Roll-out of 111 telephone hotline causes hospitals severe problems

BMJ 2013; 346 doi: (Published 15 April 2013) Cite this as: BMJ 2013;346:f2394
  1. Gareth Iacobucci
  1. 1BMJ

Ongoing problems with the new 111 urgent care hotline are contributing to the “severe pressure” on emergency departments, the president of the College of Emergency Medicine, Mike Clancy, has warned.

He told the BMJ that reported failings in the new system must be dealt with to ensure that patients are seen safely in the right setting. He said that this would help relieve the pressure on emergency departments, and enable them to concentrate on patients who really need emergency care.

Chair of the House of Commons health select committee Stephen Dorrell pledged to investigate the issue,1 after further reports of seriously ill patients facing lengthy waits when dialling 111, and patients being inappropriately transferred to emergency care across England.

The BMA has urged the government to halt the roll-out of the new telephone service until patient safety fears have been dealt with.2

This week, East Kent Hospitals Foundation Trust was forced to implement major incident procedures—usually reserved for unexpected disasters or the peak of winter—at four of its sites, owing to the “unprecedented” number of people arriving at emergency departments.

Neil Martin, medical director of East Kent Hospitals Foundation Trust, said that the procedures had been put in place “to ensure that patients continue to be looked after well and safely despite the exceptional demands on the service.” The measures could see some outpatient clinics cancelled with staff redeployed, and doctors asked to cancel any non-priority activities such as study leave or administrative tasks.

Clancy said that it was crucial that problems with new 111 systems were investigated and corrected to ensure that patients were sent to the right place to be treated.

“There is a real sense that emergency departments are under severe pressure at the moment,” he said. “111 may be a contributory factor to that.”

He added: “The college supports a system that gets the patient to the right place and the right level of care. What we want is to look after the patients who need to be in emergency departments.”

“Emergency departments are under close scrutiny every day. What we need is close scrutiny across the whole system to make the system work as well as it should.”

Clancy said that he was concerned to hear of reports of patients facing long waits to be called back by 111, which he said could lead to unnecessary attendances at emergency departments.

“At the moment, the emergency departments may become the default when patients are having to wait a long time. 111 doesn’t work if people don’t get the response they are looking for promptly,” he said.

“The triage principle is a good one, the issue is making that system work.”

Dorrell told the Telegraph1 that he was concerned that the system was becoming “overloaded,” and he said that MPs would examine the problems in the wake of the reports.

“The concerns we are hearing about 111—that too many cases are being referred to emergency services, and that the most serious cases are not being identified—are one of the main reasons that we have decided that we need to look at the whole of the system of emergency care, and whether [emergency] departments and ambulance services are becoming overloaded,” he said.

Speaking at the NHS England board meeting on 12 April, its chief executive David Nicholson acknowledged that NHS 111 had had “operational problems” and pledged to manage the “unacceptable” situation to improve the service.


Cite this as: BMJ 2013;346:f2394