1. ITV Report

'Inadequate' NHS 111 line putting patients 'at risk of harm'

Substantial staffing shortages and inadequate training at one NHS 111 helpline put patients at "risk of harm", including leaving urgent callers on hold for lengthy periods of time, a damning report has revealed.

One patient was left waiting for a call back for 22 hours.

The helpline provided by the South Western Ambulance Service NHS Foundation Trust was rated inadequate. Credit: ITV News

The phone line, run by South Western Ambulance Service, has been ordered to make immediate improvements across the board after Care Quality Commission (CQC) inspectors slammed the "inadequate" operation.


CQC inspectors found that some patients were waiting too long to receive a call back, including one patient who was left for almost a day without hearing back from an adviser.

There were often not enough staff to take calls or to give clinical advice where needed.

The report reveals calls were sometimes answered by staff who were not trained to assess patients' symptoms, and said there was a risk that patients needing urgent attention were not given priority or could be put into a long queue awaiting call back.

Some calls were answered by staff without the training necessary to assess symptoms. Credit: ITV News

Staff reported working long hours, with many feeling high levels of stress and fatigue.

There was also a high staff turnover and high sickness rates, while some had been denied annual leave because of staff shortages, the report found.

percentage of calls that should be answered within 60 seconds
the percentage the trust was achieving at one time

Prof Mike Richards, the CQC's chief inspector of hospitals, said inspectors had been working with NHS England, NHS Improvement and the local commissioners to ensure that their most urgent concerns around the triaging of calls were dealt with as soon as possible.

If patients needing help can't get a reply, if they are dealt with by someone who doesn't understand their immediate needs, or if they have to wait too long for a nurse or paramedic to call them back for an assessment before they are referred to the out-of-hours GP, it can have potentially serious consequences.

We found that patients were at risk of harm because the triaging system was not good enough. Too many people whose call was urgent were not being assessed in relation to their medical needs in a timely manner. A lot of people needing less urgent advice might have to wait all day for a call back.

Despite the best efforts of staff - the service was not doing enough to identify why this was happening or what needed to be done to improve. The trust had known of these concerns but it took the staff to bring them out into the open to ensure that something was done.

– Prof Sir Mike Richards, Chief Inspector of Hospitals

Although staff were supported in raising safety concerns, the report said, the trust failed to act to ensure these concerns were addressed.

The Chief Executive of the South Western Ambulance Trust, Ken Wenman, said that now they have the report they will be able to use the findings to improve the service over the coming months.

Required improvements

CQC has told the trust that it must make a number of "significat" improvements by a deadline of July 8.

These include:

  • The trust must continue to review staff numbers to ensure patients can access timely care and treatment when first calling the service and when receiving a call back
  • The trust must review the roles and responsibilities of Non Pathway Advisors (call handlers who are not trained to use the NHS Pathways triaging system) ensuring callers consistently receive the correct level of advice
  • The trust must ensure that the call queues awaiting initial assessment and callback are robustly monitored and managed by staff with clinical authority to intervene and allocate resources.

The mother of a baby who died following a string of NHS failures, including being let down by the 111 service, welcomed the report - and said she hoped it would lead to improvements.

Melissa Mead from Penryn in Cornwall lost her son William at just 12 month's old to sepsis.

Earlier this year, a report into his death criticised GPs, out-of-hours services and a 111 call handler who failed to spot he had sepsis caused by an underlying chest infection and pneumonia.

William Mead died of sepsis at just one year old

"We have been waiting for a very long time with suspicions but now those suspicions have been confirmed obviously this shows that William's call isn't just a one-off error within the system," she said.

"Obviously when I called 111 I wasn't aware that William was seriously ill. We called them because we wanted reassurance, we wanted some kind of signposting guidance on what to do."

She added:

111 is a faceless service, you don't have that interaction. The questions are blanketed and you are not able to expand upon your answers. I found it very blunt, very impersonal.

When we called... the call had not been triaged as a priority call which it should have been. We should have spoken to a clinician.

– Melissa Mead