By continuing to use the site you agree to our Privacy & Cookies policy

Exclusive: NHS Direct abandons cost cut plans following 111 debacle

NHS Direct has abandoned plans to down-band frontline staff because it needs to retain people to run its NHS 111 service, HSJ has learned.

A memo to staff, seen by HSJ, also reveals up to nine NHS Direct call centres earmarked for closure could be kept open.

The decisions are a sign of how badly NHS Direct miscalculated the capacity it would need to provide the NHS 111 service in the North West and West Midlands, its two biggest 111 contracts.

NHS Direct is currently only handling about 30 per cent of the NHS 111 calls it should be taking in line with the contract, and is still providing its 0845 service in a number of areas under separate contingency arrangements which last until the end of June.

NHS Direct had earlier planned to close 24 of its 30 call centres, and to reduce its pay bill by changing staff bandings. It had planned to move band 6 nurses to band 5 and band 3 call handlers to band two.

The memo said all staff will now retain their original banding “by right” so that NHS Direct could retain “the skills and expertise of our most experienced front line health advisors and nurses”.

The sites which could remain open are Stockton, Nantwich, Liverpool, Mansfield, Hull, Sheffield, Stafford, Bedford, and Ilford, although final decisions have not been made.

NHS Direct chief executive Nick Chapman admitted there had been “capacity shortfalls” when the service went live.

Asked how NHS Direct had got it so wrong, he told HSJ: “The biggest single explanation is that the length of the calls staff were dealing with and the proportion of calls referred to nurses was much higher than had been planned for. We have recognised we need to have more staff therefore it seemed to be a very sensible action [to reverse the downbanding] to try and retain staff.”

Mr Chapman, who earlier this year moved moved his focus to winding down the 0845 service while new managing director Trevor Smith led the NHS 111 roll out, has now returned to a role leading the whole organisation. He confirmed the “likelihood” was NHS Direct would continue to provide the 0845 number as contingency beyond the end of June and discussions were taking place with NHS England about additional funding.

HSJ has also learned Deloitte has been asked to investigate why the launch of NHS 111 by NHS Direct went so badly. The review has been commissioned by NHS England, the NHS Trust Development Authority and the non-executive members of the NHS Direct board.

Mr Chapman said there were serious questions to answer.

Asked why the NTDA was involved he said: “The failure to mobilise the 111 service has a potentially significant impact on NHS Direct itself as an organisation. Therefore it’s appropriate the NTDA are involved.”

Unison national officer for NHS Direct Michael Walker welcomed NHS England’s involvement.

He said: “The rescinding of the closure of so many NHS Direct centres just weeks before they were due to close, while welcomed by many staff, it will be acutely difficult for those who have already sought jobs elsewhere or had planned their exit based on redundancy pay.”

Readers' comments (27)

  • Harry Longman

    Redefinition of ambulance chasing - Deloittes cashing in on a change of drivers, new one turns out to need help from old one, not quite clear who is driving but while they fight over the wheel to stay on the road, the meter is running in the chase vehicle. #youcouldntmakeitup

    Unsuitable or offensive?

  • Why do we need an external consultant to tell us how badly things went wrong? Deloitte are not experts in the call centre field. There are more companies with far greater experience if we want to go external. Why the love affair with the "Big Four".

    Unsuitable or offensive?

  • It's blindingly obvious that the NHS lacks the commerical and top notch programme managment expertise needed to deliver this sort of transition.

    I predict two things:
    1) No heads will roll
    2) The increased costs NHS Direct will now incur will end up being met by the taxpayer.

    If NHSD underbid on price, they should face the same treatment as a commercial sector organisation would. They made a bad bid and won the business on the back of it. But it isn't a level playing field.

    It will be interesting to see if any of the unsuccessful bidders for the regions NHS Direct won will complain/challenge when (2) comes to pass.

    Unsuitable or offensive?

