Working as the clinical lead for the NHS 111 online service (111.nhs.uk ), we became aware of a problem. Whilst we were increasingly seeing people coming to 111 online for support with their urgent mental health needs, their satisfaction at the outcomes was poorer than those people using the service for physical health symptoms.

As a nurse and clinical lead, my role is primarily to ensure that a product provides a safe and effective experience for the user and supports their overall clinical journey. I find using the nursing process – assessment, planning, implementation and evaluation – as a framework helps me to look at proposed product changes and understand the impact and value of these as part of the clinical journey.

We embarked on a series of discovery activities – reviewing website data, survey responses and feedback, follow-up surveys and structured user research – to understand why people were not satisfied with the 111 online service. I also spoke with the clinical networks and patient voice groups I’m a member of in my nursing role.

We learned that although most people understood the advice they were given at the end of the NHS 111 online symptom triage process, for many reasons they did not feel it was right for them at the time:

Not wanting a call-back service was a recurring theme. However, the reasons underpinning it varied and included some notable challenges to address.

Some users reported that they chose a digital service because they felt unable to speak with someone directly at the time. Others reported practical barriers such as not having access to a telephone or having poor signal in their area.

Another reason – particularly pertinent during the pandemic when people are spending more time at home – was they didn’t want to be overheard talking about their mental health issue on the phone by others in the house, such as parents, children and partners.

All these reasons confirmed we needed to improve the service so people had more digital options to support them with their needs.

In order to address these issues and improve the clinical safety of NHS 111 online, we needed to make a number of changes. When people are advised to access urgent care at the end of the triage process, they also needed other supporting information to help them.

With this in mind, we developed new content to strengthen the clinical advice and signposting displayed on screen, including:

We took the newly designed content through more user testing, getting feedback from people who had used and/or worked within mental health services. I also took the proposed changes back to my clinical networks and patient voice groups who had provided feedback to us at our discovery stage. The content was also put through further rounds of clinical review before it was built, tested and released into live service.

All the changes were well received by the people and groups we spoke with, and it is hoped they will provide a more meaningful experience for people who come to the service with an urgent mental health need.

We’re continuing to evaluate the effectiveness of the changes by listening to users, reviewing feedback and analysing the data around how people interact with the service and these journeys.  This evaluation feeds into the assessment for the next round of changes in a continually evolving and improving healthcare product.

There is still more work to do and we want to look at how we can improve the journeys for people with less urgent mental health care needs. We also want to explore the opportunities to link people more directly with the increasing innovative digital healthcare solutions that are being commissioned in local areas.

From talking to users and hearing their feedback, it is increasingly clear that the opportunity to access support for their mental health concerns through a digital journey is something they welcome. It offers a more desirable and accessible route for some people, without the need to engage directly with another person at a time when they may feel very anxious. 

So, the work continues to not only to develop the NHS 111 online service, but the system as a whole to ensure that the digital journey leads to a safe and meaningful outcome for the people who need it.