NHS 111 non-emergency helpline for Wales set to progress

Plans to launch a new NHS non-emergency helpline service in Wales look set to go ahead despite problems in England.

The 111 line would replace NHS Direct as a "gateway" to all kinds of different services.

The Welsh government hopes it will ease pressure on accident and emergency departments said to be "at the point of meltdown".

Medical staff have mixed views as to whether the 111 line will ease or add to pressures on A&E services.

The line is intended to allow access to services such as out-of-hours GPs, district nurses, and eventually social care too, so that people will be less likely to end up taking themselves off to hospital.

The 111 service was fully launched in England in April but has been beset by problems, with reports of patients struggling to get through.

Some areas even suspended their lines after they failed to cope with demand, but NHS England said the service is showing signs of improvement.

British Medical Association (BMA) Welsh GP committee chairman Dr David Bailey fears the problems in England will also happen in Wales.

"Inevitably you'll have a service which uses call handlers who are working from a computer script and they will be risk-averse," he said.

"They will err on the side of safety all the time which means they'll more likely to refer patients to A&E rather than less. That will drive up attendance at casualty."

He says the system had the potential to work well but would need a "big investment".

Dr Aruni Sen, a consultant in emergency medicine at Wrexham Maelor Hospital, also believed that call handlers may be too cautious.

He told BBC Radio Wales that NHS Direct had not reduced pressure on A&E departments.

"If you do have experienced clinicians then what's the difference with NHS Direct?" he said.

"So what guarantee do we have that this will be any better?

"To expect this to reduce pressure on emergency departments is delusional."

But Charlotte Jones, a GP from Swansea consulted by the Welsh government over the proposals, said the BMA hoped a 111 service would be more integrated.

"It would work closely with other unscheduled non-emergency care providers such as emergency departments, out-of-hours GP providers, and the ambulance service, " said Dr Jones.

"The difference being that - rather than being a service that stands on its own as NHS Direct does... we have a great opportunity to integrate everything and make it work both on a local level and on a national level and make sure patients get the care they receive."

The Welsh government said its intention was to introduce a 111 line that will be safe and reliable and become the first point of contact for everyone needing urgent, unscheduled care.

It said it was working with stakeholders including the BMA and was keen to use lessons learned from the introduction of NHS 111 in England to ensure there were no problems.

'On the edge'

Proposals for the introduction of NHS 111 in Wales are set to go forward to Health Minister Mark Drakeford over the summer.

One part of his response to the problem of high numbers ending up in hospital is to "accelerate the introduction" of a 111 line for urgent but non-emergency patients.

Hospitals in Wales have reported A&E units being under intense pressure with record numbers of patients.

In a letter to Mr Drakeford, almost half of the Wales' A&E consultants say pressure to meet financial targets has meant the loss of beds "at the expense of quality care".

Last week a consultation was launched into a major shake-up of A&E services in south Wales, which would involve cutting the number of specialist departments from seven to four or five.

NHS leaders believe services are currently spread too thinly and have warned some specialist hospital services are "on the edge" and could "collapse" unless big changes are made to the way they are delivered.

Health officials said the "best fit" was to locate specialist services in Cardiff, Swansea, Merthyr, Bridgend and in a new hospital near Cwmbran.

The move could see the Royal Glamorgan Hospital in Llantrisant stop treating the most serious A&E cases. These units would be led by consultants around the clock and throughout the week.