NHS 111’s response to callers with Covid-19-related symptoms during the pandemic
HSIB Legacy
Published
Emergency care
Coronavirus (COVID-19)
The purpose of this investigation is to support improvements in the delivery of NHS 111 and other telephone triage services during a national healthcare emergency.
2 recommendations
3 observations
3 actions
2 of 2 responded
Safety Recommendations (2)
NHS England
R/2022/206
HSIB recommends that NHS England ensures any Single Service contract or additional services contracts reflects the minimum requirements of the core NHS 111 service for audio-recording calls.
NHS England will work with partners to ensure pandemic services meet minimum audio-recording requirements, noting the dormancy contract already includes this, but activation is situational.
NHS England will work with partners to ensure pandemic services providing clinical advice meet the minimum requirements for audio-recording calls. UKHSA has also confirmed that the current dormancy contract does include the requirement for calls to be recorded, but enacting this requirement is a decision to be taken at the time of pandemic or other high scale response. Response received on 6 January 2023.
NHS England
R/2022/207
HSIB recommends that NHS England reviews the risks associated with increased use of telephone triage in response to national healthcare emergencies. Consideration should be given to applying any recommendations of this review across telephone triage services within the wider healthcare setting.
NHS England will collaborate with partners to review risks from increased telephone triage during emergencies, using a "lessons identified" process to apply findings to broader services.
NHS England will work with partners to review risks following national healthcare emergency response as part of the lessons identified process. These lessons will then be reviewed and applied where relevant to current services as part of an established process. Response received on 6 January 2023.
Safety Observations (3)
It may be beneficial to review triage software and safety-netting/worsening advice to ensure the language used by health advisors does not deter seriously unwell people from calling back or seeking medical advice if necessary.
It may be beneficial, when dealing with a novel virus, for consideration to be given to the benefits of a face-to-face assessment for callers with comorbidities.
It may be beneficial for strategic stakeholders in the healthcare system to understand and articulate adjustments in risk tolerance and thresholds in critical situations.
During the investigation, HSIB became aware of changes the UK Health Security Agency made to processes in a number of areas. These ‘safety actions’ are noted below.
Safety Actions (3)
The UK Health Security Agency has taken steps to ensure governance arrangements are in place to assure themselves that contracted services are monitored and delivered as intended.
The UK Health Security Agency has taken steps to assure itself of the safe and effective delivery of telephone triage for future healthcare emergencies. These have been tested through the delivery of services for Monkey Pox and Avian Flu.
The UK Health Security Agency has taken steps to review contractual arrangements to ensure flexibility and the opportunity to implement the most appropriate contract for future public health issue.