Senior directors at NHS Direct warned it was not safe to go live with one of its biggest NHS 111 contracts but were overruled, HSJ has learned.

It comes as further revelations have emerged about the fallout for the organisation following its failure to fully deliver the urgent care phone service.

A series of emails, seen by HSJ, reveal discussions between senior NHS Direct figures and commissioners in the run-up to the disastrous launch of 111 in the West Midlands.

The services began failing within hours of launch at the end of March, and GP out of hours and ambulance service providers were drafted in to provide support. Across its nine contracts, of which the West Midlands is one of the biggest, NHS Direct is still only handling 30 per cent of the calls it was originally contracted for. NHS Direct is one of two major national providers of NHS 111.

The emails, about the decision to go live in the West Midlands, show it was taken despite:

  • NHS Direct’s chief nurse Tricia Hamilton warning the service was unsafe due to predictions of high rates of abandoned calls;
  • NHS Direct’s regional director for the West Midlands, Pam Bradbury, also a nurse, telling colleagues she was “very uncomfortable reassuring commissioners that we have the staffing levels right”;
  • forecasts showing that call abandonment rates could reach 71 per cent at some point during the first weekend after launch; and
  • warnings from NHS Direct’s director of service delivery for 111, Laurin McDonald, that last-minute changes to the provider’s service model for 111 would affect “every element of… future operational planning”.

In one email sent in early April, NHS Direct’s director of operational support, Sean Flynn, recalls the conference call during which the decision was taken to go live.

He wrote: “On this call a question was asked should we go live. Tricia Hamilton said something like looking at the figures she thought it unsafe. [Director of strategy and business development Ruth Rankine] reminded her of the position we had created by not going live on time [in February]. Eventually a decision was made that we would go live on that call.”

NHS England’s NHS 111 project director in the West Midlands, Wayne Bartlett, was also on the call.

A spokeswoman for NHS England told HSJ the decision to go live was taken “after very careful consideration of the balance of risk in the urgent care system across the region”.

She said the West Midlands launch had been delayed from an earlier planned date in February. This meant many call handlers for GP out of hours services, whose role was due to be replaced by NHS 111, had already been made redundant. As a result there was a lack of capacity elsewhere in the system to handle the calls, she said.

Emails leaked to HSJ also reveal concerns about late changes to NHS Direct’s service model for providing NHS 111. They show it was designed on the premise that call handling centres would be able to provide overflow capacity to services outside their area. However, commissioners were later assured the vast majority of calls would be handled locally.

On being presented with information showing contract delivery would be “ringfenced” to specific regions, Ms McDonald wrote: “I believe we have consistently warned the mobilisation team and [regional directors] to act with caution and they have not… The position as presented… affects every element of our future operational planning.”

Ms McDonald, a call centre expert, was hired as a contractor to develop the 111 service.

A spokeswoman for NHS Direct said patient safety was a “key consideration” in the decision to go live.

She added: “The biggest single cause of the capacity shortfall at launch was the unexpected length of the calls - which reduced the number of calls that could be handled by the staff.”

Exclusive: Senior NHS Direct leaders warned 111 was unsafe but were overruled