NHS111 deep reflection: the redesign

Sir David has announced a deep reflection on the NHS111 omnishambles.  How deep?

Don’t blame it on the software.

Don’t blame it on the new staff.

Don’t blame it on the short times.

Blame it on the bosses.

Don’t be diverted with trivia.  111 implementation has been “mixed”, only to be expected for a rushed, forced, top down multi-provider project.  But it’s the thinking behind it which ensured that however implemented, it was doomed.  You’ve seen enough in the media on the troubles.  For how it feels to be a patient on the end of the line, try my previous blog.  All the decisions around 111 were taken by people.  It was announced while Andy Burnham was SoS on 18/12/09.  Pilots were and were running when Andrew Lansley took over.  The pilots were evaluated and found wanting (ScHARR report), but the DH didn’t want evidence to get in the way of the plan.  Lansley didn’t pull it, Hunt didn’t pull it:  what did they know?

DH and what became NHS England Board pressed ahead in the teeth of warnings from the BMA, NHS Alliance, Royal Colleges and everyone who knew on the OOH frontline.  Individuals at the head of the NHS are responsible for the design, implementation, pain, heartache, redundancies, downbandings, sheer frustration of staff and patients, and now the investigations into deaths and serious incidents.  Their response so far has been to kick harder those they deem to have failed on implementation.  Why have they not twigged that it doesn’t work because of the specification?  We are told that blame culture should not be a part of the NHS.  How far up the tree does that go?

But we are here, not where we wanted to be, and must move on from here.  They admit we need rapid action.  Rapid action in the wrong direction will only make matters worse – the system will unravel because of its flawed design and therefore the faster we do something completely different the better.  This is different:


A system such as this has been operated by some of the most effective OOH providers for years.  It should operate only out of hours, since it provides the same clinical care that GPs provide in hours.  If “in hours” doesn’t work, then tackle it with the GPs contracted to provide it.  Why keep a dog and bark yourself?

Many in the UK have proven that a model like this works:   I could mention the excellent UC24 in Liverpool, but there are others.  Don’t try to specify every detail as for 111, set principles, measure outcomes and let people innovate.  In Mexico an insurance based scheme operates on this model because they have to manage costs as well as quality.  The call centres are staffed by GPs, and they solve 62% of calls.  See the write up in HSJ

Over to you NHS England.  Do something different now, with evidence in shedloads behind it, or stumble on pouring money down the same old drain.

PS Don’t call McKinsey et al to redesign it.  It’s been done.  Call in the OOH providers who already know how to do it – I have the contacts ready.

PPS  We’ll undercut McKinsey by 20% and it will work.


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