Optimism bias

 

Hangin’ on

 

An idea of the problems caused during the start of ‘111’, the new non-emergency service which is replacing ‘NHS Direct’, has been exposed by ‘Pulse Today’ (5^th June 2013, Jaimie Kaffash) a GP’s website which obtained a leaked report prepared by accountancy firm Deloites, into NHS Direct’s 111 service – it has contracts in 11 areas of England covering about a third of the population.

Things have gone badly wrong in the North West and West Midlands – they have been suspended- and if they lost these contracts the viability of the whole organisation would be threatened.

This was because they had got their pricing wrong;

“It concludes that NHS Direct was unable to deliver its shared goals in the North West and the West Midlands at the agreed price, saying: ‘It is clear from our analysis… that it is simply not possible for NHS Direct to recover to a position where it can deliver originally contracted volumes within the current commercial parameters without incurring significant additional cost.’”

So they were let off the hook, at least for a while;

“NHS Direct was granted a Key Performance Indicator ‘holiday’ in the first quarter of its operations and will not incur contractual penalties for the problems with the launch of the service.”

 

According to Deloites, if those contracts go wrong, the Trust would go Bust;

“There is also a recognition that interventions on these contracts would impact the overall viability of NHS Direct nationally.”

This is what it would cost to put it right;

“The report also says that a recovery plan for NHS Direct in the two regions was estimated to cost ‘in excess’ of £9m. NHS Direct told Pulse this figure was not correct and only an ‘early informal illustration provided to commissioners’, but added that the organisation was ‘now projecting that it will make a deficit in 2013/14 as a result of the operation of its NHS 111 contracts.”

Then we see what was going wrong for the public;

“It says the NHS 111 services run by NHS Direct did not have enough trained staff, calls were taking  more than twice as long as predicted and assurances given to commissioners pre-rollout were ‘less than robust’.

The service was returned to out-of-hours providers after 70% of calls were abandoned in the North West on the first day, with only 13.5% were answered within 60 seconds. In the West Midlands, 37% of calls were abandoned and 49% of calls answered within 60 seconds.”

What was going wrong?

“ NHS Direct board had ‘succumbed to optimism bias’ and that it did not pay heed to warnings from key staff.”

Actually there were not enough staff and they weren’t properly trained. What is particularly sad is that the old NHS Direct staffed by helpful Nurses, was useful and efficient. Now it’s gone, the nurses replaced by a ‘Trust’, mainly staffed by call centre staff and a small number of clinical staff.

While there is nothing wrong with working for a call centre, the problem is that no one in positions of power seems to understand that call centre staff are no more qualified in health matters than we are – we might as well make our own decisions

There was a really helpful comment made by ‘anonymous’;

“NHS Direct worked extremely well and safely for 14 years, however, 'the powers that be' deemed it was too expensive at £24 a call!......decided they needed to save money and bring the cost of the calls down…..calls to be dealt with a top heavy proportion of non-clinical call handlers. Thereby passing less calls through to drastically reduced numbers of experienced senior nurses.

With NHSD the majority of these calls were given advice about how to manage symptoms at home with specific worsening instructions, so the caller was in no doubt about what to do should their condition change.

So now we have the 111 service being managed by over 40 different organisations both NHS and private organisations, where once we had one national organisation managing we now have over 40! Non clinical staff have high dispositions due to lack of knowledge and as we know face to face consultations cost a lot more than £24!”

I’ve edited that comment to suit myself, as I did with the article, so it’s all my fault. NHS say it was only a draft report and the final version had different conclusions. Blah, Blah, Blah.

Good work ‘Pulse Today’

Neil Harris

(a don’t stop till you drop production)

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