111 is a free-to-call single non-emergency number medical helpline operating in England, Scotland and Wales. The 111 phone service has replaced the various non-geographic 0845 rate numbers and is part of each country's National Health Service: in England the service is known as NHS 111;[1] in Scotland, NHS 24;[2] and in Wales, NHS 111 Wales.[3]

The transition from NHS Direct (0845 4647) to NHS 111 in England was completed during February 2014[4] with NHS 24 Scotland (08454 24 24 24) following during April 2014.[5] NHS Direct Wales started a phased roll-out of a similar 111 service in late 2016[6] and completed it in March 2022.[7]

As of June 2018, the 111 number was not in use across Northern Ireland.[8] The NHS 111 service was extended to Northern Ireland from February 2020, although this is for advice relating to the COVID-19 virus only.[9] After dialling, callers will be asked to follow prompts to determine what nation they are calling from.[citation needed]

The service is available 24 hours a day, every day of the year and is intended for 'urgent but not life-threatening' health issues[10] and complements the long-established 999 emergency telephone number for more serious matters, although 111 operators in England are able to dispatch ambulances when appropriate using the NHS Pathways triage system.[11][12]

Origins and development edit

During 2007, the Department of Health's Our NHS, Our Future report identified confusion surrounding access to certain NHS services in England and suggested the introduction of a national, three-digit number for out-of-hours healthcare services could help simplify the situation. Arrangements to identify and secure a suitable non-emergency number for England began in July 2009,[13] with the number 111 allocated by telecommunications regulator Ofcom in December of that year.[14]

In late August 2010, the Conservative-Liberal Democrat coalition government proposed that 111 would replace the existing NHS Direct (084546 47) telephone helpline in England.[15][16] This suggestion proved controversial as some critics feared that NHS 111 would be a "cut-price" replacement for NHS Direct, because NHS 111 would be staffed mainly by telephone advisors whereas NHS Direct had been staffed by nurses. Health Secretary Andrew Lansley said that the only major change would be the phone number, and that the service would be provided by existing staff.[15][17][18]

In July 2015 NHS England decided that what was required was an integrated urgent care access, treatment and clinical advice service which would operate over a large area. Clinical Commissioning Groups were told to stop any procurement exercises until revised commissioning standards and supporting procurement advice for integrated services were produced.[19] These service specifications for England were published in 2017.[20]

In June 2020 it was announced that there were plans to integrate LIVI software into the service in three regions of the UK.[21]

111 First edit

The 111 First system, which allows patients not in medical emergencies to call 111 to “book” urgent care, was launched in 2020, as a response to the impact of COVID-19 pandemic in England on emergency services. In July 2021 Healthwatch England found that it had potential to be a useful service, but the public “don’t really know what it’s for”. They said the messaging from the NHS ‘has not been strong enough’. Only 3% of English A&E attendances in June 2021 were “booked” in advance via NHS 111.[22] The figure was similar in February 2022. According to Healthwatch England people “really welcome” the opportunity to book emergency appointments via 111, provided they know about it.[23]

Management of the service edit

In England, the service is accountable at a Clinical Commissioning Group level but was originally commissioned on a regional basis, with a number of service providers. NHS Direct staff provided some of the 111 service during the original launch of the number, with other providers including regional ambulance trusts, and out-of-hours GP providers.

The lack of clarity as to accountability was criticised in a Deloitte report into the service launch failure by NHS Direct. As of December 2013 all NHS Direct contracts are being serviced by "stability partner" organisations such as ambulance trusts or GP co-operative organisations.

The service operates 24 hours a day. When GP surgeries are closed normally between 6.30pm and 8am, at weekends and at Bank Holidays the service will refer many patients to an out-of-hours service. This can also happen if practices are closed for training purposes.[24]

The service uses a clinical decision support system which structures the response to a call, which may range from telephone advice to the dispatch of an emergency ambulance. Calls are initially assessed by a call handler and may be passed to a clinician. The service has been criticised for being too cautious and directing too many patients to A&E departments.[25] GPs have complained that the service has not been inspected by the Care Quality Commission and that it may jeopardise the safety of out-of-hours services.[26]

Between 2010 and 2015 the service has handled 24 million calls with an average call length of 14 minutes. Although 111 is a helpline for non-emergency cases, 10% of calls trigger the dispatch of an ambulance - 93,000 in the 12 months from April 2014 to April 2015.[27] A 2017 article in the British Medical Journal that studied the performance of the 111 service concluded that patients were "largely satisfied" with the service, while "its success against some key criteria has not been comprehensively proven."[28] Of calls answered by NHS 111 in March 2021, 78.2% were answered within 60 seconds. In March 2020 the figure was 30.2%.[29]

