Tuesday, 30 July 2013

The NHS Direct/111 confusion epitomises the problems with government health policy.

If ever a snapshot was needed to illustrate that a plan isn’t working, the recent news that NHS Direct are withdrawing from 111 contracts provides just such an unwelcome image. Originally running around a third of 46 regional contracts to run the 111 telephone helpline service, NHS Direct has now pulled out of the ‘financially unsustainable’ arrangements. That leaves eleven regions with no provider to run this fledgling service. The reasons that NHS Direct (itself an NHS Trust) cited for the withdrawal was that projections reported earlier this month showed they had lost £2.8m since April and were "heading for a deficit of £26m if we continue to run the same volume of 111 services until the end of this financial year".

This is a new embarrassment for the embattled coalition health team as another plan fails to quite come together as predicted.  Interestingly, but not surprisingly when this story broke – news items included Andy Burnham, shadow Health Secretary as he said it was a "mess of the government's making" which had led to nurses being replaced by computers

During a debate in the House of Lords, the Lib Dem peer, Lord Willis of Knaresborough gamely tried to defend the service: ‘My Lords, may I try to redress the balance? There is a real sense that very significant numbers of people calling the 111 service get a good service. On 9 June, I had reason to call 111 because I was having a heart attack. The response from 111 was excellent, in York. At the same time not only did the service call the paramedics but it had me in hospital within 25 minutes to an absolutely superb accident and emergency service. If York can do that in such an efficient and superb way, why cannot we guarantee that service throughout the country?

With a spectacular own goal the venerable Lord demonstrated that 111 is a confusing and potentially dangerous option facing the man in the street with a health issue. No Lord Willis – you should not have called 111 – you should have dialed 999! 111 is billed as the service to call ‘when it’s less urgent than 999’ and NHS Choices website advises the public to call 111 ‘if you urgently need medical help or advice but it's not a life-threatening situation’. What was, in theory, a good idea has now sadly deteriorated to farce as a money saving, efficiency enhancing idea is spoiled though poor procurement, poor communications and poor implementation.

Which brings me to my checklist for Jeremy Hunt to use when trying to move the NHS forward.

When you have an idea for an NHS service redesign or enhancement:

1.     Think about the logistics. How will it work? Where are the pitfalls, or weak link in the chain? What will a successful outcome look like? Does the expertise and resource exist and if not – how is this generated?
2.     Assess the benefits. Will a successful outcome mean either a better or more efficient service, better clinical outcomes and/or more cost effective care? Basically – undertake an independent and transparent cost benefit analysis.
3.     Create a robust procurement process. ‘Screwing’ a provider down to an unacceptably cheap price means that you either have an unsustainable model or you will receive substandard delivery. Either can ultimately lead to disaster and expensive damage limitation further down the line. Use the considerable procurement expertise available within the NHS. Good, sustainable contracts are born out of the premise that every party is satisfied with the deal.
4.     Ensure that robust monitoring is in place. Just because something starts well, you can’t guarantee it will continue that way.
5.     Create and implement an effective communications strategy. I have no doubt that one of the biggest failings in the 111 service is lack of clarity for the public.
6.     Keep politics out of it. I know this is a fantasy rather than a realistic possibility, but our politicians and key NHS leaders should focus on the job in hand, not play a politically expedient game.

This really is very basic stuff, but I suspect that if these simple rules had been applied, we would not be facing the confusing and worrying situation regarding our emergency and non-emergency NHS services right now.

Ah well – a girl can dream…


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