Figures provided to Unison by six ambulance services in England and Wales show almost half (46%) of staff left their jobs in the three years to April 2024.

The union says the snapshot of the system also revealed employee sickness is a significant concern, with 300,000 days lost to ill health at the six organisations from 2021 to 2024.

Unison found there were 91,681 days lost in 2023/24 – the equivalent of six working weeks or 31 days' sick leave for every call handler. This compares to an average of just four days for UK workers more generally.

In addition, the report also includes a survey of more than 200 staff. It reveals that call handlers say the volume of calls (82%), staff shortages (75%), and aggressive and abusive callers (66%) were the worst challenges they faced in the job.

As a result, almost three-quarters (72%) said they had considered quitting in the past 12 months, while 39% said they would not recommend working for NHS 111.

When asked what would improve things, 72% said better pay, while a similar number (69%) said extra staff would make them more likely to stay.

Unison says call handlers should be moved up a grade on the NHS pay scale to make a difference to low wages.

Where 111 services are contracted out, they should be brought back in-house to allow greater integration of 111 and 999 services, says the union. That would benefit both patients and staff.

Unison national ambulance officer, Sharan Bandesha, said: ‘NHS 111 is a lifeline for patients and their families. The service provides vital advice and access to care when they urgently need it.

‘But staff are under immense pressure and it's no surprise many don't stay in the role. Bringing 111 services back in-house, paying staff properly for their work and employing enough staff to alleviate pressure would help ensure NHS 111 is fit for the future.'