  • It is pretty harsh to blame the NHSD too much They were trying to compete with a wide variety of interestingly cross funded 111 offerings, plainly had no whitehall support to manage a very tricky transition of some services, thier own demise, and a complete lack of support for them as an orgnsiations. In short it was the orphan of the 111 debacle, which now looks likely to become the whipping boy !!

    Unsuitable or offensive?

  • Not harsh at all.

    Bidding competitively you need to get your business model sorted and numbers right.

    Imagine the uproar if ABC Ltd had submitted a low bid, won the work, then surfaced a few weeks later (cap in hand) and said "sorry, our projections were wrong, can we have some more money please?". Would hope they'd (rightly) be told to "do one".

    As it is, with "NHS" in their name they'll get a bail out and we'll all be told it's OK for this to happen.

    Unsuitable or offensive?

  • to anonymous about low bids and asking for more money
    thats what the train operating companies do all the time - and they get the money either by fare increases or by tax payer subsidy.
    what about circle given a handout the department of health to keep hinchingbrooke going - they are a private company

    Unsuitable or offensive?

  • No it isn't 1235. Fare increase formulae and subsidies are part of the deal from the get go. It's not the same.

    Don't know the precise terms of the Hinchingbroke deal so can't comment.

    Unsuitable or offensive?

  • To those that think it harsh on NHSD being blamed for the debacle that is NHS111 there are facts that might not be known.
    Like the fact that it was widely agreed before bid submission that they would low ball the bid and then try to renegotiate with the commissioners!
    Like the fact that they went in so low that it was impossible for them ever to deliver from mutiple sites as the costs simply weren't there!
    Like the fact that they were so suprised that they won the bid, in one of the 2 areas mentioned, that they had no mobilisation plan, no idea of where and how the service would be delivered and no team ready to take it forward!
    Like the fact that they were fully aware of the length of calls and the volume of transfer to nursing staff as they had been part of the pilot scheme in that same area for the last 2 years and had full evidence of all these things!
    The bit where Mr Chapman stated otherwise is therefore, how shall I put this, an untruth!!!
    The biggest single factor in the debacle Mr Chapman, was that NHSD were so scared of losing everything to those that actually know how to deliver a front end for out of hours service provision, i.e local OOH providers, that they went for the cheapest bid and to hell with the consequences. Far be it for them to consider patient safety in all of this!!!!

    Unsuitable or offensive?

  • Did no one take notice of the pilot information before the launch - it is unbelievable for them to say they underestimated the call length. I expect demoralised staff awaiting downgrading had some impact. Also, who on earth expected Band 2 call takers to be able to cope - These staff need to be skilled and intuitive which can only be achieved with well trained and valued staff. Paying these staff cleaner rates is totally inapproriate.

    Unsuitable or offensive?

  • That is astonishing 2:30. Thank you for putting it out in the open.

    Begs the question though. Why were commissioners not asking for mobilisation plans as part of the bid submissions? Would be entirely normal practice, in a well run outsourcing procurement, to do so.

    Unsuitable or offensive?

  • Harry Longman

    Another plague of anonymice. Since when did any of those wee cowerin' timorous beasties change anything? And no, not all of you are facing castration for putting your name on an HSJ comment.

    Unsuitable or offensive?

  • While NHS Direct publicly struggles to get this right are we saying that the ambulance trusts and out of hours services running NHS 111 are all going to plan and performance? And at the cost per call as planned? If this was truly operating in a competitive market how can ATs be able to work at marginal rates? NHS Direct spent many years running a highly regarded service (by patients mind you - not by the politics in DH). Where are the people now who ignored the warnings about timescales and timings?

    Unsuitable or offensive?

  • dear, oh dear.... NHD Direct.... fail... again

    Unsuitable or offensive?

  • When will commissioners realise that when something sounds too good to be true - it usually is! Triaging safely and appropriately, is difficult even for experienced GPs. That, together with a complicated software process ie Pathways linking with a large incomplete Directory of Services, was always an accident waiting to happen. I suspect those providers that lost the tender are thanking their lucky stars they were not lumbered with this debacle. Agree with the comments above - leave it to the experts!

