Health Policy InsightEditorial Wednesday 25 January 2012: 111 pilots saw 5-9% rise in unscheduled emergency hospital admissions
The recent discussion paper from the Clinical Commissioning Federation and Urgent Care Network of NHS Alliance (COI dec - I do some paid comms work for Alliance), NHS 111 - Getting Lost In Translation?, is worth a read.
It is based on a poll of CCG clinicians and leaders about the implementation of the new 111 urgent-but-not-emergency number, and also on data from the 111 pilot project.
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The survey of CCG leads found that the implementation of 111 was being experienced locally as, well, a bit old-school top-down. Of the 51 respondents, 23% replied ‘I knew what was happening but had no say’ and 34% perceived ‘no real engagement, the decision was out of my hands’).
79% agreed that ‘there is little scope for local clinicians to shape this service to meet local needs’. Strikingly, all respondents agreed with the statement that 'this roll out is top-down politics not local empowerment'.
Importantly, the vast majority of respondents think it simply won;t work as planned: 74% are not confident that ‘the introduction of 111 in my area in April 2013 will be a success’.
Eating strategy for breakfast
The NHS culture has a very long way to go in decentralising power. As has often been pointed out here. The management cliche 'culture eats strategy for breakfast' only became a cliche because it's true.
There is a much bigger issue in this document, and it is found in the first paragraph on page three. The text reads, "the first data in November on the crucial indicator of the impact on unscheduled admissions showed an increase compared to control sites of between 5 and 9% across all pilot sites. It is important to understand whether this is an early blip, or whether 111 could lead to substantial extra costs to a health system already focused on making substantial financial savings".
It is quite important to understand that, isn't it? In an NHS which is trying to move care and cash out of hospitals, a 5-9% increase in unscheduled admissions could be the last straw.