Is this the end for NHS 111?
Since the death of baby William Mead from sepsis in 2014, there have been some serious question marks hanging above the non-emergency call service, NHS 111.
In a critical report carried out by the Care Quality Commission in the South West of England in March 2016, the service has been rated ‘inadequate’. Inspectors noted that the service "had been consistently failing to meet national standards" with patients being made to wait for a response ‘for long periods’.
But, with waits to see a GP getting longer and longer, the need for a service like NHS 111 is increasing. If we find ourselves in need of the service, how worried should we be? Is NHS 111 routinely putting patients at risk?
There’s no doubt that the service has been struggling for a while. One of the main problems, as stated by the South Western Ambulance Service NHS Foundation (SWASFT), is the difficulty of attracting and retaining sufficient clinical staff. Chris Nelson, joint branch secretary at Unison for South West Ambulance said the service suffered, as much of the NHS does, from being "poorly understood, poorly commissioned (and) poorly funded."
Historic problems include:
- June 2015 – inquest hears that William Mead’s death could have been avoided if NHS 111 had referred him to hospital.
- January 2016 – NHS England report finds the service ‘missed chances to save sepsis baby William Mead’.
- February 2016 – NHS investigates case of ‘sleeping 111 medics’ at Dorset call centre.
- February 2016 – top paediatrician questions safety of NHS 111 helpline for young children.
- February 2016 – The Royal College of Nursing claims staff are being implicitly pressured not to transfer calls to 999.
Worryingly it was also reported by a former senior call adviser for the service that staff were actually “asleep on the job”. Whistleblower Sarah Hayes expressed concerns that with non-medically trained call handlers working alongside a limited number of clinicians, it was a common occurrence for no on-call clinicians to be present at call centres in Dorset and Devon, and that some staff were asleep at their desks. A separate report commissioned by SWASFT found no evidence for many of the allegations made about the service by Ms Hayes but it did acknowledge staff felt there had been "insufficient clinical support available".
The Care Quality Commission Report found that clinical staff were stressed and tired and calls were often being answered by staff ‘who were not trained to assess patients symptoms’. Many patients were also abandoning calls due to long waiting times. In one case in Devon, a patient waited for 21 hours for a call back. In the tragic case of William Mead, both GPs and NHS 111 failed to spot the symptoms of sepsis. His mother, Melissa Mead, said that the recent report confirmed her ‘doubts and suspicions’ but that she hoped, ultimately, it would lead to improvements.
William Mead’s case also gave rise to questions about the specific treatment of small children and whether NHS 111 was equipped to deal with these types of cases. In an interview with The Press Association, leading paediatrician Professor Modi said,
“It is uncertain – because studies have not been adequately conducted – whether or not the telephone triage service, such as NHS 111, is really going to be safe and effective for very small children. Even a clinician trying to make an assessment over the telephone would find it much more difficult in a smaller child than in an older child. Then when you add in the lack of clinical expertise, it’s going to be even more difficult. I feel really sorry for the call handlers because they are being placed in a position that really it’s questionable that they should be placed in.”
Whether child or adult, the recent findings make equally worrying reading. It’s clear that stretched resources mean patients are being put at risk and potentially serious conditions are being missed or not referred correctly to the emergency services.
- 6% of life-threatening conditions took more than 3 minutes to be passed to an ambulance
- 14% of calls went unanswered in the South West in 2015
- 8% was the national average of unanswered calls in 2015
- 21 hours longest wait for call back in Devon
The Chief Inspector of Hospitals, Professor Sir Mike Richards said that patients were being put at risk because the system being used to assess call urgency was ‘not good enough’. Despite many complaints from staff, patients and healthcare professionals, SWASFT only took ‘limited action’. However, frontline staff were praised in the report for their ‘reassuring manner’ when dealing with worried patients.
As a result of these findings, the Care Quality Commission issued a warning notice to SWASFT ordering “significant improvements” by summer 2016. It is too soon to know whether these "improvements" will make a difference and whether patients can regain confidence in a service beleaguered by so much inefficiency and criticism. However, the reality is that the growing funding crisis is causing huge problems throughout the NHS and social care system and NHS 111 is just one example of the problems caused by chronic underfunding. With access to GP's becoming more and more difficult as funding deficits bites, NHS 111 could help to ease some of the strain but only if it is given the funding that it needs to operate at a proper level.
The suggestion of a new "ringfenced" tax may be one answer. As put forward by Dr Dan Poulter, Central Suffolk and North Ipswich MP, a "health and care tax - perhaps introduced through raising national insurance" would provide a guaranteed income stream and "allow a legitimate debate about what is an appropriate level of taxation required to ensure a sustainable funding settlement". It may be time to open a proper discussion about meaningful and radical funding options if we want the NHS to continue to operate at an acceptable level.
By Jonathan Zimmern, Partner
Jonathan has been dealing with complex, high value medical negligence cases for over ten years, covering areas such as birth injury, delayed diagnosis, inquests and orthopaedic injury amongst other areas. He is a member of the Association of Personal Injury Lawyers and is acting on behalf of the Trustees for the vCJD compensation scheme – which manages £67.5m for victims of variant Cruetzfeldt Jakob Disease and their families.
He often handles cases which are reported in regional and national press and regularly takes over cases that have been mishandled by other solicitors. He has particular expertise in dealing with complicated cases of clinical negligence which overlap with pre-existing personal injury claims.
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