Report warns South West NHS 111 service is putting lives at risk

Posted by Samantha Ward on

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NHS 111 is a telephone-based urgent healthcare advice service where callers are assessed, given advice and directed to a local service that most appropriately meets their needs.  Depending on the nature of the problem, this could be a GP surgery, walk-in centre, community nurse, emergency dentist, A&E department, emergency ambulance or late opening pharmacy.

Managed effectively, NHS 111 should ease some of the pressures faced by A&E departments and GP surgeries around the country and ensure that patients get timely and appropriate access to health care.  Many of the country's NHS 111 services are run by local NHS Ambulance Trusts; the South Western Ambulance Service Foundation Trust NHS 111 service covers the counties of Dorset, Devon, Cornwall and the Isles of Scilly; a geographic area of 5,000 square miles encompassing a population of 2.5 million individuals.

The Care Quality Commission (CQC) is currently in the process of inspecting all NHS 111 services; however, the inspection of the South Western Ambulance Service NHS Foundation Trust was brought forward after patients, staff and former members of staff raised concerns.  In their report, published on 16 June 2016, the CQC rated the South Western Ambulance Service Foundation Trust NHS 111 service as 'inadequate' and a Warning Notice was issued following the inspections in March this year.  It was found that patients were at risk of harm because implementation of the triaging system - the 'NHS Pathway Triage System', was not good enough. Too many people whose calls were urgent were not being assessed in relation to their medical needs in a timely manner.  Many people needing less urgent advice were noted to have to wait all day for a call back.  Concerning findings were a lack of trained staff to answer calls and a lack of clinical advisers to provide more tailored clinical advice.  High staff turnover, stress, fatigue and a high sickness rate were found to be significant factors in the poor rating.

South Western Ambulance Service Foundation Trust NHS 111 service will be reviewed again on 8 July 2016, when significant improvements are expected to have been made.  They have been told to review the roles and responsibilities of Non Pathway Advisors (call handlers who are not trained to use the NHS Pathways triaging system). This is to ensure that callers consistently receive the correct level of advice, and to ensure that the call queues awaiting initial assessment and call back are robustly monitored and managed by staff with clinical authority to intervene and allocate resources.

It is imperative that a healthcare triage service such as NHS 111 is run efficiently and effectively, not only to ensure that patients requiring less urgent care are directed to the most appropriate service, but also to avoid potential delay in diagnosing and managing life-threatening conditions such as meningitis in young children, stroke and some mental health conditions.  If individuals have a poor experience with NHS 111 they may be less inclined to use it again and may instead turn to a less appropriate service for their need, such as an already over-burdened A&E department.  Even more concerning, they may simply not be able to access the care they need at all.

It will be interesting to see what changes South Western Ambulance Service Foundation Trust NHS 111 service have put in place by July to ensure standards are being met.  Read more here

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About the Author

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Sam is a Registered Nurse with 17 years' experience working in the NHS. She uses her medical and nursing knowledge and experience to liaise with clients.

Samantha Ward
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