In January 2020 the Association of Ambulance Chief Executives called for a more joined up approach to the commissioning of 111, urgent care and ambulance services. The lead commissioner for 999 services is generally different, as those services operate over a wider area. The associations wants single regional specifications for integrated 999 and 111 provision, with no new tendering of 111 contracts which end this financial year. They want contracts for at least 5 year terms.[30]

West Midlands Ambulance Service took on the service across most of the West Midlands in 2019 but withdrew from the contract in 2022. NHS England is moving to larger geographical areas, advocating single virtual contact centres, allowing for calls to be answered quicker by utilising spare capacity across the country.[31]

Launch and initial service failures edit

The first NHS 111 trial, in County Durham and Darlington, started on 23 August 2010. Nottingham, Lincolnshire and Luton began trialling the service later that year.

NHS 111 was launched in a limited number of regions in March 2013 ahead of a planned national launch in April 2013. The British Medical Association wrote to the Secretary of State for Health to request that the launch be postponed.[32] Its chair, Dr Laurence Buckman, warned that the service as "a disaster in the making", and recommended delaying the full launch for safety reasons.[33][34] The public sector trade union UNISON also recommended delaying the full launch.[35]

The initial launch was widely reported to be a failure.[36][37] On its introduction, the service was unable to cope with demand; technical failures and inadequate staffing levels led to severe delays in response (up to 5 hours), resulting in high levels of use of alternative services such as ambulances and emergency departments.[33] The problems led to the launch being delayed in South West England, London and The Midlands[38][39][40] and the service was suspended one month after its launch in Worcestershire.[41]

The NHS 111 service was gradually launched in England over the course of 2013, with the rollout being completed in February 2014.[4] It was announced in October 2013 that NHS Direct would be closed down in 2014.[42] The 111 number was launched in Scotland in April 2014.[5]

Coverage edit

The 111 number for NHS services is currently available in all of England, Wales and Scotland.

As of early 2020, the NHS 111 service is available in Northern Ireland for advice relating to the COVID-19 outbreak.[9]

NHS 111 online is a triage system also available for members of the public aged 5 or over in England, owned by the Department for Health and Social Care, commissioned by NHSX and developed and delivered by NHS Digital. It used the NHS Pathways series of algorithms.[43]

Coronavirus edit

During the pandemic, NHS England asked people with suspected COVID-19 infection to call 111. This was intended to reduce the risk of hospitals being overwhelmed by huge numbers of people who did not need to see a healthcare professional. An analysis by Yorkshire Ambulance Service showed that 111 triage has similar accuracy to the triage used in emergency departments and urgent care settings for other conditions suggesting it could be a good option for future pandemics.[44][45] Portions of the service were outsourced to Serco, Sitel, and Teleperformance, resulting in uneven service quality and an inability to record calls for feedback.[46]

A separate number NHS 119 is used for information and services relating to COVID-19 as of 18 May 2020. This number operates in England, Wales, and Northern Ireland, with lines being open from 07:00 to 23:00 hours. It allows people to book NHS drive through tests, order home testing kits, and apply for tests in a care facility.[47]

In Scotland, 0300 303 2713 is the non-geographical telephone number instead of 119.[47]

European number edit

Within EU member states and territories a similar type of service is available via the harmonised European number for medical advice 116 117 as one of a number of 'Harmonised Services of Social Value'.[48][49][50] The number 116 117 was never implemented by the UK and the UK has now left the EU.

Cyber attack edit

On 4 August 2022 at 07:00, Adastra, the computer system used by 85% of NHS 111 services was removed from service after a ransomware attack.[51] As of 11 August 2022, the service had not yet been restored [52] with some question as to whether patient data had been exfiltrated.[53] On 23 August 2022, London Ambulance Service was reported [54] to be the first service to return to use of Adastra after the cyber-attack, with no clarification of patient data leakage during the incident.

