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Friday 30 September 2016
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Possibility NHS 111 caused two deaths

There have been close to 22 "serious incidents" and two possible deaths linked to the roll-out of non-urgent emergency number NHS 111. 

One case involved a patient in the West Midlands who died unexpectedly after calls to the non-urgent care line went unanswered, and poor advice being given. 

NHS England announced a review of the model used to roll out NHS 111 late last week, and will “consider if the current model needs revising”. 

According to Pulse least 22 possible serious incidents related to NHS 111 have been reported, with of these possible incidents recorded by providers, or commissioners. 

‘Unexpected death’

Providers or commissioners from 39 of the 43 areas in England that have launched the service provided data.

A spokesperson from Derbyshire Health United - which covers Derbyshire, Nottinghamshire and Northamptonshire - said it was investigating two deaths.

“At this stage of the investigation it has been shown that the system and processes that were followed would have been exactly as expected,” said Lindsey Wallis, chief executive of Derbyshire Health United.

“Sadly the outcome was an unexpected death. DHU reports every death initially as a serious incident until the complete investigation where, following the investigation, there is a determination made as to whether or not it is stepped down from being a serious incident to an incident.” 

NHS Direct, which previously ran the phone line for people needing urgent treatment at evenings and weekends, has confirmed that seven potentially serious incidents on the 111 helpline it runs are being investigated.

The incidents occurred between 18 March and 11 April - which included the period when the service was being trialled, it said. During that time, it dealt with about 122,000 calls.

However, the organisation added it was "not unduly concerned" about the level of incidents.

A spokesperson said: "We take the responsibility for the safety and wellbeing of our patients extremely seriously.

"When a concern is raised we listen to the call and undertake an incident review involving experienced clinical staff. This allows us to identify clear actions so that lessons can be learnt and acted on quickly and thoroughly."

‘Careful eye’ 

An NHS England spokesman said: "The safety of patients must be our paramount concern and NHS England will keep a careful eye on the situation to ensure NHS 111 provides not only a good service for the public, but one which is also safe."

Dr Clare Gerada, chair of the Royal College of General Practitioners (RCGP), said: "The RCGP believes NHS 111 must be more effectively supported if it is going to properly direct patients to the most appropriate form of urgent NHS care.

"It is extremely worrying that there is still so much uncertainty around the delivery and reliability of the advice provided by NHS 111 in some areas.” 

A review into NHS 111 has already been announced.

Comments

I think this is yet another deception of the public by those extremists who will oppose every change just for the sake of it. I remember when we rushed out NHS Direct without prior training of the workforce; one of my then'E'grade nurse got a job working for nhs direct without ever training on consultation and physical assessment skills. What nhs direct gave us was another level of bureaucracy that did not in any way decrease GP work load; if anything it made things worse as patients stopped managing those minor illnesses that they were able to deal with previously.

The government of the day promised us the right to see our Drs whenever we wanted. What they failed to tell anybody is that they drastically reduced recruitment of Drs and Nurses from Africa and Asia under the misguided belief Europe will fill the gaps.The standard of care plummeted, we lost the workforce that were prepared to wash and feed the patients, the rest as they say is history.

As more and more services were being taken out of secondary into primary care (and rightly so), GPs became overwhelmed with the workload resulting in a good number (some of whom I know personally) either taking early retirement or emigrating to places such as Australia and Newzealand.

All the nonsense about GPs not doing out of hours (OOH) is either meant to mislead the public that treat the NHS as their religion, or it is based on abject ignorance. The OOH services are provided by GPs under a special contract. The idea that you can force GPs into doing it the way it was established in 1948 is another example of thoughtless opposition to reality. I work in a practice with 19,000 patients, 7 GP principals and 4 salaried Drs. Compared that with the time a single handed GP working with his wife as practice nurse/manager had less than 2 thousand patients on their list. GPs are flat out at the end of the day hence a good number work part time; an option that is open to every human being even Drs.

The truth remains we do not have enough numbers. I hear some ridiculous claim by one opposition minister on LBC radio yesterday on my way from work (exhausted) suggesting many Drs and nurses have been sacked since 2010. I challenge anybody to show me an unemployed nurse or Dr in this country. I will show them many colleagues who could no longer take the stress of looking after badly behaved and demanding patients that they chose to resign and work for private agencies. Not only do they earn more doing so, they have no commitment to the health establishment that they work for as temps.

