‘Risk averse’ NHS 111 algorithm sends too many patients to A&E

Dr Adrian Boyle - Paul Grover for The Telegraph
Dr Adrian Boyle - Paul Grover for The Telegraph

NHS 111 sends too many people to accident and emergency departments because its computer algorithm is “too risk averse”, the country’s top emergency doctor has warned.

Dr Adrian Boyle, president of the Royal College of Emergency Medicine (RCEM), was quizzed by MPs on Tuesday over the current pressures in A&E departments.

He said that December was the “worst ever” in A&E with nine in 10 emergency care leaders reporting to the RCEM that patients were waiting more than 24 hours in their departments.

Asked what measures could help improve pressures in emergency care, Dr Boyle said more clinical input was needed in NHS 111 calls.

“In terms of how we manage people who could be looked after elsewhere, the key thing to do is to improve NHS 111,” Dr Boyle told MPs.

“There is a lack of clinical validation and a lack of clinical access within NHS 111 - 50 per cent of calls have some form of clinical input, there’s an awful lot which are just people following an algorithm.”

Dr Boyle added where clinical input is lacking “it necessarily becomes risk averse and sends too many people to their GP, ambulance or emergency department”.

In December just 44.7 per cent of calls to NHS 111 were assessed by a clinician, according to the latest provisional figures from NHS England, down from 51.5 per cent in December 2021.

Almost one in 10 calls were referred to the ambulance service, while the same proportion was recommended to attend A&E.

‘Complex, multi-faceted problem’

Dr Boyle added: “We’ve certainly had the worst ever December we’ve had - if you look at performance figures on every metric, what went on in December was terrible.

“This is a complex, multi-faceted problem. I think we need to be realistic that just a little bit of money may not be just a magic fix. It’s not a magic wand.

“We’ve got serious structural problems that impair our ability to deliver urgent and emergency care.

“Things have been going wrong for quite a long time and came to a head over December.”

Data from NHS England show that last month a record 54,532 people in A&E departments waited more than 12 hours from a decision to admit to actually being admitted.

Dr Boyle also told the House of Commons’ Health and Social Care Committee he was concerned some vulnerable people who needed support may not seek help during the ambulance strikes.

“We worry that there will be people who don’t want to make a fuss, who are desperate not to go into hospital and not to bother people,” he said.

Chris Hopson, chief strategy officer for NHS England, said next month’s combined action on February 6 was a “step change” in the dispute and would be the biggest strike action in NHS history.

Nurses and ambulance staff will stage strikes on the same day for the first time in the ongoing row over pay and conditions.

Mr Hopson set out five reasons to MPs why the dispute will be significant, including nurses striking for two days rather than one, a shorter gap between the strikes and the coordination between the different unions.