Weekly Poll – NHS 24: 111 Service

Each week Disability Equality Scotland send out a poll question to our members on a topical issue. For the week beginning 31 January 2022, we asked a question about the NHS 24 111 Service.

Results

Question 1. Are you aware of the 111 telephone service provided by NHS 24?

  • YES – 93% (80 respondents)
  • NO – 7% (6 respondents)

Question 2. If yes to question 1, have you called NHS 24’s 111 service in the past two years? 

  • YES – 67% (55 respondents)
  • NO – 33% (27 respondents)

Question 3. Have you experienced any barriers when seeking to access NHS 24’s 111 service? 

  • YES – 30% (24 respondents)
  • NO – 70% (57 respondents)

Comments

We provide verbatim comments where appropriate to illustrate strength of feeling or personal experience.

Call Handlers

The NHS 24 111 service provides urgent healthcare advice and mental health support day or night. You can phone 111 if you:

  • think you need to go to Accident & Emergency (A&E) but it’s not life threatening
  • are too ill to wait for your GP practice to open
  • have worsening symptoms of coronavirus (COVID-19)

The role of the call handler is the first point of contact for the patient or carer/relative to establishing the nature of the call and identifying the appropriate assistance required from the information given. A large number of respondents reflected on the importance of the NHS 24 111 service and praised call handler staff for their helpfulness and capability to provide advice on where to access appropriate care.

“I used the NHS 24 111 service after my husband had a fall; they were very helpful and after getting all the information they booked an ambulance for him. It was the first time I have used the service and cannot find any reason to complain about it.”

“Always helpful and more importantly care and attention to detail and providing the best help that they can give. Were really great and helpful to me on several occasions. Many thanks”

“The service has always been fantastic, offering concise and clear guidance and directing me to where is appropriate.”

“My only experience was five years ago. Great service. I talked through the problem and then a call with a nurse who arranged for a prompt visit by a doctor who made a diagnosis. This led to an ambulance and direct access to the appropriate ward, thus bypassing A&E. All went like clockwork and testing and treatment followed.”

“I have called them at times of emergency and help has always been provided. I will highly recommend people to use this service because even as I am autistic and mostly people misunderstand me or misjudge me by the way I can explain things, I always get to have the best person on the phone call to have patience in understanding a person in distress.”

In contrast, a portion of respondents believed that some call handlers do not always fully understand the complexities of certain conditions or the severity of the situation. This resulted in call handler staff sharing incorrect information.

“The understanding of the call handler to the exact nature of why I was phoning. I spent more time on the phone to them than I did at the hospital getting treated! I know they have to screen calls – but they should do so in a person-centred way and not from the flow chart they are following.”

“Giving inaccurate information/misdiagnosis and not understanding my conditions.”

“I have had mixed service from 111. I’ve had good, where they were very helpful and really wanted to help. On the bad, there was no interest in what was wrong, and no attempt to help guide me on how to get the best treatment. “

“I find that it’s unacceptable that when I was saying someone is in severe pain, I was advised to wait a few hours and take paracetamol. When you know someone is screaming in pain that they need help, to turn you away is wrong.”

Screening Questions

Respondents commented on the number of questions asked by call handlers, which some disabled people found challenging to answer due to the nature of their disability.

“It was chronic asthma, and I was struggling to breathe and answer questions.”

“I have used the service in the past, sometimes they were okay and quick. At other times I had to ring again and go through a whole rigmarole of questions that were difficult because I was very weak. I know they were necessary, but one time the first questions were not logged properly. Once the doctors got to me, they were very helpful and good and thorough.”

“The 111 service is very helpful, it’s the questions that you have to answer before you can actually speak on a health issue and time element for health professional to arrive has been a problem. I know it must be very difficult with organisation aspect, at the same time I am happy that the service is there for people.”

“I’m unable to use the phone for the time 111 takes to respond and to answer all the questions they ask. Then there can be a long wait for a doctor/ambulance. I have to depend on Social Care Response for assistance.”

“I know my daughter has found 111 a nightmare in the time that you have to wait to speak to someone and then all the rigmarole of questions before your problem is dealt with.”

Waiting Times

The NHS 111 service is available 24 hours a day, 7 days a week. Some respondents believed that there can be lengthy waiting times to get through to a call handler. In some cases, this will result in people hanging up before they make it through to speak to someone. It was also reported that there can be a long wait to speak to a medical professional once the call handler makes a referral.

“The main barrier is time, there’s usually a long wait.”

“While I have not needed to call NHS 24 personally, members of my immediate family have. The service does seem very helpful, although call waiting times can be considerable.”

“A really useful service. Delay answering can be a bit frustrating but once through (I use them quite regularly for my service users) a very good service.”

“They need to be more efficient at answering calls. When I have called over the past 2 years I have waited over 90 minutes to get to speak to someone.”

