Why does the NHS keep making the same mistakes?

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Image caption The 111 debacle is not the first time the NHS has had problems with an advice line

The NHS non-emergency 111 telephone line may be a new feature - but the chaos surrounding its roll out is as old as the health service itself.

As the debacle has unfolded in the past month - including reports of people waiting hours for callbacks, and ambulances being sent to attend trivial incidents - questions have been asked as to why it was felt necessary to have 46 different contracts in place.

In an interview with the BBC on Wednesday, Dame Barbara Hakin, the interim chief operating officer for NHS England, who has responsibility for the service, said she was adamant the NHS would learn from any mistakes it had made.

But this is not the first time the NHS has run into problems with an advice line.

When NHS Direct - the service 111 was meant to replace - was launched, more than a decade ago, it was split into more than 30 different services. But within five years, it had morphed into a national service, after bosses realised it would be much more efficient and effective this way.

It allowed the system to become more flexible. If a local call centre was too busy, calls were channelled to other areas of the country.

By the end of its time, NHS Direct had an impressive record in dealing with enquiries promptly.

But it was not without problems.

Re-inventing the wheel

NHS Direct was essentially a stand-alone service. It could not send an ambulance to a patient or make an appointment with an out-of-hours GP, nor could it pass details of its interaction with a patient on to another part of the health service.

When ministers unveiled the plan for 111, and it was first proposed by Labour and then advanced by the coalition government's then Health Secretary, Andrew Lansley, they talked about the need to create a more integrated service to link into local services.

But, in line with devolving power away from the centre, it was decided it should be left to local areas to set up the contracts.

This has led to a lack of consistency, and when there have been surges in demand - particularly at weekends - the services have struggled to cope and, with no flexibility to share the workload with other areas, patients have suffered.

Now NHS England looks set to order a review into the problems. Behind the scenes there is talk of what can be done to create more central control.

But this is not the only example of the NHS embarking on revolution when many have argued evolution would do.

Many have been making the same point about the wider reforms. The government wanted to give more power to GPs so scrapped primary care trusts (PCTs) and replaced them with GP-led clinical commissioning groups.

But when the plans were announced groups as diverse as the British Medical Association and the King's Fund think tank were asking why the government did not just give GPs more of a say over PCTs.

And it is not just this government that seems intent on re-inventing the NHS wheel.

In the 1960s, there was a major programme of hospital building, but by the 1970s the then Labour Health Secretary Barbara Castle was arguing care needed to be shifted away from hospital and into the community.

By the end of the 1990s Labour was embarking on another round of hospital building, but now the talk is of keeping patients out of hospital.

Dr Jonny Marshall, director of policy at the NHS Confederation, believes the health service is not good enough at tapping into the expertise it has within.

He says the nature of the "political cycle means politicians come in wanting to make a mark", which has resulted in a belief among many within the health service that there is little point trying to influence change.

"We have to change this. The NHS needs to get better at learning form what works well and what doesn't," he says.