References edit

  1. ^ "NHS 111". england.nhs.uk. NHS England. Retrieved 11 June 2018.
  2. ^ "NHS 24 - when to call 111". NHS 24.
  3. ^ "NHS 111 Wales". 111.wales.nhs.uk. 26 April 2018. Retrieved 15 December 2022.
  4. ^ a b "February will see the last NHS 111 sites go live | News | Healthcare Today UK". Healthcare Today. 13 December 2013. Archived from the original on 12 June 2018. Retrieved 13 March 2020.
  5. ^ a b "Our new number is 111 - Health Information and Self Care Advice for Scotland". NHS 24. Archived from the original on 5 July 2017. Retrieved 13 March 2020.
  6. ^ "New 111 Wales Service for Swansea, Neath, Bridgend & Carmarthenshire". NHS Direct Wales. 2 May 2017. Archived from the original on 7 July 2018. Retrieved 13 March 2020.
  7. ^ "111 service now available across Wales". GOV.WALES. Retrieved 12 April 2022.
  8. ^ Pym, Hugh (16 December 2015). "Northern Ireland's health challenges". BBC News. Retrieved 11 June 2018.
  9. ^ a b "Coronavirus: NHS helpline extended to Northern Ireland". 29 February 2020. Archived from the original on 1 March 2020. Northern Ireland now has full access to the NHS 111 helpline service on coronavirus, the Department of Health has announced. [It] will replace the localised helpline [..] "people in Northern Ireland will have access to the same level of advice as citizens in England.""
  10. ^ "111 - The New Number for the Future of Non-Emergency Health Services : Department of Health - Media Centre". Department of Health. 23 August 2010. Archived from the original on 31 August 2010. Retrieved 13 March 2020.
  11. ^ "NHS Direct delivering NHS 111 in East Midlands and East of England". NHS Direct. December 2010. Archived from the original on 3 May 2011. Retrieved 5 May 2011.
  12. ^ "NHS Pathways". NHS Connecting for Health. Archived from the original on 26 May 2013. Retrieved 5 June 2013.
  13. ^ "A Three-digit Number for Non-Emergency Healthcare Services". ofcom.org.uk. Ofcom. 20 August 2009. Retrieved 10 October 2022.
  14. ^ "New 111 non-emergency healthcare phone number confirmed". ofcom.org.uk. Ofcom. 18 December 2009. Retrieved 10 October 2022.
  15. ^ a b "NHS Direct launches". NHS Direct. 28 August 2010. Archived from the original on 3 September 2010. Retrieved 28 August 2010.
  16. ^ "Government confirms plan to scrap NHS Direct helpline". BBC News. 29 August 2010.
  17. ^ "UNISON Health Care - Our NHS Our Future". Unison.org.uk. Retrieved 1 May 2013.
  18. ^ Bob Roberts (10 September 2010). "NHS Direct to continue after ConDem 'climbdown' - Mirror Online". Mirror.co.uk. Retrieved 1 May 2013.
  19. ^ Renaud-Komiya, Nick (8 July 2015). "All 111 and out of hours tenders suspended". hsj.co.uk. Health Service Journal. Retrieved 10 October 2022.
  20. ^ "Integrated Urgent Care Service Specification" (PDF). england.nhs.uk. NHS England. 25 August 2017. Retrieved 10 October 2022.
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  22. ^ "NHS' promotion of 111 First 'not strong enough', watchdog warns". Health Service Journal. 2 August 2021. Retrieved 6 September 2021.
  23. ^ "A&E bookings via 111 fall 'far short of aspiration'". Health Service Journal. 25 February 2022. Retrieved 22 April 2022.
  24. ^ "Patients turned away after GP surgeries are all shut on the same day". Local Berkshire. 11 October 2014. Retrieved 11 October 2014.
  25. ^ "Too many patients call the 111 NHS hotline and end up at A&E". The Sentinel. 15 September 2014. Retrieved 11 October 2014.
  26. ^ "Concern over NHS 111 as CQC praises GP out-of-hours care". GP Online. 3 October 2014. Retrieved 11 October 2014.
  27. ^ "How NHS 111 helpline refuses to send out ambulances". Daily Telegraph. 30 June 2015. Retrieved 1 July 2015.
  28. ^ Pope, Catherine; Turnbull, Joanne; Jones, Jeremy; Prichard, Jane; Rowsell, Ali; Halford, Susan (2 June 2017). "Has the NHS 111 urgent care telephone service been a success?". BMJ Open. British Medical Journal. 7 (5): e014815. doi:10.1136/bmjopen-2016-014815. PMC 5623427. PMID 28576895. Retrieved 28 November 2017.
  29. ^ "NHS 111 Minimum Data Set, England, March 2021" (PDF). england.nhs.uk. NHS England. April 2021. Retrieved 10 October 2022.
