The '111' emergency service fails again.

For the last few years I've highlighted the catastrophe of the closure of the highly effective 'NHS Direct' phone line created by the 2002 Labour government.

The Conservative Liberal alliance closed it down and replaced it with the 111 service which is staffed by people who have no medical qualification.

There have been many examples of failure to spot serious conditions - this is just the latest. This inquest report makes it clear once again that 111 needs Nurses and Doctors available for patients; 


William Mead's 'fate was sealed' after NHS 111 call handlers failed to identify his deadly illness, says mother

The report called into question the NHS non-emergency helpline’s ability to identify deadly illnesses
Kate Ng  
The Independent

The mother of a one-year-old baby who died of sepsis said his "fate was sealed" after NHS 111 call handlers failed to identify his deadly illness. Melissa Mead, mother of William Mead, told BBC Radio 4: “When I dialled 111… we were told William’s condition was non-urgent and didn’t require any emergency treatment, and that we would get a call-back within six hours.

“But when the doctor called back after three hours, I think William’s fate was sealed. He died within 12 hours of that phone call. We found him just after 8 in the morning… he had been passed away for a little while [already].”

Her interview follows an NHS England report into William’s death in 2014, which found there were 16 missed chances to save his life.
The report, seen by the Daily Mail and the BBC, said he might still be alive today if NHS 111 call handlers had realised he was in a life-threatening situation.

The NHS 111 non-emergency helpline’s ability to identify deadly illnesses in children and babies has been called into question.
NHS 111 call handlers are not medically trained. The report suggested that if a doctor had taken the call instead of 111 staff, they would have most likely recognised the need for "urgent medical attention".

The report detailed the opportunities missed to save William’s life.

Out of 16 missed chances, the five main windows were:
 
William’s GP had not recorded all the relevant information in his notes
 
The severity of William’s symptoms had not been recognised
 
Inadequate advice was given to William’s parents about what to do if his condition worsened
 
The out-of-hours GP service had no access to the baby’s primary care records

 
The pathway tool used by NHS 111 call handlers was not sensitive enough to pick up “red-flag” warnings of sepsis

It also included failure by GPs, who saw William six times in the months prior to his death, to spot pneumonia which could have prevented his circumstances.

The report said: “Had any of these different courses of action been taken, William could probably have survived.”

Recommendations made by the report included training call advisors to spot when there is a need to probe further into the condition of the patient, and when to escalate cases.

It also called for better recognition of the signs and symptoms of septicaemia by GPs.

The report is the result of a year-long campaign by William’s parents, Paul and Melissa, to find out what really happened to cause their son’s death.

Director of nursing with NHS England in the south west, Lindsey Scott, told the BBC: “One of the significant learning points for us is how difficult it is for both professionals and parents to diagnose septicaemia.

“Everyone involved in this report is determined to make sure lessons are learned from William’s death, so other families don’t have to do through the same trauma.

“None of this detracts from our profound regret at the loss of William. For that loss, on behalf of all NHS organisations involved, I would like to apologise publicly to Mr and Mrs Mead,” she told BBC.

Neil Harris
(a don't stop till you drop production)

Home: helpmesortoutthenhs.blogspot.com
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The 999 scandal spreads nationwide.

The South east Coast Ambulance trust scandal (where the trust fiddled their NHS targets by "reassessing" response times whenever a call came via the 111 number) was exposed by a whistleblowing Paramedic.

He or she has told us more;

To put it simply the trust was also doing some other "reassessments".

Whenever they missed the requirement that an ambulance should arrive within 8 minutes of a call 75% of the time......they changed the rules.

They created an app which told them whether a defibrillator was nearby and if it was.....that counted as if the ambulance had arrived in time, even if it hadn't.

What's worse is that this appears to just be an extension of the NHS rules.

If it's true, all the Ambulance trusts are probably missing their targets and thousands of people are potentially dying unnecessarily.

Here's the full article;  

Telegraph.co.uk
Sunday 08 November 2015

NHS accused of 'scandalous' 999 response time policy
Exclusive: Whistleblower from troubled ambulance trust says thousands of calls that appeared to miss eight-minute target are being counted as hit.
 
