NHS 111 crisis adds pressure to health system as Strep A calls spike

A crisis in the NHS’s 111 service has left vulnerable patients unable to the get help they need while staff struggle to cope with the volume of calls – piling pressure on other overstretched areas of the emergency care system.

Staff say that as call numbers grow, their jobs have become like “working in a sweatshop”, with call targets being put before patient safety.

Over the weekend there was a surge in 111 calls in relation to the Strep A outbreak which has killed nine children so far, staff told The Independent.

Dr Adrian Boyle, president of the Royal College of Emergency Medicine, has warned a lack of clinical staff manning the service means that call handlers were more likely to refer patients to emergency departments.

He told The Independent that non-clinical staff “rightly err on the side of caution and may often direct patients to the only available service at the time – A&E”.

Have you been affected by this story? Email rebecca.thomas@independent.co.uk

Dr Boyle added that NHS 111 online services were “poorly evaluated” and “risk averse” adding: “NHS England is in a difficult position given the historic, prolonged under-resourcing of the health service, but 111 is not going to be its saviour. Wishful thinking that patients should or can go elsewhere should not be government policy.”

Leaked emails seen by The Independent reveal the service has been at the highest level of pressure for weeks, with one source claiming almost 800 patients have been left in long queues for callbacks during one weekend.

NHS 111 is supposed to protect 999 call centres and A&E by pointing patients without emergency needs to other services, but figures show that almost one in six callers give up before they get through to an operator. Some who do get through are having to wait more than 12 hours for a call back which should take a matter of minutes.

An email sent in November asked handler staff to send patients needing a call from a clinician to the nearest A&E or Urgent Care Centre rather than placing them in a queue.

It also asked staff to signpost patients facing a 12 to 24-hour call back to their GP for Monday, Pharmacy or A&E if their symptoms become worse.

It told call handlers: “It’s extremely important we are utilising other services to ensure we are not adding any extra pressure on our [Clinical Assessment Service] queue.”

In another email sent this month, managers said the service was “extremely overwhelmed” and warned staff not to place patients who need primary care advice into the clinical assessment service queue unless urgent.

One call handler told The Independent: “The pressure is too high, we take calls after calls, it’s a never-ending process. Patients are not happy because they do not receive the callbacks on time [so] they keep calling back.

“It’s a sweatshop… [Managers] only care about the number of calls we have taken per hour and the focus on the duration of the calls. Patient safety is out of the window… it is completely ignored.”

They said even patients who are priority one and two, who should receive calls back in 15-30 minutes, are waiting hours.

It comes as NHS 111 staff – generally among the lowest pay grades for the health service – are set to join thousands of ambulance and healthcare staff in striking over pay before Christmas.

Rachel Harrison, of the GMB union, said call handlers were facing “overwhelming demand”.

Meanwhile, in A&E, the latest data uncovered by The Independent reveals 183,000 patients had to wait more than 12 hours to be admitted to a ward in October, up from 143,000 the previous month. Sources in the NHS said they were concerned that this month that number could top 200,000.

Mathew Westhorpe, an NHS 111 manager in the East of England said that there was no point in having more call handlers to help patients if there were no services to direct them to.

He added: “111 is very much in the front line, it’s the point of contact for the majority of the patient population…We run a signposting service, and we’re trying to get people to the right places but the reality is there aren’t enough places for the demand anymore. When services [such as GPs] shut down, that puts more pressure on 111. So out of hours absolutely becomes the sort of the key critical point.”

Emergency 999 call centres are also being pushed to the brink as internal NHS data, seen by The Independent, reveals almost 100,000 calls took more than two minutes to answer, it should take up to 60 seconds, with demand rocketing to nearly one million calls.

UK Health Security Agency on Friday sent out an alert over scarlet fever following the deaths of children, following a four-fold increase in the infection.

Parents are being told to contact NHS 111 or GP services early if they suspect children have scarlet fever as early treatment is important to avoid worse conditions such as sepsis.

Mr Westhorpe went on: “There’s been a huge uptick in general demand [over the last week], a significant proportion of cases I’ve dealt with have been for poorly children and one of them was confirmed scarlet fever case.”

“Given that we're facing sort of ongoing Covid concerns [and] rising [cases of] Strep A/scarlet fever, and everything else that existed before that, then people are going to be unwell this winter and I worry that we're not going to get all of the care to all of the people all of the time because it's just not practical.”

Another NHS 111 call handler said during the weekend they’d had an increase in calls related to Strep A symptoms, with numerous callers mentioning warnings made in the news.

One mother, Holly Ramsey, told The Independent at the end of November she waited 12 hours for a call back for her children who were later treated with antibiotics for suspected Strep A.

Ms Ramsey had to go to NHS 111 online and ask for a call back after being told there was a high demand for calls.

But the automated online service, which looks at symptoms you’ve entered, directed the mother-of-three to A&E, which she said she knew was too “drastic”.

After getting through to NHS 111 she had to wait 12 hours to be called back for advice on her six-year-old twins, and a further 12 hours when her five-month-old daughter also showed symptoms.

She secured a GP appointment for the next day, at which point they were given antibiotics because doctors suspected scarlet fever, but Ms Ramsey then became ill herself, having to wait another 17 hours for a callback.

Ms Ramsey said: “What really upset me is if didn’t have my mum there helping and a husband, with the children, I don’t know what I would have done. I was so ill I couldn’t get out of bed, and I couldn’t even talk because of the pain in my throat. It’s just awful knowing that you don’t get that call back.”

NHS England said: “The NHS in London, as across the country, has been under huge pressure this autumn – with recent figures showing there were over 235,000 calls to NHS 111 in the month of October.

“There are however, measures in place to boost capacity and we have prepared for winter like never before, expanding the use of 24/7 control centres across the capital for urgent and emergency care and recruiting additional 111 call handlers.”

NHS England recently launched a drive for the public to make greater use of 111 online, saying that hundreds of call handlers were being recruited.

The DHSC and London Ambulance Service were approached for comment.