NHS Direct wants to End NHS 111 (Non Emergency) Phone service Contracts

http://news.sky.com/story/1121638/nhs-direct-plans-withdrawal-from-111-helpline

29 July 2013

Photo: NHS Direct

      NHS Direct, which provides the non-emergency phone line in nine regions of England, said it wanted to quit its contracts because they were too expensive. It has found that the cost of providing the service, where staff give the public non-emergency health advice, exceeded the contract price. NHS Direct is now seeking a "planned withdrawal" from the deals after projecting a £26m deficit for the coming financial year. Its chief executive Nick Chapman said: "We will continue to provide a safe and reliable NHS 111 service to our patients until alternative arrangements can be made by commissioners.

    "Whatever the outcome of the discussions on the future, patients will remain the central focus of our efforts, together with protecting our staff who work on NHS 111 to ensure that the service will continue to benefit from their skills and experience." The announcement came as an undercover investigation revealed "serious failings" in the system, with staff shortages, long waits for callers and unnecessary ambulance call-outs. In Channel 4's Dispatches programme NHS Undercover, one call centre manager was secretly filmed admitting the service was exposed at the weekends. "We had a very bad service. Still realistically on the weekends we still are unsafe. We don't have the staff to deal with the calls that are coming in," the worker said.

     Reporters posed as trainee call handlers and filmed secretly at centres run by the private health care company Harmoni, which has a third of the hotline contracts in England. They found many patients had to wait longer than 10 minutes to hear back from a clinician and some workers with no medical training were filmed giving medical advice to the journalists. A spokesman for Harmoni told the programme: "We provide a clinically safe service. We expect all staff to only provide advice according to their role and their level of training and take a zero-tolerance approach to any breach. "Our audits show no evidence of widespread poor practice. Our staffing levels are extremely robust with around one clinical adviser to every four health advisers.

     "While it has been acknowledged that NHS 111 services generally did not get off to a good start, we and other providers have successfully delivered substantial improvements including recruiting 180 more advisers." The 24-hour phone line replaced NHS Direct as the number to call for non-emergency care but has been dogged by problems since its inception. Patients complained about unanswered calls, poor advice and calls being diverted to the wrong part of the country. Doctors claimed its "problematic roll-out" had left patients not knowing where to turn and it has also been blamed for fuelling the current A&E crisis. Earlier this month, the Health Select Committee attacked ministers for the "premature" launch, claiming it was done with little understanding about how it would affect the wider NHS.

     NHS Direct worked on the 111 pilot, which was based on a cost of £13 per call to cover staff salaries and other costs. But it says local health commissioners refused to pay more than £7.80 per call when the first 111 contract was awarded in the North East of England. NHS Direct initially won 11 of the 46 regional contracts for the hotline but pulled out of two before they were even launched. It now wants to axe the remaining nine in Buckinghamshire, East London and the City, South East London, Sutton and Merton, West Midlands, Lancashire and Cumbria, Greater Manchester, Merseyside and Cheshire and Somerset. A company spokesman said it had encountered "significant problems" when it launched the three contracts in the north west of England and West Midlands in March.

     She said the calls took "twice as long as expected" and as a result, NHS Direct did not have "sufficient capacity" to handle all the calls that it received. The firm had worked on the pilot, which was based on a cost of £13 per call to cover staff salaries and other expenses, but local health commissioners refused to pay so much. The NHS Direct board remodeled its costs and decided it could bid based on £7 to £8 per call and was later awarded deals covering 34% of the country. However, its annual report says: "It is now clear that the trust is not able to to provide the 111 service within this lower cost range, and that the 111 contracts that the trust has entered into are financially unsustainable."

     David Cameron's spokesman admitted there had been problems with the hotline's launch but insisted performance and patient satisfaction was now high. "He is confident that we will continue to push up standards and deliver a high level of service for patients across the country," the spokesman said. NHS England blamed the earlier problems on providers not having enough call handling capacity in place but also claimed they had now been resolved. The Department of Health said NHS Direct had "struggled to meet the standards required" but defended the hotline as a whole and vowed it would continue.

     A spokesman said: "There is widespread consensus that NHS 111 is in principle a good idea. "It makes obvious sense that for many patients, accessing the NHS by phone is often the quickest and easiest way to get advice and speak to a doctor or nurse when needed. "So of course it's disappointing that there have been problems with its implementation but these are flaws that can and will be overcome."

