Access is a mess – 111 won’t help much

Roy Lilley nailed the issue in a soundbite: “access is a mess”.  He was referring to the confused and confusing mix of who to call and where to go when you think you need medical help.  That’s just the problem – what do you –  the patient, parent or family member  – think is needed?  It’s you have have to make the decision about who to call and where to go.  There’s a new addition to this range of choices   –  111.  Whatever its creators hope for it, I am not convinced it will help that much, at least if the majority of the comments on NHS Choices from people who have tried it out already are anything to go on.

Self-triage is not fun

Roy described the dilemma thus:

 what is a frightened, worried, anxious in-pain person, mum, grandmother, brother or sister supposed to do? Should they ring 111, call 999, web-visit NHS Choices, try NHS Direct, ring OOH, the surgery, make an appointment, go to the walk-in centre, A&E, ask a Boy Scout or helicopter-in  Medecins sans Frontiers?

The new 111 telephone service for the NHS – not to be confused with the new 101 number for non urgent Police help (who knew that was happening?) –  starts rolling out soon and has already been piloted in some areas of the country.  We get it in my part of London in early autumn.  I worry about how the public and people working in healthcare at the coal face of primary care are being prepared for it.

And speaking of confusions, we have to hope that visiting South Koreans don’t use 111 to report terrorism suspicions or Kiwis to report gas leaks –  both uses of 111 in their home countries.  But I digress.

 What does “less urgent” mean to you, and you and you?

The strap line on the 111 branding is “when it’s less urgent than 999”.  The explanation of what this means is: “You should use the NHS 111 service if you urgently need medical help or advice but it’s not a life-threatening situation.”  

I am not sure this helps in the way it is meant to.  It raises big problems of understanding and interpretation of emotive and subjective words on the potential user’s part, like “urgent” and “life-threatening”.

The advice about how to use 111 is

Call 111 if:

•             You need medical help fast but it’s not a 999 emergency.

•             You think you need to go to A&E or need another NHS urgent care service.

•             You don’t know who to call or you don’t have a GP to call.

•             You need health information or reassurance about what to do next.

For less urgent health needs, contact your GP or local pharmacist in the usual way.

For immediate, life-threatening emergencies, continue to call 999.

Can anyone point me to the the evidence for how ordinary people in this country understand these messages?  Surely there is some.   Does anyone know where all of this communication was evaluated? Surely no one would undertake such a big change with the public without testing out the messages for comprehension beforehand?  I don’t think this is asking too much.

We’ve been here before

This confusing language speaks for itself (no ironic puns intended).  And it is still as muddled as when the messages were about “urgent care” alternative a few years ago.   We had some things to say about that back at the beginning of 2011.

“Urgent” is hard enough to grasp; defining things against “urgent” as “less urgent” are even more so. Just think of the situations in the middle of the night with an acutely ill partner, child or yourself.  It isn’t the time for calm reflection – just as Roy Lilley so aptly said.  You want help quickly, so the default will be – you guessed it- 999 or A&E.

Bad comms could kill it

Will 111 work?  Probably the call handling and the clinical side of it can be made to work.   But I am concerned with the public’s understanding.

Only if the public understand what it is for, trust it (poor word of mouth from users could kill it at birth) and grasp how to use it will it be a success.   We would all like to follow simple directions when we have a problem, but we have to understand what those directions mean us to do.  That’s the issue. As Mrs Thatcher’s press guru Bernard Ingham was fond of saying, “If they haven’t heard it we haven’t said it.”  Time will tell if his dictum applies to the public’s understanding of what 111 is and how to use it.

As always, it is the effectiveness of the communications about the new service which will make it or break it.  As always, perception is reality.  The communications effort around  111 is likely to be too late in the day and ambiguous.  It is a subject we have aired before and we will return to as the 111 roll out gets closer.


The Moore Adamson Craig Partnership supports user and public participation, trains lay representatives and develops responsive health, care and education organisations. We are ready to work with and support all those who want to make sense and a success of the new structures of patient and public engagement within the new arrangements for health and social care commissioning and providing. Feel free to contact us to discuss the opportunities


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