NHS’s non-emergency phone line sending rising number of patients to A&E

Nuffield Trust think tank says proportion of people transferred to ambulances after dialing 111 has 'crept up' over the last three years from 150,000 to 200,000

An ambulance outside an entrance to a hospital Accident and Emergency department (Press Association)

The NHS's non-emergency phone line is sending a rising proportion of patients for emergency care, new analysis shows.

The proportion who call NHS 111 and are transferred to ambulances has “crept up”, according to a new report from the Nuffield Trust think tank.

However, researchers concluded the phone line had also prevented millions from seeking emergency care.

The report examines data from the phone line which was rolled out across England by the end of 2013.

The phone line is “widely used”, taking more than one million calls every month.

The largest number of patients are sent to primary care, their GP or other community services.

But, corresponding to increased call numbers, the number of patients sent to A&E or transferred to an ambulance has risen over the last three years from 150,000 to 200,000.

The researchers found the proportion of patients sent to emergency services has also risen, in its first years 18-19% of patients were sent to emergency care, a figure which has now increased to 20-22%.

The think tank estimated this means 20,000 more people a month are sent to emergency services than would be if NHS 111 kept to its original pattern.

Meanwhile there were high levels of variation noted across the country with patients in some regions more likely than others to be passed along to ambulatory care.

In North East England during 2016, 17% of callers were transferred to an ambulance compared to 8% in South Essex.

“This is a very high level of variation, and it is a problem for emergency services and patients if some areas are too eager or too reluctant to send an ambulance,” the authors wrote.

They also found there is a higher number of people sent to ambulance services instead of A&E.

The researchers added: “This is the opposite of what happens with patients in general, where far more people attend A&E than are despatched in an ambulance.

“It does lend some plausibility to the suggestion that NHS 111 is too risk averse with people who have more urgent problems.”

However, surveys conducted on people who have used the help line have revealed it may have prevented millions from going to A&E or calling for an ambulance.

Around 45% polled said without the line they would have gone to their nearest emergency department or called for an ambulance but once they call only around 20% are sent to these services.

“A look over the three years suggests that NHS 111 has in fact redirected a large number of people from emergency services to general practice, and a smaller number of people who would have used services not to do so at all,” the authors wrote.

“Summed up across those years, it could have prevented as many as eight million people from presenting to emergency services.”

They added the phone line “soaks up” extra demand during the NHS's busy winter months.

Professor John Appleby, chief economist and director of research for the Nuffield Trust, said: “Halfway through one of the toughest winters the NHS has endured in recent times, we wanted to see whether there was any truth in the assertion that referrals from NHS 111 may be contributing to the pressure on A&E departments and ambulance trusts.

“What we found was a bit of a mixed picture.

“It's a concern for the NHS that the proportion of callers sent to A&E and ambulances is growing all the time; but surveys of callers appear to show that even higher numbers would have opted for these emergency services if they hadn't been able to ring 111.

“What's not clear is why different areas are sending such varying numbers of callers to ambulances and A&E, and it would be worth NHS England or the Department of Health investigating the reasons for this.”

An NHS England spokesman said: “The increased number of people referred to emergency care is proportionate to the higher number of calls being handled.

“111 continues to do an important job helping patients to get the right care, at the right place and at the right time, and in protecting both A&E and ambulance services from unnecessary attendances and call-outs.

“The latest monthly figures show NHS 111 answered over 1.35 million calls, 11% more than the previous December.

“Of these, nearly 300,000 spoke to a clinical adviser, compared with 262,000 in December 2015. Typically, of the calls NHS 111 triaged, just 13% led to an ambulance being dispatched and just 8% were recommended to A&E.”

Labour's shadow health secretary Jonathan Ashworth said: “The decision to scrap NHS Direct and replace it with the NHS 111 was strongly criticised by health professionals, and today we have learned that NHS 111 is sending more callers, and a higher proportion, to A&E than in previous years, with great variations in performance across different regions.

“Overstretched and under-resourced, NHS 111 has not met the 60 second call target for two and a half years.

“Ministers need to get a grip, take responsibility for these mistakes, and set out what action they are going to take to make sure all parts of the health service are running to the standard that patients expect.”

PA