NHS England board, agenda item, call 111

Stop wittering about poor implementation.  Call the number and hear for yourself.

I have phoned 111 and tried the system.  Blame me for wasting 10 minutes of a poor suffering operator’s time for an unnecessary call, but I picked a quiet time, late on a sunny Thursday afternoon, in hours.  Ten minutes waste to add to the inferno that is the 111 project.  So, on to the detail:

I have corns on my left foot.  At 17.29 it takes 54 seconds for a human operator to answer – not bad.

It takes a further 2 minutes 36s to establish my name, date of birth, postcode, street address and, hardest of all because there are so many to search through, the GP where I am registered.

At 3 minutes 30s into my call the well trained, competent and polite operator begins asking about my symptoms.  I have some painful areas under my left foot.

For the next 6 minutes he asks me a series of 27 questions (if I counted right), running through more deadly diseases than I have ever heard of.  Why, when I had already told him I had a bit of pain, not too bad, under my left foot, did he ask whether I was coughing up blood?  Would I not have noticed?  Breathless, tight chest?  Blood clot? Swollen groin? Leg blue?  Can I walk three steps?  (As it happens I ran the London marathon last week).

He did explain that some of the questions might sound scary, but he had to rule them out.  Finally he asks how long I’ve had it, over two weeks.

In the end, a sigh of relief from both of us as he advises that I must call my GP within three working days.  In the meantime take paracetamol, ibuprofen or similar.  We haven’t quite finished though, as he warns that if it gets worse, goes cold, white or blue, I should go straight to A&E.  Or I could call 111 again.  They keep a record of the call, but they can’t send it through to my GP because there is no system in place.

The correct diagnosis would have taken a competent person a few seconds – you have corns.  I did not exaggerate my symptoms in any way.  I received no diagnosis, gained no benefit, and was given the wrong advice, directed to a GP instead of a chiropodist.  I’m no clinician but I would expect a balance of about 50/50 talking and listening in the consultation, yet I spent about 95% listening to a list of diseases, 5% saying I didn’t have them.  10 minutes 8s of both our lives goes by, for nothing.

Readers, this service is burning your taxes.

Volumes have been written on the failure of implementation of NHS111, blame has flown around the system, directed at private providers (because they are private), public providers NHSD (because it’s a public bureaucracy), untrained staff, inaccessible GPs.  No.  It’s the design that is totally wrongheaded and bound to fail.

We heard an admission of troubles from NHS England within 11 days of the April Fools’ Day national go-live.  We have a parliamentary committee investigating the matter.

Yet we don’t hear them question the fundamentals.  111 is designed to minimise transaction cost.  I heard the boast last year that it was going to come in below £10 per call, by having a layperson ask a series of questions and feed the answer into NHS Pathways software.  Then the answer would be already connected up, so that if an ambulance was needed, it would already be on its unstoppable way.  They didn’t ask whether ambulance calls (£340 each) would go up.  Unbelievably, they didn’t seem to think about the purpose of it from the point of view of the patient.

To be fair DH was prepared to run pilots and have them evaluated by an academic team.  The ScHARR report showed that it did not meet its cost saving objectives and that emergency demand on average went up.  It had a 21% chance of saving money.  I read that as, it had a 79% chance of costing more money.  Why didn’t Lansley, who was handed the idea by Labour, look at the evidence and quietly ditch the whole project?

In the inexplicably long delay between collecting the data and publishing the report, the April Fools’ day timetable required all the provider contracts to be let, and it was too late to stop this enormous ball rolling.  Cock up or conspiracy?  Perhaps only a handful of people know the truth on that, and I’m not one of them.  Perhaps a curious journo will find out.  What I do know is that during the pilots, people who had seen the 50% rise in ambulance calls through 111 were told to shut up.  I personally witnessed the bullying.

Dear NHS England board, you could spend a long time today debating risk registers, project reviews, corrective actions and so on.  Cut to the chase:  one of you must have some minor ailment, maybe a little deafness or sight loss.  Call 111 from the meeting, just listen, and as the song goes, “Let’s call the whole thing off.”


For the record, these are the questions asked regarding my sore foot (as many as I can remember)

Do you have a blood clot?

Any swelling?


Are you hot or inflamed?



Weight loss?

Feeling tired?


Calf pain over two weeks?

Contact your GP, must be within 3 working days, just in case.

Can take paracetamol or ibuprofen

If it goes cold, white or blue in colour, go to emergency.

Can’t pass this on to GP as no system in place.

10.08 mins


3 responses to “NHS England board, agenda item, call 111”

  1. Ruth Livingstone says:

    Hmmm. Well, since NHS111 is an urgent care number, I am not sure why you were calling about your corns in the first place.

  2. Mark Buckle says:

    A very insightful and, to be fair, restrained commentary on this sad affair. You have absolutely hit the nail on the head in observing that the NHS has absolutely no concept of service design.

    And the sad thing is that it probably never will, because ‘effective services’ are not a driver of the organisation. The leadership may talk a good story around becoming more patient-led, but in reality it lacks the skils to look beyond the latest set of ill-conceived instructions from above.

    Until the political leadership recognises that an organisation the size of the NHS needs to have at least 10-year planning horizons, over which party politics is made to steer clear (other on budget setting), we will remain ending up where we’re heading…

  3. “Why didn’t Lansley, who was handed the idea by Labour, look at the evidence and quietly ditch the whole project?”

    Because the Conservative manifesto in 2010 said “We will commission a 24/7 urgent care service in every area of England, including GP out of hours services, and ensure that every patient can access a GP in their area between 8am and 8pm, seven days a week. We will introduce a single number for every kind of urgent care – to run in parallel with the emergency number 999.”

    In other words, Lansley said he would implement the 111 service, so he did.

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