  30. ^ "Ambulance chiefs call for commissioning shakeup". Health Service Journal. 8 January 2020. Retrieved 24 February 2020.
  31. ^ "Ambulance trust to hand back key NHS 111 contract". Health Service Journal. 25 July 2022. Retrieved 28 September 2022.
  32. ^ "GPs urge delay to phoneline implementation". British Medical Association. 25 February 2012. Retrieved 1 May 2013.
  33. ^ a b Goodchild, Sophie (22 March 2013). "Lives are being risked by five-hour delays on NHS helpline, say GPs - London - News - London Evening Standard". Standard.co.uk. Retrieved 1 May 2013.
  34. ^ "Contract changes and 'chaotic' reform put patients at risk, warns GPC". GPonline.com. 22 March 2013. Retrieved 1 May 2013.
  35. ^ "Union says it warned NHS bosses about dangers of 111 service (From This Is Wiltshire)". Thisiswiltshire.co.uk. 28 February 2013. Retrieved 1 May 2013.
  36. ^ "Patients failed by helpline disaster". This is Bath. 1 March 2013. Retrieved 1 May 2013.
  37. ^ "Launch of new NHS call centre in Lancashire branded a 'disaster' (From Lancashire Telegraph)". Lancashiretelegraph.co.uk. 26 March 2013. Retrieved 1 May 2013.
  38. ^ "Out-of-hours GP helpline launch called off after trial causes chaos". This is Somerset. 23 March 2013. Archived from the original on 26 March 2013. Retrieved 1 May 2013.
  39. ^ "Shropshire non-emergency medical advice calls diverted". BBC News. 25 March 2013. Retrieved 13 March 2020.
  40. ^ "NHS 111 in 'total meltdown'". E-Health Insider. Archived from the original on 31 January 2016. Retrieved 1 May 2013.
  41. ^ "Worcestershire withdraws NHS 111 advice line". BBC News. 25 April 2013. Retrieved 13 March 2020.
  42. ^ "NHS Direct to close down next year". BBC News. 24 October 2013. Retrieved 10 November 2013.
  43. ^ "NHS 111 online is a Class 1 medical device". digital.nhs.uk. NHS Digital. 6 August 2021. Retrieved 10 October 2022.
  44. ^ "COVID-19 urgent care: can NHS 111 reliably identify people?". NIHR Evidence. 28 April 2023. Retrieved 26 May 2023.
  45. ^ Marincowitz, Carl; Stone, Tony; Bath, Peter; Campbell, Richard; Turner, Janette Kay; Hasan, Madina; Pilbery, Richard; Thomas, Benjamin David; Sutton, Laura; Bell, Fiona; Biggs, Katie; Hopfgartner, Frank; Mazumdar, Suvodeep; Petrie, Jennifer; Goodacre, Steve (30 March 2022). "Accuracy of telephone triage for predicting adverse outcomes in suspected COVID-19: an observational cohort study". BMJ Quality & Safety: bmjqs–2021–014382. doi:10.1136/bmjqs-2021-014382. ISSN 2044-5415. PMC 8983415. PMID 35354665.
  46. ^ Sirin Kale (23 September 2020). "Blue lips and black skin: Did a standard 111 question help cause Olufemi Akinnola's death from Covid-19?". the Guardian. Retrieved 8 August 2023. Earlier this week, the Guardian revealed that private contractors including Serco, Sitel and Teleperformance had been commissioned to provide a "Coronavirus Response Service" on behalf of NHS 111. In the rush to get this service operational, some providers were initially unable to record calls.
  47. ^ a b "Get a free NHS test today to check if you have coronavirus". www.GOV.uk. HM Government of the United Kingdom. Retrieved 28 August 2020.
  48. ^ "Ofcom | Harmonised European numbers for harmonised services of social value (116XXX numbers)". Stakeholders.ofcom.org.uk. Archived from the original on 28 July 2014. Retrieved 1 May 2013.
  49. ^ "THA response to Ofcom 111 consultation". The Helplines Association. 20 August 2009. Archived from the original on 10 March 2012. Retrieved 13 March 2020.
  50. ^ Ray, Bill (9 July 2009). "NHS Direct gets to be number one, one, one". www.theregister.co.uk. Retrieved 13 March 2020.
  51. ^ "NHS 111 software outage confirmed as cyber-attack". BBC News. 6 August 2022. Retrieved 11 August 2022.
  52. ^ "NHS IT supplier held to ransom by hackers". BBC News. 11 August 2022. Retrieved 11 August 2022.
  53. ^ "Fears for patient data after ransomware attack on NHS software supplier". The Guardian. 11 August 2022. Retrieved 11 August 2022.
  54. ^ @davewwest (23 August 2022). "London Ambulance Service has gone back onto Adastra, the software taken down by cyber attack nearly threw weeks ago. Statement below" (Tweet). Retrieved 23 August 2022 – via Twitter.

External links edit