By  Laura Donnelly, Health Editor
08 Nov 2015

The NHS has been accused of operating a "scandalous" policy that means 999 calls are being recorded as receiving a swift response - even if no help was given.

Thousands of “life threatening” calls which apparently miss the response time target have been retrospectively assessed and counted as a hit regardless of whether the patient was seen by professionals, a whistleblower has told the Daily Telegraph.

It is alleged that the South East Coast Ambulance trust was able to manipulate the figures by proving that equipment used to restart someones heart - put in place in thousands of shopping centres, doctors’ surgeries and village halls – was within 250 metres of the patient, even if their symptoms were completely unrelated.

The 111 number was brought in for people to call if they felt their medical condition was not life threatening.

Ambulance services are supposed to ensure that three quarters of
"life-threatening" calls receive a response in eight minutes.

South East Coast Ambulance Trust is already under investigation for deliberately delaying thousands of “life-threatening” calls which came to them via 111.

Regulators are trying to establish the extent of the harm to up to 20,000 patients who were forced to wait up to twice as long under a secret scheme.

But a whistleblower from the trust has spoken out about his concerns about the separate policy affecting thousands more life-threatening calls.

National NHS guidance about "Red 2" cases - the second most serious level of urgency - says the eight-minute target can be achieved if a response comes from an ambulance, rapid response vehicle or from a "public access defibrillator” with a person trained to use it.
 
The equipment can be used to try to restart the hearts of those suffering a cardiac arrest.

But the Telegraph has learned that trusts have been allowed to count the targets as being hit as long as the equipment is on hand.
The rule is applied even if the medical emergency could not have been helped by a defibrillator, and no attempt was made to use it.
South East Coast Ambulance Service NHS trust has been accused of retrospectively changing more than 5,600 calls in a year, because a public defibrillator was within 250 metres.

A paramedic whistleblower said a web programme had been deployed to reasess "life-threatening" cases which appeared to have missed the eight-minute target.

If the mapping tool located a nearby defibrillator, the case would be recorded as meeting the eight minute target, he said – whether or not the heart-starting device was used.

These included cases in which the patient had suffered conditions such as strokes or breathing problems, in which a defibrillator would be no help.

The trust said the rule would only apply if the 999 caller had been asked if someone was available to collect the device.

A data report leaked by the paramedic discloses that in the 12 months from April 2014 to March 2015, the “webdefib” tool was applied 5,631 times by the trust.

The classification of such calls as achieved within eight minutes helped the organisation towards the NHS target to achieve this in 75 per cent of “life threatening” cases.
 
Official figures show that the trust narrowly achieved this last year, with 75.3 per cent of such calls getting a response in eight minutes. Without the reclassification, the target would have been missed.

The paramedic told The Telegraph: “This is a complete scandal, the public would be deeply concerned about this if they knew.”

“Every day in the control centre administrators look at every missed 'red' call to see if a defibrillator was within 250 metres.

They use a mapping tool to see.

"It doesn’t matter if it was used, or even if it could have been used – some of these are people suffering strokes, or breathing problems. This is occurring when a defibrillator has not left the wall where it was mounted and no one has been sent to collect it.”

“We simply should not be doing this,” he added. “We are manipulating data to hide the true picture.”

The use of the protocols meant that calls appeared to be met far earlier than they were, he said.

"In areas - especially rural settings where we frequently miss our 8 minute responses - a defibrillator will be placed, meaning we will always reach our 8 minute response time, even if an ambulance takes 30 minutes to get to scene," he
said.

The revelations follow a string of disclosures about the trust, which is at the centre of a growing scandal.

Last week, an official investigation found up to 20,000 “life threatening” calls were deliberately delayed under a secret policy.

The NHS England report said a failure to monitor the scheme meant it was impossible to say how many patients had come to harm, under the protocols affecting 111 calls.

Regulators have launched a new investigation to try to establish the extent of the harm.

A spokeswoman for the trust denied any manipulation of response times. She said: "Our response time performance is recorded completely in line with the national guidance."

She said the trust understood that under NHS rules, such calls would be treated as met within eight minutes if as an automatic external defibrillator was publicly accessible, and the 999 caller had someone available to fetch it. Such public devices were specifically devised for use by those with no training, she
said.

