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More ambulance call-outs from 111

The troubled NHS 111 service has led to a rise in numbers of ambulances sent to patients, according to Government-commissioned research.

Experts found there was no reduction in the number of 999 calls made, numbers of people going to A&E or use of urgent care centres in the first year of the 111 service.

Instead, it led to a 2.9% increase in emergency ambulance incidents "and an increase in activity overall in the emergency and urgent care system".

Researchers said this could translate into an extra 14,500 call-outs for an ambulance service attending 500,000 incidents a year.

The study comes after NHS Medical Director, Professor Sir Bruce Keogh, said he wanted to see an "enhanced" 111 service.

In his report on A&E, he said 111 staff would have medical records to hand so they could give the right advice to patients, and a wider range of medical staff - such as doctors, paramedics, pharmacists, dental experts and mental health nurses - would be available to speak to patients.

Workers at 111 would be able to book appointments for patients at their local A&E or urgent care centre, and doctors and pharmacists could provide prescriptions ready for patients to collect. If a problem was more serious, staff could still call an ambulance.

But today's research found that, in its first year, "NHS 111 did not deliver the expected system benefits of reducing calls to the 999 ambulance service or shifting patients to urgent rather than emergency care".

The experts said there is potential that this type of service actually creates rather than reduces demand for urgent care.

The 111 service is a freephone number for patients with urgent, but not life-threatening symptoms.

The phone line operates 24-hours a day, seven days a week, although its busiest periods tend to be out-of-hours when local GPs are not available.

It was designed to replace NHS Direct and is run by different organisations in each area, including private companies and ambulance trusts.

The service has been beset by problems since its launch, with reports of patients facing long waits for advice and emergency services being inundated with patients who have been either incorrectly referred by 111 or unable to get any help at all.

Some 111 services apparently had problems answering calls within a 60-second target, while some doctors who received referrals from 111 said patients had been sent to the wrong services.

The service is operated by non-medical staff who have received training and who have support from nurse advisers.

Today's research from the University of Sheffield, published in the journal BMJ Open, involved detailed analysis of four pilot sites set up to run the 111 service, covering 3.6 million people in England, and 36 months of data.

Overall, NHS 111 triaged 277,163 calls in the first year of operation for a population of 1.8 million.

The researchers found "no evidence that NHS 111 changed use of most of the emergency and urgent care services" while there was "an increase in numbers of emergency ambulances sent to patients".

The experts said a system designed to be used by handlers without clinical expertise will inevitably err on the side of caution and might offer less flexibility than one designed for clinicians.

In the accompanying podcast, the lead author suggests this issue may resolve as the service matures and the handlers gain more confidence.

NHS 111 also offers an easily remembered number, the authors added.

The authors of the study said there was an increase in activity overall in the emergency and urgent care system, and it was expected this increase would stay the same even when the full roll-out of NHS 111 was complete.

But the Department of Health insisted the study findings did not reflect the current state of 111.

A spokesman said: "This study does not represent how NHS 111 is performing now. It was undertaken when NHS 111 was being piloted and was available to just a small proportion of the population.

"We have backed the service with a £15m fund to support it over winter. NHS 111 now deals with more than half a million calls a month and 97% of them are answered in under a minute.

"We are looking in detail at Sir Bruce Keogh's recommendation to enhance NHS 111, so it provides even more expert advice and personalised care over the phone, to give people a quicker, more effective service and also help with the demand on our hospitals by supporting patients at home where possible."

Shadow health secretary Andy Burnham said:"2013 has been the worst year in a decade in A&E.

"It is a crisis of David Cameron's own making and proof that you cannot trust the Tories with the NHS.

"It is clear that Cameron's decision to scrap NHS Direct, and replace nurses with call handlers, has added to the pressure on A&E.

"It was a major mistake that he now needs to put right.

"He should implement without delay Bruce Keogh's call for a return to an NHS Direct-style service with clinicians, not computers, making the decisions."

An NHS spokesman said the study is "significantly out of date" and "is not directly comparable to the current 111 service."

He added: "The Sheffield study looked a very low volume of calls. Only 400,000 calls were offered to 111 for the first year of the study, whereas 111 is now being offered around 600,000 calls a month.

"There is now no evidence that 111 is increasing A&E attendances - in fact attendances in areas with 111 for the most recent 12 months compared to 12 months earlier is down by 0.2%.

"Ambulances dispatched from 111 transport the same proportion of patients to hospital as those dispatched by 999 - showing the service is appropriately sending ambulances."

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