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Is the NHS 111 telephone service putting children in danger?


    Ali Cloak considers the recent report published by Cardiff University which reviewed all patient safety incidents involving children over a ten year period, particularly those involving the NHS 111 telephone service, and whether the service is providing safe patient care.

    By Ali Cloak

The NHS 111 service replaced NHS Direct. It operates like a hospital triage system, so when a patient phones 111 their symptoms are assessed by call handlers who ask a series of questions in order to establish the best course of action. If appropriate the patient will be booked an appointment with a GP, advised to attend A&E or will receive a call back from a health care professional.

What is going wrong?

A recent study by Cardiff University, published in January 2017, assessed 2191 reports of patient safety incidents involving children in primary care (so including GPs, pharmacists and the NHS 111 service) in England and Wales between 2003 and 2013.

The study found that 30% of the adverse patient safety incidents involved the NHS 111 telephone service. The study highlighted that the software used to assess children is unclear, particularly its sensitivity to detect signs of serious illness in children.  The conclusion of this study was that “out of hour’s telephone triage systems are not fit for paediatric purpose”.

It has been noted that paediatric patients are more at risk, as children’s symptoms are often difficult to explain and will not easily be diagnosed by a script of questions being answered by a parent.

One of the key recommendations of the study was for a “robust evaluation of the effectiveness and safety of NHS 111 in the paediatric population”.

Previous concerns raised by the Care Quality Commission

This recent study follows the death of one year old baby William Mead, who tragically died in December 2014 following a failure of the NHS 111 Service, amongst others, to recognise red flag warnings of sepsis, which we have written about previously.

The Care Quality Commission subsequently investigated the NHS 111 Service in the South West and reported in 2016 that it was found to be “consistently failing to meet national standards”.

The report found the main issues to be:

  • Too many abandoned calls.
  • Patients waiting too long for their calls to be answered or for a call back with advice.
  • Calls being answered by staff who were not trained to assess patient’s symptoms.
  • High staff turnover rates and high levels of sickness.

The report found that the service was ’Good’ for caring, but ‘Inadequate’ for: safety, effectiveness, responsiveness and being well-led.


The purpose of the NHS 111 Service was for it to streamline the way which patients were treated, allocating the appropriate resources to the symptoms of the patient. However, in order to be effective the service needs to provide a better balance of trained clinical staff and call advisors. It needs to be recognised that when diagnosing medical conditions it simply is not sufficient to expect that every symptom will fit into a computer script and algorithm, particularly when it involves children.

These concerns continue to be raised about the service such that it must be time for change. Without changes to the way that the system is currently operating there will be further cases of injury and death, such as William Mead, which are entirely preventable.


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