“Long waiting time, usually 4 hours plus before a practitioner calls you back after the initial call.”

One respondent suggested that employing more call handler staff will help to reduce waiting times. In January 2022, a new NHS 24 call centre opened in Dundee, to help facilitate the increase in demand for the NHS 24 service, which has been generated by the redesign of urgent care.

“Far more operators are required, and you should be able to get to speak to a health professional quickly rather than so much time being spent with an admin person who has then to relay your problem to someone else.”

Mental Health

There were specific comments from respondents about the support that is offered for mental health services.

“I called NHS 24 for mental advice and support and had no problems at all with the service”

“I needed mental health advice for my father. The right professional rang us back and spoke to him.”

“The response when calling for mental health problems is pretty good.”

“I recently called in a mental health crisis and discovered two days later that the call handler had put a referral in to social work without my knowledge or consent. This felt like a massive breach of trust and confidentiality and made me afraid to use them again in future.”

Impact of COVID-19

There was recognition that the NHS 24 111 service had received additional pressures as a result of the COVID-19 pandemic. Despite this, a portion of respondents praised NHS staff for continuing to provide appropriate advice and assistance.

“It is a wonderful service that provides people with access to great information and advice at a time of need and that the staff who take the calls are highly trained but are friendly which help put people at ease. I phoned once in the last two years and during the peak of the first COVID lockdown and again the staff were fantastic.”

“I found NHS 24 helpful, even when obviously stressed due to COVID”

Some respondents commented on the number of COVID related questions that are asked when speaking to a call handler.

“I fully appreciate and understand how much pressure they are under, but the biggest part of the screening is COVID related, and then sometimes they just tell you to wait until your doctors opens if it’s not anything to do with COVID.”

“I feel they think COVID is the problem and don’t really listen to other symptoms.”

“I don’t know how clear it all is, especially with COVID, which is why I think folk are rocking up to A&E.”

Contact Methods

There are alternative methods to contact the NHS 24 111 service. If you use British Sign Language (BSL), you can use the free BSL interpreting video relay service contactSCOTLAND-BSL. If you use a textphone you can contact NHS 24 on 18001 111. Or you can contact NHS 24 using the Relay UK app. One respondent, who is a British Sign Language user, praised the service for being able to speak to a call hander via the Contact Scotland BSL service.

“It gave me the independence to speak to NHS 24 111 colleagues via Contact Scotland BSL with a BSL / English Interpreter. They’ve supported my family with different situations at different times with my children.”

Some respondents reported on the challenges of accessing the NHS 24 111 service in a format that met their accessibility requirements.

“Difficulty focussing on speaker on phone if any background noise, a text phone/chat service may be better as I could respond when I processed questions.”

“The system should be a video call with immediate assistance. In practice I found the system inaccessible, fragmented and poorly managed.”

“I don’t speak on the phone so have to have someone ring and speak for me which is stressful and not ideal. A ‘messenger chat’ style option would allow me to access this independently.”

“I cannot use telephones because I am deaf. What we really need is a 24-hour emergency email service.”

“As an autistic person who struggles with verbal communication, especially in a distressed state, the service doesn’t work well for me as I am usually unable to call. It would be good if there was a way to access NHS 24 through text or online, as it would remove a huge accessibility barrier for people who can’t talk on the phone, including autistic people, people who are deaf or hard of hearing, and people who don’t have a private space at home to be able to make sensitive phone calls.”

Travel

For respondents who received a referral for an assessment or treatment, this involved making travel arrangements. Doing so can be challenging for disabled people due to inaccessible modes of public transport and limited services.

“Trying to get a home visit out of hours is virtually impossible as the call handlers don’t appreciate that some disabled people can’t get to out of hours medical centres.”

“I have numerou long term complex health problems which could mask more serious problems and I am frequently asked to drive ~20 miles to see the doctor. I’m not certain that it is always safe for me to be making these journeys, but I am asked to do so all the same.”

“The only challenge for me was to get to the hospital by public transport on a Sunday evening with a broken ankle. But I was able to walk and coming home wasn’t so bad because I had a lovely pair of crutches and a moonboot! God bless the NHS! Long may it last.”

Conclusion

Overall, 93% (80 respondents) were aware of the 111 service and 67% (55 respondents) had used the NHS 24 111 service within the last two years. A large portion of respondents shared positive comments about the importance of the service and praised staff for providing valuable advice on access to appropriate care. Some respondents stated that on occasion, call handlers had provided inaccurate information due to not understanding the severity or complexity of certain conditions. It was reported that there can be long waiting times to speak to a call handler, as well as the time it takes to receive a call-back from a medical professional. It was suggested that more NHS staff are required to help reduce the demand on the service. There was also recognition that a range of contact methods are required to make the service accessible for people with different communication preferences. When referrals are made, there must also be awareness and support in place to ensure disabled people can travel to their appointment.