30.09.15
‘Extremely worrying’ NHS 111 understaffing – health minister demands answers
Health minister Ben Gummer has demanded assurance from NHS England after allegations that surfaced yesterday that the NHS 111 service is severely understaffed and operated by untrained workers.
The situation has been dubbed “pitiful” and “extremely worrying” by the Royal College of Nursing, whose regional director, Patricia Marquis, told the Daily Mail: “We really fear that a tragedy could occur. It is extremely worrying that vast numbers of calls are not being answered, leading to patients giving up.
“It is still more worrying that people with an urgent need for care may not be having that need recognised because they can’t speak to an expert.
“Shifting to deliver this service on the cheap has been a real false economy, with people either not receiving urgent advice or making unnecessary trips to A&E.”
Marquis was “particularly concerned” about nurses being instructed to stop advising on complex cases in order to answer more routine calls to meet set targets.
Following the Mail’s investigation, Gummer said the government had asked NHS England for “assurances” that the service is “doing all it can for patients”.
He added: “NHS 111 staff should be overseen by clinical experts, including nurses, in every 111 centre.”
Katherine Murphy, chief executive of the Patients’ Association, warned that, with the “winter crisis” approaching, the service’s failings needed to be addressed.
“If the service that is supposed to be there to keep people away from A&E is not fit for purpose, then we need to address it now.”
One of the hotline’s call operators featured in the paper’s investigation, Irsah Tahir, claimed to have no medical training – but had to make complex decisions for patients because “there was never enough nurses”.
She dubbed the service “completely unsafe” and said her colleagues were left overwhelmed by calls from across Derbyshire, Leicestershire, Nottinghamshire and Northamptonshire.
She told Good Morning Britain: “I’m sure if you look into it, lives have been lost because mistakes have been made. We need more nurses, we need more money to help.”
Furthermore Tahir revealed to the Mail that, on one occasion, a single nurse had to cover an area containing 2.3 million people in one of the centres.
And according to the investigation, 75% of calls go unanswered during the busiest times.
Joyce Robins, from the campaign group Patient Concern, called the debacle a “crisis situation”, telling the paper: “NHS 111 is supposed to help doctors and keep people out of surgeries, but there is no point having the service if you cannot staff it properly. It just deceives people into thinking they are getting help, which isn’t in fact available.
“It is absolutely ludicrous and it is dangerous. The calls could be urgent and they don’t recognise it.”
A series of patients came forward during the investigation to tell of experiences when the service had failed them, including a woman who received incorrect medication instructions that led to the death of her son.
Long-time BMA concerns over 111 service
The non-emergency number was created to help patients and direct them to the best medical care, but NHS England has since been looking at reviewing how these services are procured.
Dame Barbara Hakin, its outgoing commissioning operations director, halted tenders in July to give the national body time to create commissioning standards and a clinical model for a “functionally integrated, urgent care access, treatment and clinical advice service” – expected to join up 24/7 urgent care, NHS 111 and OOH provision.
Dr Charlotte Jones, BMA GP Executive team lead on NHS 111, said at the time: “A lot of work still needs to be done, but this is a step in the right direction. The BMA was raising concerns about NHS 111 before its disastrous launch in 2013, and has continued to have doubts about how the service is being run in some parts of the country.
“Many GPs and doctors in A&E departments remain sceptical that all the cases being referred to them are appropriate. NHS 111 should be prompting effective, safe care, whether this is via a clinician or through self-care, in the right circumstances.”
She questioned whether NHS 111 had the resources to meet patient demand and whether its call operators had enough training or sufficient support to be able to deal with patients’ health needs.