111 Telephone Service

Jamie Reed Excerpts

Wednesday 5th June 2013 Westminster Hall

[Mr Jamie Reed (Copeland) (Lab)]

It is a pleasure to be called to speak under your chairmanship for what I think is the first time, Mr Robertson. I extend my most sincere thanks to the hon. Member for Thirsk and Malton (Miss McIntosh) for securing this important debate. We have worked closely on a number of issues during my time in Parliament, and she is rightly respected across the House as an independently minded Member. I must express my most sincere sympathies to her, but also my profound thanks for the real courage she has shown in sharing her family’s experiences with us.

It is a mark of the severity of the crisis our A and Es are experiencing that Members of all shades of political persuasion have spoken at some length about their constituents’ experiences. It is no exaggeration to state that members of the public are very concerned about the situation regarding NHS 111. A and E is arguably the most visible part of our NHS, and what happens there is felt throughout the system. From the patient waiting at home for an ambulance to the person waiting on a trolley for a bed, what happens in A and E touches every patient in the NHS.

The crisis in A and E has happened on this Government’s watch. When Labour left office, A and E was performing well, with 98% of patients seen within four hours. However, the number of patients waiting for more than four hours has now doubled, and ambulance queues have doubled too. Let us not forget that the target for the number of patients seen within four hours in A and E has been reduced under this Government, from 98% to 95%. Today’s debate is therefore extremely important, and the Government must finally offer some real solutions to address the crisis they have caused.

[Andrew Percy]

I find it incredible that the shadow Minister states that the issue was caused by this Government. A lot of my constituents are having to ring 999 because 50,000 beds were taken out of our hospitals nationally on his party’s watch; wards were closed in my local hospital on his party’s watch. Elderly, vulnerable patients who do not have local hospital beds to go to are now forced to ring 999 to get access to emergency services, so it is pretty shameless of the hon. Gentleman to attempt to politicise the issue.

[Mr Reed]

I have to say I am staggered by the hon. Gentleman’s manufactured indignation. I do not know how long he has been a Member of the House, but he will recall that, between 1997 and 2010, the Labour party took the NHS budget from about £30 billion to £110 billion. However, on every occasion the budget was put before the House of Commons, the Conservative party voted against an increase. He should think again about his manufactured indignation.

[Andrew Percy]

rose—

[Mr Reed]

I am going to make some progress, because I want to get on to the substantive issues in play.

When Labour first suggested a new NHS 111 service, we were clear—the hon. Gentleman should listen—that it would not replace NHS Direct. Our manifesto in 2010 said:

“A new national 111 telephone number will make nonemergency services far easier for people to access and book.”

The 111 service was planned to help people find an emergency dentist, a late-night pharmacy or an out-of-hours primary care GP. This Government scrapped that and instead pressed ahead with the botched implementation of a system that just could not cope with what it was expected to do. They were warned, but, as usual, they did not listen.

There is no doubt that the 111 service is not fit for purpose. The statistics show it, the examples given by Members today show it and, most importantly, patient testimonies show it. Indeed, the Minister herself acknowledged it in response to the right hon. Member for Mid Sussex (Nicholas Soames) in late May, when she stated:

“We recognise that the service has not been good enough and we are working closely with NHS England to ensure improvement in performance. NHS England have put a number of measures in place already.”—[Official Report, 21 May 2013; Vol. 563, c. 740W.]

I hope the Minister will outline what those measures are and what their effects have been, because the contributions we have heard today suggest they are having a negligible effect.

The implementation of the system has undoubtedly caused serious problems; indeed, in my area, NHS Direct is having to be maintained alongside the 111 service to cope with demand. The Minister must explain in detail how a botched, fragmented implementation was allowed to happen despite there being a significant pilot scheme.

[Barbara Keeley]

On the issue of propping up NHS 111, I wonder whether this is the point at which to give credit to the NHS Direct nurses whom Janet Davies of the Royal College of Nursing cited. Even though some of them are being made redundant, they were prepared to prop up the service during its few weeks in places such as Greater Manchester. We really should give those nurses credit. What a dreadful experience, just before they were made redundant, to have to prop up the service that was replacing them.

--- Later in debate ---

[Mr Reed]

I could not agree more. We must give credit to all the people in the NHS coping and labouring under a creaking system right now. The case of the NHS Direct nurses my hon. Friend draws our attention to, who are about to be made redundant but are propping up the system, speaks volumes about their commitment to the ethos underpinning the NHS. I thank my hon. Friend for that contribution.

