Another major round of efforts to divert patients away from A&E departments is under way as winter approaches.
Walk-in patients to be called upon by selected hospitals to phone ahead and book appointments in emergency departments, while hospital bosses are putting more pressure on 111 call handlers to be less “risk averse” – and divert more than the current 18% of calls to alternative services rather than A&E.
The HSJ reports at least one major hospital in every “health system” is expected to trial the new arrangements, although the problems of ensuring that walk-in patients are aware in advance of the need to phone ahead – and able to do so, especially patients on low incomes and those with mental health needs – appear not to have been discussed.
Nor is it clear where patients should be sent instead, especially when there have also been complaints by GPs and the NHS Confederation that some callers have been wrongly directed by 111 to primary care during the Covid pandemic, delaying their access to appropriate treatment.
The 111 service replaced NHS Direct in 2014, and in some areas it has since been outsourced to different providers, and been hit hard by a decade of NHS underfunding and privatisation. Operators can earn as little as £9 an hour and receive as little as six weeks of training.
There are concerns that an inadequately prepared and funded 111 system failed unknown numbers of patients when swamped with calls in the early stages of the Covid crisis.
Adrian Boyle, vice president policy at the Royal College of Emergency Medicine, reminded the HSJ that “NHS 111 is only as good as the services that are behind it.” Concerns over local 111 services reflect “a lack of alternatives to the emergency department. … there really is not adequate community alternatives to emergency department care.”
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