The review of lessons to be learned from the introduction of NHS 111, led by independent advisor, Peter Garland, was one of three commissioned by NHS England in May following the chaotic national roll-out of the phone triage service earlier this year.
NHS England took over resonsibility for the centralised elements of 111 from the DH on 1 April.
The review found the biggest problems came about because providers lacked the necessary capacity to provide the service.
The providers were principally responsible for these failings, but the report also raised questions about ‘whether commissioners had a real understanding of the capacity and capability of successful bidders and if not, why not’.
Funding pressures led commissioners to drive down costs. The inquiry found costs in contracts were set at around £7.50 to £8.50, compared with the £20 per call spent on NHS Direct.
Some CCGs were criticised for a lack of rigour in testing providers’ bid claims.
The report noted: ‘In some instances it appears from the outcome that assurances were given by bidders and accepted when the underlying evidence to support this assurance was missing.’
Commissioners also increased the complexity of the services by incorporating GP out-of-hours services.
In some areas CCGs may have gone ahead with launches despite problems because of a perception of political pressure.
The report said: ‘There may have been a perception that because this initiative was high on the political agenda and featured in the coalition agreement the imperative to meet the pre-announced timetable was very strong and that arguments for delay had to be similarly convincing. This may have led to reluctance to seek a deferred launch.’
The report found: ‘In delivering a one-off initiative of this complexity, local commissioners almost certainly needed both more help and more challenge.’
It said: ‘The skill set that was needed to deliver this one-off procurement was not something that it was reasonable to expect all CCGs to possess without help.’ Help, the report concluded, which should have been provided by NHS England.
The report called for NHS England to have clear protocols for handling major new initiatives, to have structured responses to pilots, to ensure local commissioners have the advice and support required for complex procurements, review its risk escalation process, and engage with frontline clinical staff.
NHS England’s deputy chief executive, Dame Barbara Hakin, said most of the recommendations made had been put in place at the end of March, including setting up a programme oversight group.
She said: 'In terms of assurance and checks, we are expecting any new provider of NHS 111 to undertake due dilligence and share this with us. But we are also ensuring we have a full external assurance process available to our CCGs to look at any new provider, so that will be a dual process.'
'In terms of procurement,' she added, 'we are ensuring we find a way to have a national procurement expertise which can support CCGs when they undertake any of these similar procurements.'