Privatised NHS call centres are causing an A&E crisis


A 38 Degrees member didn't find the government's line on the A&E crisis very convincing. When he obtained the figures in question, the problem was quite clear - privatised call centres had lead to an increase in A&E referrals of 50%.

Suresh Chauhan
20 May 2013

I was born in Kenya and came to Leicester in 1968. I was a ‘sickly’ child needing lots of medical help. As this was predominantly private care, I could see how difficult it was for my dad to pay my medical bills. From that time, the idea of a National Health Service has been very important to me.

I am an accountant by profession and have been a business consultant for the past eight years. I have always believed that a society can only call itself civilised if it has a good level of social help available to the poor. Whenever possible, I volunteer to help others.

I came across 38 Degrees when the initial legislation for the Health and Social Care Bill was released in July 2010. I found electronic campaigning heart-warming; you quickly became aware that there were lots of other people who felt the same way as you.

It was through my involvement on local 38 Degrees campaigns at public meetings with my local CCG, that I became aware that my CCG was overspending on our A&E service. I was also aware that our hospital was being fined over £1.4 million for continually missing its target of dealing with 95% of A&E patients within four hours.

The explanation proffered by our CCG was that our A&E was inefficient. But I soon learned that missed targets had occurred elsewhere in the country. I also heard Jeremy Hunt blame GPs for the increased workload. The explanation given started to sound dubious. The Health Secretary was falsely claiming that the chief cause of the current sudden crisis in A&E departments was the GP contracts negotiated and signed by the previous government - more than 10 years ago.

I decided to conduct a detailed investigation into A&E attendances over the time that this government changed from NHS Direct to the new, largely privatised NHS 111 service. NHS Direct - previously responsible for triaging out-of-hours calls for medical advice - had an impressive record: it led to a reduction in A&E referrals of close to 24% by 2009. NHS Direct operated from some 40 dedicated callcentres across the country and was an integral part of a properly national NHS.

Given that accurate information on the new NHS 111 services would be all but impossible to gather since it began in April, I made the assumption that the number of calls remained at the level achieved in 2009/10. I contacted NHS Direct myself and obtained figures on call levels, headcount and number of referrals to A&E. What I found was astounding.

As I did the calculations, it became quite clear that the real cause of the crisis is the Coalition government’s 2010 policy decision to dismantle NHS Direct. It chose instead to privatise the various call centre regions, as part of which the new NHS 111 phone service was introduced.

The Impact

NHS 111 - using fewer highly skilled and many more less qualified staff - has led to a much higher proportion of callers being referred to A&E. The number of callers referred to A&E since 2010 has increased by 50%. This factor alone accounts for about 437,000 extra referrals to A&E last year. This, coupled with the disastrous effect of hastily closing down NHS Direct has meant a further steep increase in referrals to A&E departments.

What is more, in some areas the new service has not even started. Where it has, the performance has been very poor, with less qualified staff giving dangerous advice. Last but not least, the rushed closure of the trusted NHS Direct has lead to around 1500 lay-offs of dedicated and hardworking nursing staff.

Thus, it is plainly the increased referrals from NHS 111 that are the real cause of our overwhelmed A&E departments, which are now struggling to treat the higher numbers of patients with the same resources. The inevitable result: longer waiting times.

The consequence of dismantling an existing public service in favour of a private one has lead only to problems for patients and demoralization of committed NHS staff. All the while, at the other end of the scale, a few private providers are reaping rewards for providing a second rate system. Harmoni, the biggest private provider of NHS 111 services, was recently bought out by Care UK – the same Care UK whose former chairman, John Nash, made substantial donations to both the Conservative party and to the personal office of Andrew Lansley.

If Jeremy Hunt is serious about sorting out the problems his government’s actions have created, and reducing referrals to A&E to normal and manageable levels, the decision to dismantle NHS Direct must be reversed. This is an example of what privatisation of our NHS can and will mean – profiteering at the expense of good service. It also proves an old maxim: “If it ain’t broke…”

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