Report highlights 13,000 needless deaths across 14 NHS hospital trusts

     Sir Bruce Keogh's investigation will suggest that 14 trusts had higher than average mortality rates- 

http://www.independent.co.uk/news/uk/home-news/report-out-today-will-highlight-13000-needless-deaths-across-14-nhs-hospital-trusts-8710313.html


      Hospitals are preparing for tough criticism over the thousands of needless deaths that will be revealed in a major report released today. A report conducted by NHS England medical director Professor Sir Bruce Keogh is expected to say that 14 healthcare trusts had higher than expected death rates between 2010 and 2012. It will describe poor care, medical errors and management blunders at the 14 Trusts which have been investigated over high mortality rates. The review has been examining if trusts have already taken action adequate enough to improve care quality or if they require extra support.

      In his review, Sir Bruce will highlight that the Mid Staffordshire hospital scandal may not have been an isolated incident. Sir Bruce's investigation indicates that there may have been up to 13,000 needless deaths from across the 14 trusts since 2005. The Prime Minister's official spokesman has suggested that hospital board members could be suspended following care failings. “Clearly there have been examples where patients and families have not received the high quality, compassionate care that it so important,” David Cameron's spokesman said.

     “The Prime Minister, the Secretary of State, and all the Government are deeply, deeply concerned at the evidence of failings in the NHS. “It is important to have undergone the review to get to the bottom of where failings may be occurring. What people can be very clear about is the Government's commitment to that culture of compassion and high quality care. “The Government will continue to take the action that is necessary. “One of the things the Prime Minister said in response to the Francis Inquiry is that a single failure regime would be set up whereby the suspensions of boards can be triggered by failures in care.”

     As part of the Government's response to the Francis report into serious care failings at Mid Staffordshire NHS Foundation Trust, ministers said that if a hospital is deemed to be failing, the Chief Inspector of Hospitals could initiate a failure regime in which the board could be suspended or the hospital put into administration. Following publication of the public inquiry, Sir Bruce launched an investigation into the 14 other trusts because of their high mortality rates. Nine of the trusts have been “outliers” on the Hospital Standardised Mortality Ratio (HSMR) for two years running and the other five were identified by the Summary Hospital-level Mortality Indicator (SHMI) as having higher than expected death rates.

    The latest SHMI data, published in April, in which the number of patients who died following admission to hospital is compared with the number who would be expected to die, suggests that as many as 3,000 people may have died needlessly in just one year at the 14 trusts. Researchers said that death rates were deemed to be “higher than expected” at eight of the trusts and “as expected” at the other six of the trusts. The trusts which have been under review are: Basildon and Thurrock University Hospitals NHS Foundation Trust, Blackpool Teaching Hospitals NHS Foundation Trust, Buckinghamshire Healthcare NHS Trust, Burton Hospitals NHS Foundation Trust, Colchester Hospital University NHS Foundation Trust, The Dudley Group NHS Foundation Trust, East Lancashire Hospitals NHS Trust, George Eliot Hospital NHS Trust, Medway NHS Foundation Trust, North Cumbria University Hospitals NHS Trust, Northern Lincolnshire and Goole Hospitals NHS Foundation Trust, Sherwood Forest Hospitals NHS Foundation Trust, Tameside Hospital NHS Foundation Trust and United Lincolnshire Hospitals NHS Trust.

      Reports suggest Health Secretary Jeremy Hunt will send teams of expert “hit squads” into 10 of the trusts to turn around hospitals, the Daily Telegraph said. Professor Sir Brian Jarman, one of Sir Bruce's advisers and a mortality data expert, said that he warned health officials over the course of a decade about the high death rates but was ignored. “We felt we were banging against a locked door,” he added. Tories are likely to seize on the findings of the review to attack Labour's handling of the health service. Shadow Health Secretary Andy Burnham was in charge of the NHS between June 2009 and May 2010. But Ed Miliband, Labour leader defended his party's management of the NHS and said yesterday that he was “proud” of Labour's health record in government.
      Pressed on the role of the then Health Secretary, he said: “I think that's what you get from this Government, which is that they are wanting to politicise some of the problems there have been in the NHS.
“Now, we were very vigilant about dealing with those problems and I am very proud of Labour's record on the NHS.” “The high mortality rates had been known about for years previously and some of the trusts also had other indicators suggesting problems with patient safety. For example, Tameside had failed to implement large numbers of patient safety alerts at the same time as it had high mortality rates. We need a regulator who will investigate when there is one serious indication of a problem, let alone several”.