However, NHS England said the clock should only be stopped if a "fully trained" person and a defibrillator were right by the patient's side.

A spokesman said that if these criteria were met within eight minutes, the response target was achieved - regardless of what turned out to be wrong with the patient or whether the device was used.

Neil Harris

(a don't stop till you drop production)

Home: helpmesortoutthenhs.blogspot.com
Contact me: neilwithpromisestokeep@gmail

The NHS Report into the South East Coast Ambulance Trust scandal.

Investigation into 111 scandal branded a 'whitewash' after it fails to establish who was responsible

Patients groups and safety campaigners have criticised an NHS investigation which found up to 20,000 patients were subjected to deliberate delays under a secret policy - but failed to work out who was responsible for the scandal 

By Laura Donnelly, Health Editor

 05 November 2015
    

An investigation into deliberate ambulance delays has been branded a "whitewash" after it failed to establish who is to blame for a major NHS scandal.

An eight-day-old baby and a patient suffering an obvious stroke were among up to 20,000 patients whose ambulances were delayed as part of a secret policy by South East Coast Ambulance Service NHS Foundation Trust.

For two months, “life threatening” cases referred to them from the 111 phone line were routinely forced to wait twice as long for an ambulance.
 

The secrecy meant that 111 call handlers assured patients in 'life-threatening' situations that an ambulance was on its way, with no idea that it was not.
 

NHS England on Thursday published the findings of its investigation into the matter, the findings of which were revealed by the Telegraph earlier this week.

The report was unable to establish which senior managers were responsible for the secret project, and how it came to be hidden from the trust’s medical director, non-executives, and the public.

 

Under NHS rules, calls designated as “life-threatening” are supposed to receive an ambulance response within eight minutes regardless of whether the caller dials 999 or the non-emergency 111 line. The target is to achieve this in 75 per cent of cases.

 

But the ambulance trust “unilaterally” invented its own system resulting in the routine downgrading of thousands of 111 calls, which were held in a special queue to be reassessed, with ambulances either cancelled or delayed for up to 10 minutes more.

“They were warned again and again about the risks this was posing to patients.”

Call handlers were not even told about the secret project – reassuring callers that an ambulance was on its way, when this was simply not true, the report found.

 

The scheme was introduced by a group which was established by Paul Sutton, the trust’s chief executive, and overseen by at least four executives, but health officials could not work out who was responsible for the scheme.

 

"Because of the lack of documentation and the lack of information provided at interview, we have not been able to understand who made certain decisions or if they were issues that had been considered," the report concluded.

 

It was only when a whistleblower contacted NHS organisations responsible for monitoring safety that the scheme was aborted.

 

Katherine Murphy, chief executive of the Patients Association, said: "The findings of this report are very damning and paint a worrying picture.

 

"It is unacceptable for NHS England to say they cannot identify who gave the instructions to downgrade calls to 111 services in the South East. These decisions placed the public at risk and their actions were completely inexcusable.

"This is a whitewash and a major scandal.”

 

Surveillance of the scheme was so poor that it was impossible to work out whether patients were harmed by the delays, the report found.

 

Regulators have ordered a further independent investigation to establish how many patients were affected by it.

 

Cases placed in the queue included an eight day old baby, whose “clinical outcome” was not recorded, and a 60 year old man, who was suffering clear signs of a cardiac arrest but was pronounced dead soon after a 40 minute wait for an ambulance.

Peter Walsh, chief executive of patient safety charity Action against Medical Accidents said: "It's unacceptable that after an investigation of several months into a major scandal we are now none the wiser about who was responsible."

"I don't find it credible that neither the ambulance trust nor NHS England seem able to establish who took the critical decisions here."

 

A spokesman for NHS England South said: "The report makes clear that this project was initiated entirely within South East Coast Ambulance Service and resulted in changes to the handling of calls within the 999 service, not the 111 service.

"The regulator, Monitor, will oversee the next steps with the trust."

 

Paul Sutton, trust chief executive said: "Patient safety is fundamental to what we do.

 

"As paramedics, we come to work to save lives and we would never do anything to deliberately put patients at risk.

 

"We understand the concerns that the public have and wish to reassure people that we work constantly to provide the safest service possible.