    Unsuitable or offensive?

  • dear, oh dear.... NHD Direct.... fail... again

    Unsuitable or offensive?

  • in Wiltshire, paramedics said they had been sent to patients with a sore throat, patients stuck in a chair, patients with ear ache and a painful wrist. “We are picking up calls that are completely inappropriate and we are having to respond with lights and sirens on,” a paramedic in south-west England said. Daily Telegraph april 26th. This is the 111 service provided by Harmoni in the west of England. A service so terrible that A&E departments were using senior doctors to triage referrals. A service so catastrophic that the commissioners were threatening to cancel the contract afer 2 days ! A service so loaded with problems that NHS Direct are still the default safety net for the unanswered calls .....

    Unsuitable or offensive?

  • Sorry 5.28, I disagree. GPs experienced in out of hours care can deal confidently in all scenarios presented. I consider myself one having worked since 1993 through all the changes since my own practice did its own on-call, though co-operatives, OOH providers and now thre first few weeks of 111.

    Three differences now. First Nurses have become the major clinicians supported by cumbersome computer programmes. Most have trained but have limited experience , are risk averse, and spend much time deciding to let someone else take the decision, often a doctor in the end, and more often than before a paramedic via 999. Second, much less GP involvement and hence younger GPs are not developing the skills and experience. Finally, the good old public who can do no wrong when it comes to health. Their demands are met , they learn bad behaviours and demand more and more. This group consult more than ever outside normal hours, fuelled by the press scare stories (didnt have children vaccinated with MMR now every rash is Measles !), these undue demands load the system even more, the respected GP firmly and fairly adjusting help-seeking behaviour modification a thing of the past.This all a recipe for melt-down.

    Along comes NHSD, the supernumery risk averse OOH advice supplier , bids for 111, ironicallybecomes the first non independant sector out of hours community provider for decades ( GPs of course being independant companies), and they get it so wrong.Meanwhile the independant sector out of hours providers with GP management and experience slot into 111 with ease ( see Northern Doctors Urgent Care).

    Solution - give GPs the a proportion of the masses of extra funding pumped in when they lost OOH responsibility, include nurses with appropriate roiles to their experience, and start to educate the public again, both in and out of hours.

    Finally, the problem with the whole NHS, take the politicans out the equation - the recent rant by politicans to blame GPs for this mess is laughable, fed by inaccurate garbage from DoH. The political cycle has much to answer for!

    Unsuitable or offensive?

  • NHS Direct are unable to use all their staff to support the 111 service because the DOH are using the organisation as the contingency back -up for failures elsewhere principally by private sector providers. Same old story....

    Unsuitable or offensive?

  • Reading all of the above makes me realise how much people haven't got a clue what is going on here. The other providers are staying in the NHSD shadows because they are failing also but the usual thing to do is kick NHSD my friends wake up the others are failing as we'll believe me. You don't know the half of it.....

    Unsuitable or offensive?

  • Perhaps anonymous from 0114 should declare an interest as we may not know half and it appears he / she doesn't know the other half. Isn't that why NHSD are where they are- didn't know the full picture.

    As to 9.33 - names of private providers failing please - otherwise little value in your comment.

    GPs like myself can only sit with a feeling of sadness and "I told you so" . You valued OOH care, provided by GPs at £6000 to get rid of us for an unrelated political agenda. You never really understood what OOH care was, and now you struggle to find any other system that works without ultimate dependence on doctors, now paid significantly more at the end of a pathway that costs a fortune.

    There will be many retired GPs sitting with pension and a wry smile on their faces!

    Unsuitable or offensive?

View results 10 per page | 20 per page | 50 per page

Have your say

You must sign in to make a comment.

Related Jobs

Sign in to see the latest jobs relevant to you!

Sign up to get the latest health policy news direct to your inbox