NHS 111 helpline is on brink of collapse after contracts abandoned

The announcement came after managers of centres run by other firms admitted their services were unsafe.

A number of safety incidents have come under investigation, including three deaths, amid concerns about serious illnesses which have been missed, and dying patients denied pain relief.

An investigation last night found some centres have no qualified nurses to diagnose patients overnight, while ambulances are being sent to trivial cases.

The helpline was introduced across the country in spring to provide non-emergency health advice 24 hours a day.

Ministers said the system would simplify NHS services, because as well as issuing advice, call handlers would be able to dispatch ambulances and book urgent appointments with GPs.

But there have been concerns that safety has been jeopardised, because centres are staffed by too many unqualified workers, in an effort to cut costs.

Last night an investigation disclosed that staff at some centres undergo just two weeks training in a classroom before being left to make critical decisions about patient care.

The 111 phonelines have now been introduced across almost all of the country after being piloted in four areas.

But yesterday, NHS Direct disclosed that when the service was tested, and found to be safe – though it did not reduce demand on AE – centres were spending £13 on each call, much of it to cover staff costs.

When the system was then rolled out across the rest of the country, “extremely challenging” cuts were demanded, with NHS commissioners only agreeing to pay between £7 and £9 a call, its annual report said.

Widespread concerns have emerged in recent months that the centres do not have enough qualified staff .

Last month leaked emails disclosed that senior officials from NHS Direct in the West Midlands launched the service despite their fears that it was not safe.

NHS Direct’s regional director for the West Midlands, Pam Bradbury, told colleagues she was “very uncomfortable” about stating that the service had the right staffing levels before the decision was taken to launch the service.

In the same discussion, NHS Direct’s chief nurse Tricia Hamilton warned that the service appeared to be unsafe.

Investigations have uncovered thousands of patients hanging up in frustration, while critically-ill patients were denied help, and trivial calls prioritised.

In total, 39 of 44 contracts for 111 are now operating across England, with a similar service in operation in Wales. Private company Harmoni has 12 contracts, while 11 were initially awarded to NHS Direct, with the rest given to ambulance trusts and social enterprizes.

Yesterday, John Reid, the former Labour health secretary, delivered a scathing assessment of the phoneline.

He told the House of Lords: “111 appears to be in turmoil both practically and commercially. The deterioration in our Accident and Emergency services is getting exponentially greater. Trolley waits are back and predicted to potentially reach crisis point.”

Earl Howe, the health minister, said that the government is taking the problems “extremely seriously” and criticised NHS Direct for “getting its sums wrong”.

He said: “I don’t think anyone takes issue with the concept of 111. Unfortunately, however, we have seen in a few isolated cases [of] problems arising. I emphasise that the vast majority of the country are receiving a good service.”

In a Dispatches documentary for Channel 4 broadcast last night, a manager at a call centre in Dorking run by Harmoni, who was secretly filmed said: “We had a very bad service. Still realistically on the weekends we still are unsafe.” A call handler said some nights there was not even a nurse on duty.

At a centre in Bristol, a manager said that on a recent Sunday, only 60 per cent of those who needed to speak to someone clinically qualified were able to do so.

Yesterday Dr Chaand Nagpaul, Chairman of the BMA’s GP committee said: “The implementation and planning of NHS111 has been an abject failure”.

“We cannot have a situation where patients are placed at risk or suffer from substandard healthcare because contracts have been improperly awarded,” he said.

Staff for 111 have been recruited for as little as £8 per hour to man the phone lines, working through computer checklists to ascertain the seriousness of each case.

Patients may then be referred to nurses or doctors. Job adverts do not demand medical experience but experience of telesales experience and typing skills.

As well as missing serious calls, handlers have sent ambulances to cases including a person with a hangover, one with a “cat scratch” and another who could not sleep.

Dr Peter Carter, General Secretary of the RCN said: “Parts of the NHS 111 service are now in chaos, and urgent action is needed to prevent this from having tragic consequences for patients.”

The Prime Minister’s official spokesman yesterday admitted that there have been problems with 111 – but insisted Mr Cameron was “confident” the service would improve.

Conservative sources pointed out that the principles behind the scheme were signed off by Labour before the General Election.

NHS England’s deputy chief executive Dame Barbara Hakin said: “Over 90 per cent of NHS 111 calls are now answered in under a minute and patients are rating the service highly.”

She said the organisation would work closely with NHS Direct to ensure it provided a safe, high quality service until replacement providers were found.

Dame Barbara said “constructive discussions” were underway with a number of potential new providers, including ambulance trusts.

NHS Direct delivers NHS 111 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 spokesman for Harmoni said: “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.”

The firm described staffing levels as “robust” with one clinical advisor to every four health advisors.