The NHS 111 service is often most people's first port of call when they have concerns about their own or someone else's health.

People are encouraged to use the phone-line where the issues are not immediately life-threatening but still require urgent attention. The helpline opened in 2010, replacing NHS Direct, and the service received 7.29 million calls from January to July 2015.

The development of NHS 111

NHS 111 has come under recent scrutiny after claims from Irsah Tahrir, who worked at one of its call centres, that it was 'dangerously understaffed' and 'completely unsafe'. It was reported in the media that there were times when no nurses were available, and call centre staff with no medical training had to give advice to patients. This has been rejected by Derbyshire Healthcare United, which runs the service in the Derbyshire, Leicestershire, Nottinghamshire and Northamptonshire area.

However, they have admitted that Ms Tahir's claims related to the period over Easter, when they had experienced high demand for the service. There was an admission that the service does come under pressure at peak times.  

Others have highlighted the fact that the system relies on a computerised tick-box system that does not always accurately assess the needs of the patient calling. A mother recently lost her one-year-old son to sepsis after a 111 operator, with no medical training, told her to give him Calpol. When the system prompted the call handler to ask if he had been crying for more than an hour, his mother replied that he was unable to stay awake for more than 45 minutes, leading the call handler to input 'no' to the question. This, and other anomalies in the system, as well as errors made by the call handler, led to the young boy not being admitted to hospital, with tragic results.

NHS 111 whistleblowers

A second whistleblower, who worked for the service covering the Southwest, tells a similar story to Ms Tahir.

She states that staff were told to deal with calls as quickly as possible in order to meet targets, and that sometimes, especially on bank holidays, there were more than 200 calls waiting to be answered.

She reveals that the computer system used to make decisions about patient care was unreliable, and would often prompt an ambulance being dispatched unnecessarily – when someone had a nosebleed, for instance.

At other times, however, when a patient perhaps needed more urgent attention such as when suffering from an asthma attack, the system would leave him or her waiting for a call-back within up two hours. This was due to a question relating to whether the patient had bleeding 'that would fill more than two cups'. If the answer were 'yes', the system would automatically prioritise the patient.

Flaws in the system

Using a system based solely on yes/no responses to generic questions seems far from ideal and, in some cases, outwardly dangerous, leading to some patients being falsely reassured that there is nothing to worry about and wasting resources on those not actually requiring urgent medical attention.

The first contact made with the 111 number is often when patients are at their most vulnerable and require an accurate, efficient assessment. It is therefore essential that this service, as well as out-of-hours doctors and minor injuries units, can provide a good service even on bank holidays and weekends. These services often act as the gateway to accessing emergency assessment and treatment and, if patients are not advised or signposted appropriately, precious time can be lost that could mean the difference between life and death.

While service provision on NHS 111 is, of course, largely very good, mistakes at this initial stage can lead to catastrophic consequences for patients.

Under these circumstances, clinical negligence claims can become inevitable, particularly when services are stretched over bank holidays or where there is insufficient out-of-hours provision to support the hotline.