 

"We recognise that the proper processes were not fully followed in setting up the project and we do apologise for this.”

 

The policy affecting thousands of calls was launched without the knowledge of 111 staff, board non-executives, the medical director or local commissioners of services, the report found.

 

• Patients with life-threatening conditions can wait twice as long for ambulance because they called 111

 

The secrecy meant that 111 call handlers assured patients in “life-threatening” situations that an ambulance was on its way, with no idea that it was not.

 

Instead, paramedics with just one day’s training in call-handling, were ordered to phone thousands of cases back to see if ambulances were really needed.

 

As a result, life-saving cases forced to wait up 18 minutes, were still counted as hitting the eight-minute target, while non-life threatening cases were given an extra 20 minutes.

 

Because the 111 staff referring the calls were never told about the system, many remained on the phone to monitor patients – blocking the line for the assessment call.

 

Those who should have been in charge of surveillance were not notified, with incidents only reviewed retrospectively by an administrator with no clinical background, it says.

 

The NHS England report examined seven “serious incidents” including five deaths.

However it says such cases are an unreliable way to assess safety, as they are usually under-reported.

"Not enough work has been done to identify whether patients were harmed as a result of the project"

A Monitor spokesman

Highlighting the main concerns found by the investigation, the report says:

 

• "There was no transparency with the public, as they were not told their call was going into a queue. They thought an ambulance was on its way when this was not true.

 

• This organisation potentially put the public at risk by changing nationally agreed operating standards with a project that had no evaluation built into its design.

 

• The governance structures that the Trust had in place were not followed. Whether or not this was intentional we have not been able to answer.

 

• The risks of the project were either not recognised or were ignored.

 

• Key staff were not consulted during the design and implementation of this project.

 

• The project was overseen by at least 4 Executives, who had a responsibility to have worked to the governance policies of the organisation.

 

• Serious Incidents were not identified, as the clinical risk system had no clinical input and key people within the department were unaware of the R3/G5 call partition."

 

The trust's efforts to check whether harm was done to patients were neither "appopriate" nor safe, it concludes.

This report speaks for itself; the NHS prepared a secret report which we only got hold of because it was leaked.

The report fails to tell us who was responsible for the scandal because the executives at the trust wouldn't tell them and because they didn't keep any records.

To me this seems like fraud - a job for the Police.

After all there's every reason to believe that people died as a result.

Neil Harris
(a don't stop till you drop production)

Home: helpmesortoutthenhs.blogspot.com
Contact me; neilwithpromisestokeep@gmail.com

 

111 Emergency - still an emergency.

This is an article from The Daily Telegraph today – figures are now coming through which prove what this Blog has been saying for over a year.

The old ‘NHS Direct’ phone line was a real help to patients; it offered quick access to experienced nurses who could confidently divert patients away from Accident and Emergency.

The new ‘111’ line is staffed by unqualified staff who use a computer programme to advise patients.

If in doubt? Send them to A and E because you can’t go wrong.

It’s not the whole answer, of course. The real delays are because too many Nursing jobs have been lost, too many beds are empty and too many wards have shut.

The effect of this is that when patients are treated in A and E but need in patient time – there aren’t the beds.

Every one waits, operations are cancelled, simple problems become emergencies.

By  Laura Donnelly, Health Editor

Daily Telegraph.

14 Jan 2015

NHS 111 is to blame for almost all of the last year's rise in Accident & Emergency admissions, one of the country's most senior medics has said.

 

Dr Cliff Mann, president of the College of Emergency Medicine, said it was "absurd" to suggest patients were wrong to go to casualty units, when large numbers were being directed there by the telephone service.

 

Speaking at a session of the Commons health select committee on Wednesday, he said the NHS needed to change its systems so they work better for patients.

 

 

He told MPs that the 111 phoneline, which was supposed to help patients and relieve pressures on hospitals has had the opposite effect.

 

 

"The reason these people are attending these emergency departments is because we told them to," he said.

 

"Of the 450,000 extra attendances in the system in the last year, 220,000 were advised by NHS 111 to come to the emergency department and another 220,000 had an ambulance despatched to them by NHS 111.

