Pandemic proves combined 999 and 111 services more effective, claim ambulance leaders

Daren Mochrie, chief executive of North West Ambulance Service Trust and chair of the Association of Ambulance Chief Executives, said the pandemic had demonstrated the importance of close working between the two services in allowing excess capacity to be utilised to respond to less urgent 999 calls. Trusts which ran both these services have been able to pool their resources to respond more effectively to the high level of demand seen during the pandemic, he said.

His call comes as the NHS moves towards a “111 first” model for A&Es where walk-in patients will be encouraged to call NHS 111 first and then given a slot to attend A&E. This is intended to improve the flow of patients into A&E and, crucially, avoid units becoming overcrowded and to operate social distancing. As part of the scheme, ambulance services will try to increase the number of patients treated and discharged at the scene.

“Having 999 and 111 more integrated offers significant opportunities around reducing variation” between the two services, said Mr Mochrie. Having staff working across both 999 and 111 call handling could help meet peak demand – which tends to differ between the two – as had happened during covid.

“With an integrated 999 and 111 service we could have some finite specialist resources pulled together to and could provide a more cost-effective service,” he said. This could include, for example, mental health nurses and pharmacists offering advice to patients and supporting crews on the road across a wider footprint than just a 111 service.

In the north west the ambulance service is already talking to commissioners about such an approach. In areas where NWAS also runs the patient transport service, it has been able to offer further assistance to the 999 service during the covid peak when fewer patients needed transport to outpatient appointments, he said.

At the moment 999, 111 and PT services are commissioned on different footprints – 999 is commissioned by clinical commissioning groups regionally, covering multiple sustainability and transformation partnerships, while 111 and integrated urgent care services are commissioned at an STP level. Patient transport services are generally commissioned by CCGs, sometimes working together.

111 and PTS contracts tend to be tendered, with some contracts won by ambulance trusts but many others by private operators. The short-term nature of these contracts also creates uncertainty and lack of willingness to invest, AACE argues.

AACE argues a more integrated approach to commissioning would help 999 and 111 resources to be pooled and increase resilience to deal with major incidents, and would reduce the number of ambulances despatched and avoid unnecessary conveyances to hospital.

Mr Mochrie also warned of the risks of ambulance handover delays – which he said had become “almost non existent” during the height of covid – returning this winter. These affect patients who are looked after by ambulance staff before they are handed over but also other patients in the community who won’t get an ambulance so quickly, he said.

“We know the risks,” he said. “It is a massive issue for staff in terms of morale but there is also a patient safety risk if they are not available for the next patient.”

AACE was working on how to improve flow with partners as it needed a whole system approach, he said, but some of the government’s A&E expansion money could be used for measures which reduce handover delays, he suggested.