“Unprecedented” central pressure and a procurement process focused more on cost than quality were two of the biggest factors in the failure of NHS 111’s launch, a new report has concluded.

The NHS Alliance, which represents individuals and providers involved in primary care, produced the report following a crisis meeting bringing together members involved in the roll out of the non-emergency telephone number from all over the country.

The discussion paper, shared exclusively with HSJ, said: “In many cases it is clear that providers were put under unprecedented pressure by the Department of Health to meet their agreed go live dates, even if the providers felt they were not prepared.”

NHS 111 had been due to go live across the country by 1 April but at least half of the country missed this deadline.

The report said there was also widespread concern about the effectiveness of the NHS Pathways triage software system which the service relies on. In Bristol, where the service is being delivered by Harmoni, local GPs reported “numerous” inappropriate responses, including the police being called to the death of a palliative care patient, which appeared to be due to Pathways.

Members of the alliance also criticised the DH for its oversight of the procurement process which required contracts to be delivered for a certain price. This meant that in some cases the tender assessment criteria were heavily skewed towards cost, the report said.

In addition, the fear of legal challenge among local commissioners led to bids being considered “blind” and “random” decisions that did not take into account local knowledge.

In the North West, where NHS Direct won the contract, and services failed within hours of going live, plans had originally involved a consortium bid with North West Ambulance Service and all of the region’s GP out-of-hours providers. The report said NHS Direct was asked to leave the consortium as it was unable to price its services in line with the other partners, yet it went on to win the contract with a significantly cheaper bid.

A spokeswoman for NHS Direct said no final consortia price had been agreed and the consortia was “working through the detailed modelling when partners withdrew”.

NHS Alliance chief executive Rick Stern said: “Like so many procurement processes in the NHS they seem to be much more about avoiding legal challenge than having a clear vision for where the service is going to go.

“The other pressure is the behaviour we all know of which is if there is a clear target and a priority set by ministers then people in the system will make it absolutely clear it has to be done. If clinical commissioning is to really take off… it needs more clinical leaders to say no when they get these demands.”

The alliance is calling for a “period of reflection and learning” before further roll out of NHS 111 and more co-operation between different parts of the urgent care system.

The DH declined to comment on allegations it had put inappropriate pressure on providers to go live but a spokesman pointed out some areas had been given more time.

Topics