 

"If you put those figures together you have more than 95 per cent of the rise in type 1 [major A&E unit] attendances. I don't think we should blame people for attending the emergency department when we've told them to go there. It's absurd."

 

Earlier this month, emergency medicine experts said that when nurses handled calls on the helpline's predecessor, NHS Direct, they had the experience to know when an A&E visit was not appropriate.

 

It came as figures emerged showing that NHS 111 sends an extra 50 per cent more patients to A&E at the weekend, when GP surgeries and other clinics are shut - increasing the strain on already stretched hospitals.

 

Latest figures show A&E waiting times in England are now at their worst levels in more than a decade.

 

Suzanne Mason, professor of emergency medicine at the University of Sheffield said the numbers of patients being sent to A&E after calling 111 was a huge problem.

 

She said ambulance services in some parts of the country had been "brought to their knees" by call handlers, who follow a risk-averse computer symptom checker, that defaults to A&E as a safety-first option.

Neil Harris

(a don’t stop till you drop production)

 

Home: helpmesortoutthenhs.blogspot.com

Contact me: neilwithpromisestokeep@gmail.com

 

 

The cost of 111 is getting clearer.

Hangin’ on…

V 111

 

It’s always a bad sign when my Blog produces another bad logo. The NHS 111 service has been a running sore and it will get worse. This article from the Independent misses the point rather.

The service was launched before the pilot schemes to test it out had been completed. The point was to save money – a clinician led service (NHS Direct) was to be replaced by a call centre (111) which had a few back up clinicians.

End result? If in doubt send them to Accident and Emergency.

Solution? More Nurses and Doctors at the Call Centres. Result? It costs a lot more.

 

Cahal Milmo   

 Thursday 02 January 2014

 The service designed to lessen the burden on hospital casualty units by assessing non-emergency cases was thrown into chaos last summer when NHS Direct, one of the main providers, pulled out of its contracts saying it could no longer afford them.

 

An investigation by the British Medical Journal has now established that the cost of re-tendering the contracts is likely to run into millions as managers attempt to reshape the service to meet concerns that it is diverting people to hospitals and needs to improve access to trained clinicians.

In the West Midlands, just one of 11 regions where NHS Direct had won contracts, the cost of securing a new operator has been put at £500,000, leaving the health service with a potential bill of £5.5m if the charge is repeated across the country.

 

Doctors’ leaders and Opposition politicians said that the public was paying the price for the premature launch of NHS 111 and problems persist with the quality of call handling and an over-reliance on computer algorithms. NHS England said it had acknowledged initial difficulties and insisted 111 was now “a stable and improving service”.

 

Andrew Gwynne, a Labour Health spokesman, said: “It is now clear that ministers wasted millions on flawed contracts. We warned the Government at the outset that 111 was fundamentally flawed but they pressed ahead with the rollout regardless.

 

“Now, profits are being put before patient care as private companies run the advice line – with call-centre operators directing too many to A&E. Patients in large parts of England still face uncertainty over their 111 line.”

 

NHS Direct, which ran the original health service helpline, won nearly a quarter of the 46 contracts across England to provide the 111 service from Merseyside to Cornwall. But it announced in July that the contracts, which covered more than a third of the population, were “financially unsustainable”.

 

The organisation, which will now close after running up a £26m deficit, denied that it had deliberately underbid for the contracts despite evidence unearthed by the BMJ that it had underpriced the cost of running NHS 111 by as much as £30m and launched in some areas with a quarter of the recommended staff.

 

Dame Barbara Hakin, chief operating officer at NHS England, acknowledged that at the launch of the service some NHS 111 call centres had not been properly staffed and there had been an increase in A&E attendances but the issues had been “very shortlived”.

 

She added: “NHS 111 is now a stable and improving service and we are confident it will continue to get better.”

 

The award of the new contracts has been delayed until 2015, leaving a number of “step in” providers, dominated by NHS ambulance trusts, to manage 111.

Neil Harris

(a don’t stop till you drop production)

Home: helpmesortoutthenhs.blogspot.com

Latest Accident and Emergency analysis.

I’ve edited this Guardian article, based on Accident and Emergency statistics published yesterday. It’s almost word for word what the BBC said today, so someone’s been copying a press release.

