Department of Health decides to roll out 111 nationally - without knowing the cost

In a letter published today, demanding plans for implementation of the 111 telephone service throughout England, it is announced that the roll out will happen. This decision has been taken before the planned evaluation of the pilots which was scheduled for the Autumn. Most disturbingly, it has been taken before any of the costing figures from the pilots have been assembled.

Cost was a primary motivation behind the decision to abandon the nationally managed NHS Direct health advice and information service, in favour of the locally run 111 service.

The modest subsidy which NHS Direct derives from its use of a 0845 telephone number (at much greater premium cost to callers, e.g. 1.7p per minute vs. 41p per minute) goes little way towards offsetting the considerable costs it incurs in providing a comprehensive health advice and information service by telephone.

The 111 service was said to be ONLY for URGENT, but non-emergency, calls. The evidence from the few pilots that are currently running shows that many non-urgent calls are being received and handled. This is not identified as an issue that needs to be addressed.

The NHS Direct NHS Trust has been awarded the position of being the default provider of the 111 service, despite its poor record for economy. The idea that each locality could address the needs of its people in the most suitable manner has been abandoned. A needless rush will, most likely, simply transfer the same costly NHS Direct service from one number to another, whilst also adding further costs.

Rather than benefitting from a fraction of the premium rates paid by patients to call the 0845 number, calls to the 111 service will be at no charge to the caller. Even if the caller would have been able to call a local or 03 number at no cost, the NHS will pay every telephone company for every call to 111. When the figures are assembled and released we will know how much that amounts to.

At a time when great care is being taken with public spending, it is extraordinary to see such recklessness. I am not opposed to spending money on the NHS, nor to the concept of the 111 service. I am however disturbed to see so much money being spent on ill-justified reorganisations and unproved projects at a time when resources are under pressure.

There are some who think that the present NHS re-organisation (which will be simply rubber-stamped when the Health Bill is passed) is just phase 1 of something bolder. Some think that the NHS is being deliberately fattened up with cash denied to others.