CALL 999... GET SKYPE INSTEAD

Whistleblower reveals how NHS avoids sending ambulances

PATIENTS who dial 999 are being assessed over Skype instead of being sent an ambulance, it has emerged.

Trials are under way across England to see if video consultations on smartphone apps could replace ambulances for thousands of ‘lower priority’ calls.

They are being used on patients whose conditions aren’t deemed immediately lifethreatening, such as back pain, abdominal pain, falls or heavy bleeding.

Details of the Skype and FaceTime trials were revealed by former South Central Ambulance Service emergency call handler Karen Frederick, who says patients are being failed because the service is so overwhelmed.

The whistleblower revealed a string of controversial practices being used to cope with rising numbers of 999 calls. They include:

A ‘no send’ policy whereby patients are refused ambulances if their lives aren’t thought to be in immediate danger;

Operators being allowed to take highpriority calls while drunk or high on drugs;

Call handlers being banned from giving out medical advice to heart attack patients because they don’t have time;

Taxis being used to ferry patients to hospital if ambulance crews are too busy;

Elderly patients who have fallen being made to wait nine hours for an ambulance as they are repeatedly bumped down the queue.

Just last week the NHS said heart attack

and stroke victims will have to wait longer for an ambulance under controversial new targets. Paramedics will have 18 minutes to arrive – up from the current eight minutes – although in some cases, the target will be as high as 40 minutes.

Ambulance chiefs are also battling a recruitment crisis of paramedics and about one in 14 posts nationally are vacant. To add to the pressures, ambulance crews are increasingly having to queue up outside A&Es to offload patients, meaning they are unable to respond to incoming calls.

The Skype consultations were initially trialled on patients in nursing homes, but they have been widened to include other patients whose conditions aren’t life-threatening and who would normally be dispatched an ambulance within 60 minutes.

Patients dial 999 as normal and if their condition is classified as not being an emergency, they get trans- ferred to a hub of paramedics and nurses at the call centre.

One of them will call back using Skype, FaceTime or a similar app on their smartphone or computer.

In the case of elderly patients, carers or relatives who are more technically knowledgeable may take charge of the call and zoom the phone’s camera in on particular injuries.

But doctors’ leaders are concerned by the practice and say virtual consultations should never replace assessing a patient in the flesh.

South Central Ambulance Service is one of the better- performing trusts, having recently been rated ‘Good’ by the inspection watchdog.

But the fact it has to resort to such drastic measures to cope with the demand suggests the situation is far worse elsewhere.

Dr Richard Vautrey, interim chairman of the British Medical Association’s GP committee, said: ‘You can’t rely on it for making a physical examination. You always have to err on the side of caution. There’s also sometimes technical difficulties, the broadband might fail, the connection takes longer.

‘You need to be that bit more cautious as it’s only when seeing a patient face-to-face in the consulting room or at home that you can really do a proper physical examination.’

Miss Frederick, who was employed by South Central between October 2015 and May this year, said: ‘You can’t do blood pressure via Skype, you can’t do a heart rate via Skype. There are a lot of issues I can see happening.’

She said Skype consultations would not help diabetic patients with potentially fatal high blood sugar levels who have a distinct smell on their breath.

Miss Frederick left the ambulance service after suffering serious health complications she believes were triggered by stress.

She also told of how call handlers often turned up to work drunk or high on drugs and managers refused to dismiss them. ‘When you call 999, don’t assume the person on the other end is sober,’ she said.

It also emerged that people who dial 999 are increasingly being sent taxis to take them to hospital instead of ambulances. Managers say patients have been ‘overwhelmingly positive’ about the policy and the taxis had freed up ambulances for the most urgent calls.

But taxi drivers do not carry medical equipment and most have never been trained in first aid. If a patient suddenly deteriorates, there is little they could do to help.

Nonetheless ambulance services covering 20 million patients in London, Yorkshire, South Central England and Wales all have arrangements with local taxi firms.

A spokesman for South Central Ambulance Service – which covers Oxfordshire, Hampshire, Buckinghamshire and Berkshire – said other trusts were testing the use of video consultations but did not name them.

‘South Central Ambulance Service is currently trialling the use of technology to provide face-to-face consultations over the telephone.

‘This enables both the patient and the trained clinician... to see each other. This gives the clinician more information when they are assessing the patient as they can see the patient and view the injury severity, symptoms, etc.’