In fact if you’ve been following this Blog or my other one, you’ll have been reading me making provocative statements – all of which are borne out by these statistics.

1) While the number of elderly people attending A and E is rising it isn’t rising more than the proportion of elderly people in the population.

2) 53% of people attending A and E need treatment and it’s usually urgent. Only 47% don’t. How do they know they don't need treatment until they receive that advice?

3) Closing the NHS Direct helpline is probably responsible for the increase in those attendances.

4) The increase in attendances is not at A and E but in the walk-in centres and minor injury units that are there to take pressure off A and E. I have often complained that their stats should be excluded – they only inflate the figures. A and E attendances have barely risen.

5) The long waits are caused by too many beds and wards having closed –there aren’t enough to admit those patients who need admitting to hospital.

Of course it's so much easier to blame the patients....

Haroon Siddique         

The Guardian, Tuesday 3 December 2013

 

 

Attendances at A&E departments in England have risen significantly in recent years, with more than 600,000 more people using their services last winter than under the previous government, official NHS statistics have revealed. The figures show comprehensively for the first time the rise in numbers presided over by the coalition government, as fears mount of an impending "winter crisis", and prompted charities to warn that the situation could get worse.

 

Caroline Abrahams, charity director at Age UK, said: "The numbers could continue to increase since the social care system is being stripped to the bone, with access to high-quality social care becoming ever more difficult as vital services are withdrawn or reduced as a result of the current crisis in care. The NHS will struggle to cope with the increasing pressures brought on by lack of social care provision unless the system is radically reformed and given adequate funding."

 

The figures, published on Tuesday by the Health and Social Care Information Centre (HSCIC), show that the most deprived 10% of society are twice as likely to go to A&E as those in the least deprived 10%. They also reveal that the proportion of old people attending major A&E units has risen from 19% to 21% over the past four years, with nearly half of them being admitted to hospital, a situation Jane Harris, policy director at disability charity Leonard Cheshire, claimed was avoidable. She said the government "should be investing in a better care system. Disabled and older people and families shouldn't feel they have to go to A&E unless it really is an emergency".

 

Attendances at A&E departments were up 11%, to 21.7 million, over the past four years, compared with a 3.2% growth in the population during the same period, mainly due to a rise at minor injury units, the statistics showed. Almost half (47.2%) of people who attended A&E received only guidance or advice or no treatment, which will add to concerns that A&E services are seeing patients who could be treated more efficiently elsewhere.

 

Measures taken by Jeremy Hunt, the health secretary, to alleviate pressure on A&E include a named GP for elderly patients in their local surgery and making surgeries open for longer hours, although the HSCIC statistics show that attendances overnight are a small proportion of the total.

 

Dr Mark Porter, chair of the council of the British Medical Association, said patients needed to know how and where to access appropriate care. "Key to this is having an effective out-of-hours telephone service, yet the disastrous introduction of NHS111 replaced a clinician-led service with a call centre and was responsible for many people being wrongly directed to emergency departments," he said.

Last winter, 10.6 million people attended A&E, compared with 10 million in 2009-10. The number of people visiting A&E has been above 5 million in every quarter since the coalition government came to power, compared with exceeding 5 million in only three quarters (from April to December 2009) between April 2004 and March 2010. In the last full quarter (January to March 2010) of the previous government, attendances stood at 4.9 million, compared with 5.3 million in the same period this year.

Neil Harris

(a don’t stop till you drop production)

First study on the non-emergency 111 scheme.

Hangin’ on…

V 111

I protested, then I grumbled – it didn’t do any good. The excellent NHS Direct was closed down at great expense by NHS England to save money and reduce the numbers attending Accident and Emergency.

Now Sir Bruce Keogh has recommended that the 111 non-emergency line be upgraded with adequate numbers of clinical staff – in effect going back to a poorer version of of NHS Direct.

Now we know why;

The next day out comes a properly researched report from, of all places The Department of Health who evaluated the 4 pilot areas results.

Of course, you and I would have carried out a pilot, evaluated it and then decided whether to roll it out nationwide.

The findings were that emergency ambulance call outs did not fall (why would they?) in fact they rose by 3 %.

The numbers attending A and E rose.

Nice one.