The 111 service data for March published by NHS England show that only 122 patients responded to the NHS 111 patient experience survey. When the Minister responds in a few minutes, I hope she will not try to justify the implementation of a system that needs to serve millions of people on the basis of the experiences of just 122 patients.

The main purpose of the debate is to look at the implementation of NHS 111 and its impact on A and E attendances. There is no better place to look than the Isle of Wight—the hon. Member for Isle of Wight (Mr Turner) was present earlier. The 111 service there went live on 25 October 2011. The area has had a long time to address teething problems and to ensure that the service operates properly. What has A and E performance looked like over the past few months? Since the end of September, almost 2,000 patients have waited more than four hours, and the trust has missed its target for 23 out of 35 weeks. That is hardly a ringing endorsement of the system, even when it has had a chance to bed in.

Consultants on the Isle of Wight have even said that although patient numbers would be falling and the pressure would be easing if NHS 111 was working as intended, that is not happening—patient numbers are rising, and the pressure on the NHS is increasing. Indeed, Chris Smith, the director of NHS 111 on the Isle of Wight told the BBC that the service is fragmented and that that has led to problems. In response to the hon. Member for Tewkesbury (Mr Robertson), the Minister said that every NHS 111 provider is able to handle inquiries from any part of the UK, but I would challenge her to repeat that assertion today, given Mr Smith’s comments. If a system is fragmented, and CCGs are commissioning different providers, it will be almost impossible for those trained to handle calls to work within different systems. For example, the process for referring people through the system in an area with which they are unfamiliar will be totally alien to them, which is bound to cause further problems.

That brings me to my final point about the system. Following Labour’s A and E summit in Westminster last week, it was revealed to us that 111 call handlers do not necessarily have clinical backgrounds, as my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) said. Even more shockingly, it was revealed that some areas have an enforced threshold on how many calls nurses can answer, and that that was as low as one in five. The fragmentation of the system means that the figure varies from area to area, because it would have been negotiated in local contracts. Therefore, the service provided is not universal. That is in stark contrast to NHS Direct, under which 60% of calls were directed to nurses. Under 111, however, the figure stands at less than 20%. Does the Minister believe that the low level of engagement between trained medical practitioners and patients in the service is contributing to A and E pressures?

The chaotic reorganisation of the NHS is clearly producing a deteriorating experience for patients. In the last week of March, one patient in the south-east waited for 11 hours and 29 minutes for a call back. In the area covered by NHS Gloucestershire and NHS Swindon, 43% of calls lasting longer than 30 seconds were abandoned by the patient before they were answered. Will the Minister outline the lessons that have been learned from that experience and explain what measures will be put in place to ensure it is not repeated on a national scale?

In four weeks, the 111 service will be live across the country, and the Government need to be more honest about how the service is performing before wider implementation. Royal colleges, patient groups and other stakeholders have long warned the Government that the health and social care reforms brought about by the Health and Social Care Act 2012 would be distracting and cause chaos, and that such top-down reforms would stop the clinically driven reforms needed to help address the crisis in A and E.

That there is now a crisis engulfing accident and emergency services is beyond doubt. It was caused by the Government. We have heard today of a political vacuum and we have heard legitimate fears about the lack of accountability. Patients deserve better; we all do. If the hon. Member for Thirsk and Malton will allow me to say so, her family and her father deserve better. I hope that the Minister will take the time to address all the issues, and to outline the Government’s plan to deal with the current A and E crisis that they have caused.

--- Later in debate ---

[Anna Soubry]

I will take interventions, but I want to make these points first.

The population is also living considerably longer. That is good and welcome, but there are many frail elderly people with complex illnesses and diseases, so they attend A and E in a way they did not previously. In addition, we suffered under the previous Government from a lack of integration between health and social care. That was one of the things that the Health and Social Care Act 2012 addressed, and will solve. It is about better integration. The hon. Member for Copeland sneers at that.

[Mr Jamie Reed]

I do not sneer; I laugh.

[Anna Soubry]

He laughs at it, Hansard will record. It is not a laughing matter at all. What I was describing is one of the achievements of the Act. I am confident it will deliver.

