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It is hard to decide which is the most disturbing fact that has come to light about the NHS 111 service as a consequence of The Daily Telegraph’s recent investigations. Our undercover reporter revealed that the service 111 provides to patients can be alarmingly poor: some were deliberately denied ambulances, despite clear medical need.
That was disturbing enough, but also alarming is the tacit admission made in an internal letter to NHS bodies from Dame Barbara Halkin, NHS England’s chief operating officer. Ordering the immediate suspension of all negotiations over new contracts for local 111 services, Dame Barbara says that such contracts should not be agreed until the NHS has put in place “a functionally integrated urgent care access, treatment and clinical advice service”. In other words, until the health service has worked out how 111 should relate to hospital accident and emergency departments and GPs. The implication of that, of course, is that such fundamental decisions, on which an efficient and effective health service depends, have not yet been taken. That is troubling indeed.
But perhaps more worrying still is that it took the determined efforts of journalists to bring these things into the public domain. No large organisation can ever avoid errors or weaknesses, but the successful ones deal with their mistakes quickly and openly. The NHS is often too slow and too secretive about its own failings, a closed culture that has contributed to a number of scandals in recent years. The challenge for the health service following our investigation is not just to address failures of care and organisation, but to adopt a truly open culture where such shortcomings cannot be concealed.