Neil Harris

(a don’t stop till you drop production)

Home: helpmesortoutthenhs.blogspot.com

A harmonious arraingment.

Hangin’ on…

 

‘M.D.’, who is ‘Private Eye’s medical correspondent is someone I don’t always agree with – I suspect our politics are very different. What we do have in common is a pretty similar analysis of the problems.

This week in the ‘eye’, he has a go at the new ‘NHS 111’, the non-emergency call service. For once we are saying much the same things about it. He deals with Channel Four’s exposure of what goes on at Harmoni, one of the contractors providing the new service as well as NHS Direct’s withdrawal from its 11 contracts as it has found them uneconomic.

 I’ll quote M.D. directly, I’m sure he won’t mind;             

“Harmoni has a third of the contracts and will probably now mop up some more. It beat Care UK in the tenders, but Care UK retaliated by buying Harmoni and then recruiting, as its managing director, Jim Easton, who was lured from the Department of Health and then NHS England having, er, “overseen the NHS 111 procurement process”.

I think, given the possibilities of legal action that I won’t comment further on the ethical position of losing a tender and then buying out your successful rival, then poaching the person who set up the process, to manage your organisation which is providing that service to that person’s previous employer.

I just don’t like it at all.

Meanwhile:

I haven’t forgotten about Professor Berwick’s report on the NHS – my review of his review is coming up.

Neil Harris

(a don’t stop till you drop production)

Home: helpmesortoutthenhs.blogspot.com

A rough guide to the 111 non urgent NHS call service.

Hangin’ on…

I’ve been very critical of the new ‘111’, service since it started in some regions in April this year.

Life has a habit of making fun of us all; I’ve had to use the service twice in the last month, which probably serves me right.

I’ve always been completely honest in my Blogs – so it’s time for an honest review of the service.

Although I’ve been doing the calling, I’ve been doing it on behalf of someone else, so there will be no details that could identify anyone. Wherever I’m a bit vague it’s because I was in an emergency situation and didn’t have doing this in mind at the time!

Call 1).

Answered: fairly quickly.

Description:

Call Centre operator about 10 minutes.

Separate call back from a Nurse lasting about 10 minutes.

Result: Attendance by emergency callout Doctors, which prevented an A and E attendance.

Call 2).

Answered: Fairly quickly.

Description:

Call Centre Operator: about 12 minutes.

Separate call back from a Nurse lasting 15 minutes.

Result: The Nurse carried out a complex calculation which indicated that an 999 callout and A and E attendance wasn’t needed.

 

You can (I hope) work out from this that the medical advice from the experienced Nurses was excellent, and in both cases prevented a difficult attendance by ambulance to A and E. This saved the NHS money, freed up two ambulances, reduced other peoples waiting time at A and E and improved life for patients, Doctors and Nurses.

Problems:

The service we got was pretty much the same as we used to get from NHS Direct which was entirely staffed by Nurses – because I ended up having two lengthy conversations with nurses.

The new system employs far fewer nurses, calls are taken by unqualified people, using a computer programme with a series of prompted questions which I am now getting very familiar with – all warning signs for serious problems which need help quick.

While this may have the effect of filtering out silly timewasting calls, I actually doubt that there are so many of these. All my research on A and E attendances tells me that the number of unnecessary attenders are exaggerated.

NHS Direct has just announced that the organisation is quitting its franchises to supply services to ‘111’, because the volume of calls breaches the terms of its contract.

The real reason is that the duration of calls and the need for fully qualified staff makes it uneconomic.

NHS Direct assumed that it would receive about £20 a call, in fact it’s been paid £8 to £12 and cannot afford to lose that kind of money.

If you look at my calls; I rang ‘111’, because I already had doubts that we needed an ambulance but I wasn’t qualified to make that decision.  As a result, both were long, both needed a qualified Nurse and both would have lost the provider money. It worked well for us, but in a real emergency I wonder whether the extra time spent on the first part of the 111 call could have unfortunate results?

Conclusion

Good quality service, time wasted on talking to unqualified staff is not a problem unless it is a real emergency.

Back-up Nurses are vital to the service – if there are enough it will be an uneconomic contract. If the provider reduces the qualified staff to save money, the service will become useless.

 

Neil Harris

(a don’t stop till you drop production)

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