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Report raises doubt over expected benefits of NHS 111

An independent evaluation of the Government’s national NHS 111 pilots says the new service may never deliver the reduction in emergency care activity it was designed to achieve.

The final report from researchers at the University of Sheffield said the service - designed to simplify access to non-emergency care - had ‘not delivered the expected benefits’ in terms of improving patient satisfaction or stemming the flow of patients being directed to emergency care.

They also warned it ‘cannot be assumed’ that the scheme will produce the expected benefits with increased use and time, and that they expected it to be more costly than current arrangements.

The report analysed the first year of operation of NHS 111 across four pilot sites and compared it with other matched control sites without NHS 111.

It found ‘no statistically significant change’ in emergency ambulance calls, emergency department attendances or urgent care contacts/attendances in pilot sites.

There was a statistically significant reduction in calls to NHS Direct of 193 calls per 1,000 NHS 111 triaged calls per month, but emergency ambulance service incidents increased by 29 additional incidents per 1,000 triaged calls per month.

The Government had stated that the introduction of the three-digit urgent care number would help to reduce the number of unnecessary ambulance journeys, reduce avoidable A&E attendances and unscheduled admissions from A&E, and reduce the number of 999 calls for non-emergency issues.

But the researchers identified a ‘low probability of cost savings to the emergency and urgent care system’, estimating the service would cost an extra £307,000 per month.

Each site operated a slightly different model, but the report concluded that all four ‘seemed to produce the same lack of measurable benefit in terms of improving urgent system user satisfaction and reducing use of emergency care services.’

The Government has already pre-empted the publication of the report by scheduling a national rollout of the new telephone-based service from April 2013, despite calls from the GPC for ministers to wait for the full findings before proceeding.  The service is already up and running in 13 locations across England.

The report found that overall satisfaction with the service was good, with 73% of respondents to a survey of users reporting they were very satisfied, and a further 19% quite satisfied. But it highlighted that ‘there was no evidence that NHS 111 improved satisfaction with urgent care generally’.

All four sites exceeded the national quality standards for the number of calls answered within 30 seconds.

The authors said those involved in designing and implementing NHS 111 ‘were generally enthusiastic about the service and believed that patient benefits could be achieved, but were less confident about the likely impact on the wider emergency and urgent care system.’

They authors concluded: ‘The lack of impact of NHS 111 in its first year in the pilot sites could be explained by the small “dose” of NHS 111 within the emergency and urgent care system or the early stage of development at which it was evaluated (one year).

‘It takes time for early problems to be identified and resolved, for a new service to become established with users, and for reflection on how the service can be improved.

‘However, it cannot be assumed that increase in use, and time, will produce expected benefits.’

The evaluation said the likelihood of achieving the anticipated benefits could be increased by reviewing the call assessment process ‘to ensure relevant questions are asked [and] pathways are improved, particularly those resulting in the need for an emergency ambulance’.

It also suggested focussing attention on further integration with other services, and exploring how the service will deal with ‘increased and probably different demand’ when it replaces the NHS Direct 0845 number.

Health minister Lord Howe said: This report shows that NHS 111 is benefiting patients by improving access to urgent care services and ensuring they get to the right service, first time, to meet their medical needs.

‘Of course, it is early days for NHS 111 and this report is based on the first four pilot sites.  There are now thirteen sites up and running and we expect to see NHS 111 have a greater impact as more areas go live.’