of the NHS, in other places a private company did it. However, it's worth remembering an enormous amount of invoicing goes on between parts of the NHS and has done for years - this is no different.

This is what happens when you sell of bits of the NHS. It will get worse.

The Dispatches programme looked at a company called Harmoni which had a contract to provide the 111 service in certain areas.

It looked pretty shocking - the call handler saying he didn't know how to use the software properly, and them just saying 'go for it,' I had eight weeks of training and had to be signed off on 10 perfect live calls before I was allowed to 'go for it'

The model for private providers within the nHS was established under Blair, and it seems similar bidding process here.

But omnishambles (and not sure how this straddled change in administrations) got the figures badly wrong, and the contract became unsustainable (NHS Direct making a loss given call volumes). Now, was it their fault for bidding an unrealistically low price, or did one or other Government provide seriously skewed assumptions? We don't know at present.

What we do know is that a number of NHS/private provider contracts from 00s have been pretty ropey (eg PFI T&Cs, but many others too) and that this Government has made a number of administratively incompetent decisions. So either way, there is a legacy of poor contract management (not just NHS, successive problems with eg railways and others) which is pretty depressing really.

And no prospect of any administratively competent alternative.

I am a 111 call handler (not Harmoni though) and we are miles above any competition, have been 'live' for around a year now.

Any new service is bound to have teething problems but we are lucky that although we started off understaffed, we are now a finely oiled machine with staff that actually care, and apart from certain restrictions the software is almost idiot-proof as long as the clinical meaning of the questions is not lost in asking the caller.

I may be biased, but I love my job and 99.9% of the calls I deal with are positive experiences for me and the caller.

So they do, Carol, so they do. I'm very glad nurses don't have to work for free.