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Blog: NHS 111 was 'too good to be true'

Blog: NHS 111 was 'too good to be true'

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NHS 111 was too good to be true, according to NHS Alliance chief executive Rick Stern. He explains exactly where he thinks it all went wrong

The NHS Direct story this week has brought together a whole series of concerns and issues with NHS 111. Perhaps most significantly, its withdrawal from NHS 111 has highlighted the real problem that the NHS seems to have with running major procurement programmes. While the objective for NHS 111 was for local implementation, in practice these procurements happened over quite large areas and they seemed to be driven by procurement experts, rather than people with a clear vision for what 111 was seeking to achieve.

There were a lot of practical issues with the procurement process, let alone the problems with unrealistic costs. For example, what checks were made to see whether proposals were viable?  It was clear for many months before the service went live that training new staff was going to be a major challenge. Again it is unclear what steps were taken by commissioners to check whether these staffing plans were realistic or deliverable.

Concern was also raised previously that there was so much focus put on ensuring the process was fair, that commissioners seemed to use very little real judgement about who would actually deliver the best service for the local area.

It’s not good enough just to run a procurement exercise, you have to be clear what you are trying to achieve. There is also a responsibility to check, scrutinise, and review the plans carefully, and it’s not clear that that happens anywhere near well enough in some parts of the country.

The desire was to have an integrated approach but, in practice, working in this way actually seemed to cut across people working well together. In the very few places where people did put together interesting joint ventures, they appeared not to win or ran into problems. For example in the North West, a joint venture was originally set up among a large number of mutual out of hours providers, the ambulance service and NHS Direct. However, when NHS Direct couldn’t bring their costs down to the level required, they withdrew their bid and returned with a bid of their own which undercut the joint venture. It was this ill-fated bid that was eventually accepted.

So, if we are seriously interested in integrated solutions to delivering health - which has to be the right solution to a complex service like urgent care - there are questions about whether unsophisticated procurement exercises like this are ever going to deliver the result we really want.

The big question is where do we go from here? The priority for clinical commissioners remains to take a strategic view of how all the services within out of hours care are delivered, and for them to work out how all the different parts can be improved and work well together.

Politicians were looking for that single magic bullet that would transform urgent care services: unfortunately, solutions of that kind rarely deliver. In practice it’s about making lots of small improvements across a complex system, where it’s the relationships which underpin everything. People have got to work hard together to make this work.

Honestly, anyone ought to be suspicious of something that looks too simple, because it probably is. Those of us who suspected that 111 was too good to be true a long time ago have largely been proven right. The real problem of an idea with such compelling simplicity as 111 was how it was implemented, and in practice it wasn’t implemented well; too much was going on and there weren’t enough resources. In reality it’s actually about the whole system working together and not just putting one new number on top of it.

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