[Anna Soubry]

I, too, know that it does no one any favours to make out that someone forcefully and passionately giving a view based on their experience is manufacturing it. I know that that is not true of my hon. Friend, and I thank him for his valuable contribution. He is right.

[Mr Jamie Reed]

I think casual outside observers will struggle with the concept that politicians from different political parties should seek to have different political opinions about the services and Department for which the Minister is responsible. She makes an almost Kafkaesque defence of the Government’s NHS record, but will she accept that the awful implementation of the 111 scheme, the collapse of adult social care, the closure of walk-in centres and the huge pressures on the NHS elsewhere in the system have resulted in the crisis in A and E?

[Anna Soubry]

I will not accept any of what the hon. Gentleman says, because he does his cause no service when he makes cheap political points. The matter is hugely complex, but it is wrong to say that the Government caused the problems in A and E. He is wrong in that. It is difficult and complex.

--- Later in debate ---

[Anna Soubry]

Indeed. I will answer as many of my hon. Friend’s questions as I can. There are some questions I will not be able to answer, but I will certainly write to her.

One of the reasons we introduced pilot schemes was to learn from them, and I can tell my hon. Friend a few things as a result. The university of Sheffield did an evaluation report, which said that there was “no statistically significant” impact on services in most of the pilot areas. Importantly, NHS England is collecting data on 111 and its impact on other services, especially, as one would imagine, on A and E. NHS England is in a position to monitor that, and it will report in due course. I am told that the April data will be published this Friday.

I am reliably informed that the A and E performance of York Teaching Hospital NHS Foundation Trust, which serves my hon. Friend’s constituency, is that in 2013-14 so far, 96.1% of people have been seen within the four-hour target. That is above target. I think the average across England for people being seen in A and E is some 55 minutes.

[Mr Jamie Reed]

This question is not a trap in any way, shape or form. The Minister just said that NHS England is assessing data on the performance of 111 thus far, which will be made available in due course. This is an empirical question: will the system be rolled out across the country without the data on the effect of the 111 service on the rest of the system being fully understood?

[Anna Soubry]

I do not know the answer, and I will not start speculating because it invariably gets one into terrible trouble.

[Mr Reed]

Will the Minister write to me?

[Anna Soubry]

I am more than happy to write to the hon. Gentleman with some sort of answer from either NHS England or the Department.

I should say, of course, that we know that 111 has not been successful in the way it should have been in many parts of the country, and we know that there were particular problems over the bank holiday and Easter periods, but we also know that it has now been rolled out to 90% of England. NHS England is monitoring, overseeing and collecting the data, as we would all hope.

I will do my very best to respond to the content of today’s debate and the questions that have been raised, with apologies for those questions that I do not answer.

The ratio of call handlers to professionals, about which my hon. Friend the Member for Thirsk and Malton asked, is 4:1. That ratio is not specified, however. There is no prescription that it must be 4:1. As 111 is locally commissioned in the way that I have explained, it is for local commissioners to decide whether to change that ratio, depending on the particular needs of the people in their area. One of the great benefits of the 2012 Act is that we have enabled local commissioners, either as a CCG or as a cluster, to commission services to meet the specific needs of their patients. I hope that will mean that a cluster or CCG in a rural area, obviously knowing that its patients live in a rural area, will ensure that its service is tailor-made to suit the needs of those patients, which may be different from the needs of patients in, say, a city and its surrounding suburbs. That is one of the joys of local commissioning.

My hon. Friend asked whether the three to three-and-a-half hours—in truth, I think it was really four hours—before her father was seen is normal, and the unequivocal answer is no. Is it acceptable? In my view, it is certainly not acceptable.

My hon. Friend then asked who pays. She is concerned about whether the debt in which her primary care trust found itself will have an impact. The 111 service is paid for by CCGs, which is one reason why CCGs are involved in the local commissioning of the service.

How are the concerns of GPs being addressed? The NHS is having a review in the way that I described. My hon. Friend the Member for Brigg and Goole (Andrew Percy), who must be a member of the Select Committee on Health—that shows my profound ignorance, and I apologise to him—has helpfully reminded me that Dr Gerada, who is the chair of the Royal College of General Practitioners, said in her evidence yesterday that she has not seen such queues since the flu epidemic of two to three years ago. She said that the reasons for the high demand are mixed and complex, including the nasty flu virus that went around earlier this year and at the end of last year. I reiterate my point: if only it were so simple to cure the problems in A and E.