Ambulances are sent even if the caller has refused one.

Within the Pathways process, this is not true. Any 'disposition' [the recommended course of action arrived at by the assessment process] offered by a health advisor can be refused by the caller, at which point the call will be passed over to a clinical advisor.

At this point, the judgement of the clinician takes precedence over the Pathways disposition. Of course no ambulance is going to be sent without good cause and if there is an appropriate alternative treatment pathway, that would be explored - and in many cases it enables us to work with the caller to arrive at an informed and safe decision. However, in certain circumstances, healthcare professionals have a duty of care and may be required to act in the patient's best interests in spite of their preference. We would only do so if there was no other option, and would ensure that ambulance dispatch was informed of the situation.

These circumstances are relatively rare, but with increasing challenges faced by community mental health, patients discharged prematurely without appropriate home support, and other underfunded and buckling systems, it's a sad truth that the ambulance service is the only option in certain circumstances, lest the system abandons these people entirely.

6. Abandoning NHS 111 altogether and leaving the public to decide on the most appropriate treatment pathway would relieve pressure on 999 and other services.

This is hard to prove without actually doing it, but it seems very unlikely. With GP services facing a national crisis, A&Es already overburdened and ambulance service utility spiraling out of control, I would imagine a significant proportion of people who currently rely on 111 and out-of-hours GP services would simply call 999 or attend A&E out of desperation.

I believe some ambulance personnel are suffering from confirmation bias. Every ambulance attendance generated by 111 which turns out not to be as it initially appeared is held up as an example of failure, whereas the thousands of calls which might otherwise have resulted in a 999 call are never seen by ambulance staff.