You often hear people talking about long journeys to A&E. Sometimes we need to ask ourselves whether we really need to go to A&E? How does the health of people that live next door to A&Es compare to that of those that live in the country sides far from A&E? How come people survive strokes and heart attacks better now that we have less hospitals and less A&Es compared with when there where A&Es in every square mile in town? We now have well trained paramedics especially the motorcycle ones that beat the city traffic jams, better technology; in fact the better survival rates are more down to the care patients receive at their places of first contact with paramedics and less to what happened when they got to A&E. The motorbike paramedics administer the emergency drugs and immediate tests before the vans arrival.

I know the struggle I face trying to recruit the right calibre of nurses to take on the challenges of general practice which include urgent care and chronic disease management. When we have recruited out of desperation and offered training, we achieved mixed successes as some left after a few weeks despite all the investment in training; they just could not take the pressure. The assumption often is GPs are idle and therefore practice nursing must be rosy. Far from the reality; to be a generalist clinician, you must know enough about all body systems and that is tough. Gone were the days when every GP practice closed in the afternoon and staff were able to get their shoppings. These days if you are lucky to work in a place that closed for two hours in the middle of the day, you are bugged down with mountains of paper work.

As is the case with my practice, it is becoming common place to find GP practices, generally large ones that open 8-8, 7 days a week with a walk-in centre (WIC) attached. This dependency on unstructured use of health services has resulted in people using the WIC for the most absurd of demands that I am unable to list here. Again one of the callers to the LBC drive time yesterday claimed her local WIC does not treat children under the age of 5. As difficult as I find it to believe her (I manage a WIC), if indeed her local service is commissioned that way, then the commissioners and contract negotiators are either letting them down or the local area cannot find the skills to look after young children safely and competently. My WIC sees all ages from the age of 0- whatever. This lady talked about her child getting chest infections. What about the parent's responsibility to manage her child expectantly, and how come this child relies on emergency services rather than planned GP care?

Some patients claim they cannot get appointment with their GP's but when we care to call their Drs' indeed there are appointments. The problem with nhs is fundamental and can only be solved when we start changing the behaviours of both service users and some providers. The introduction of 111 was triggered by abuse of emergency services including ambulances. Unfortunately, the debates we have on these subjects are often disjointed making it difficult for people to have a global view of what the issues are. On a number of occasions before 111, my WIC had patients brought in by ambulances for irrelevances that the paramedics thankfully triaged to us rather than to A&E. I will give you two examples: (1)the sister of 1 European girl age 24 called the ambulance to take her to casualty as she "was unable to breathe". The motorcycle ambulance was there in 5 minutes, followed by the blue light almost immediately. She was assessed and history taken. This girl had fever and cough for 2 days and sister was petrified this illness has lasted for so long so she called the ambulance! After assessment at the WIC, she was sent home with advice on self care. (2) A 55 year old lady was brought in by ambulance; called by her husband as she had fainted having had diarrhoea for 6 hours on a Saturday morning. Again motorcycle ambulance got there in no time, assessed and found no evidence whatsoever of faint nor shock nor dehydration. The disappointed couple came down to the WIC where the lady joined the queue and conveniently "fainted" again in the waiting room. All the clinicians rushed out to the waiting area, checked her out and there was nothing to suggest she fainted. She did however jump the long queue as we had to sort her out with a prescription before seeing those that arrived before her. She walked out 30 minutes following her supposed faint. I am sorry to add here that this lady is from Europe as well though they are not the only ones that abuse the system. As you can tell from my name, I am black African, however the political correctness of leftists avoiding the issue of pressure on the system brought on by immigration is part of the problem. That we can have people on the waiting list for hip replacement and other planned procedures living in Greece, Lithuania etc only for them to come down to the UK for their surgeries, then back to their countries is the kind of health tourism that nobody wants to address. Employing managers to chase up the odd Asian or African immigrant that use the nhs is probably not good use of resources

Going back to 111, 7 incidences under review out of 122,000 calls is minuscule. These statistics will make more sense when compared along side that of 999 and nhs direct. I personally visited my local call centre on two separate occasions and was very impressed with how the call handlers did their jobs. Indeed they were well supported by Drs who took some of the calls themselves depending on the brief history the caller presented at the time they contacted the service. In other words, the calls are triaged.

The nhs cannot continue to function without innovations. The way it was set up in 1948 was better than nothing. Anuerin Bevan was a great man for getting it off the ground, however, there are still some great visionaries of today, we need to listen to them, innovate if we hope to have the nhs in place 2 decades from now. It is not a perfect system, hence we are not the healthiest nation despite our free health service, neither has it been copied in its entirety by any other nation nearly 70 years on