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27.01.16

NHS urgent care and 111 ‘must be simplified’ to ease confusion – Hunt

Health secretary Jeremy Hunt has admitted that the government “must improve the simplicity of the [NHS] system” after a report found the health service’s 111 hotline is unsafe for seriously ill children.

The report, seen by the Daily Mail, was commissioned by NHS England after 12-month-old William Mead died from sepsis despite his parents contacting 111 call handlers and visiting GPs multiple times in the months before his death.

Responding to an urgent question from shadow health secretary Heidi Alexander MP in the Commons yesterday, Hunt said: “Fundamentally, when we look at the totality of what the Mead family suffered, we will see that there is a confusion in the public’s mind about what exactly we do when we have an urgent care need, and the NHS needs to address that.

“The issue is that there are too many choices, and that we cannot always get through quickly to the help that we need. We must improve the simplicity of the system, so that when a person gets through to 111, they are not asked a barrage of questions, some of which seem quite meaningless, and they get to the point more quickly and are referred to clinical care more quickly.

“We must simplify the options so that people know what to do, and that is happening as part of the urgent emergency care review. It is a big priority, and this tragic case will make us accelerate that process even faster.”

As well as issued with the 111 service, the report highlighted three other areas of concern, totalling 16 fundamental mistakes that contributed to Mead’s death.

Among them were the six GP appointments made by the baby’s family in the months leading up to this death, during which doctors were unable to spot his life-threatening chest infection. There was also a “general failure to listen to parents” during appointments.

It highlighted great pressure on doctors to reduce prescriptions for potentially life-saving antibiotics (to prevent microbes from building resistance to the drugs), cut down on acute hospital referrals and excessive workload, as well as a general lack of understanding of sepsis and its symptoms across the NHS. It is estimated that around 35,000 people die from it a year, including 1,000 children.

The report also admitted that the deteriorating condition is “not easily identified through the structured questioning” used by 111 call handlers, who do not necessarily have clinical training.

Hunt said: “There were specific recommendations in relation to NHS 111 which should be treated as a national, not a local, issue. Call advisers are trained not to deviate from the script, but the report says that they need to be trained to appreciate when there is a need to probe further, how to recognise a complex call and when to call in clinical advice earlier. It also cites limited sensitivity in the algorithms used by call-handlers to red-flag signs relating to sepsis.

“The government and NHS England accept these recommendations, which will be implemented as soon as possible.”

But Alexander pushed Hunt further, asking when he will review the training that 111 call handlers get and whether he would increase the number of clinically trained staff available. A clinically trained person, the report said, would have recognised the significance of Mead’s loud crying in the background.

She referred to NHS Direct, replaced by NHS 111, which was “predominantly a nurse-led service”.

“The report says the computer programme that call handlers are using did not cover some of the symptoms of sepsis, including a drop in body temperature from very high to low,” Alexander added.

“Does the health secretary have confidence that the 111 service is fit to diagnose patients with complex, life-threatening problems who may not always fit the computer algorithm call-handlers have to rely on?”

Hunt said that there are some things “we can and must do quickly” with regards to the 111 service, but a “more fundamental change” is needed too.

(Top image: Jeremy Hunt during Urgent Question debate, courtesy of Parliamentlive.tv)

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