OUT OF HOURS NHS HOTLINE IN MELTDOWN
■ Only one nurse on duty for over 2 million people ■Tens of thousands of calls go unanswered ■ Baby boy died after parents got wrong advice
The NHS out-of-hours hotline is in meltdown in parts of Britain, a Daily Mail investigation reveals today.
Chronic staff shortages mean call centre staff with just three weeks of training are being overwhelmed. Lacking medical qualifications, they must follow on-screen computer prompts that often lead to a referral to a nurse.
But so few nurses are on standby that at times there is only one to serve as many as 2.3million people.
The hotline, which replaced NHS Direct and deals with urgent cases, has missed its call-answering targets for the past seven months. Half a million patients were unable to speak to anyone at all during this time.
Evidence obtained by the Mail, including shocking testimony from an NHS whistleblower, reveals that:
■ A tick-box computer culture means call centre workers can miss vital symptoms;
■ Two babies died after staff failed to recommend treatment that could have saved them;
■ Up to 75 per cent of calls can go unanswered at busy times, with one case of an 11-hour wait for a call back;
■ Nurses have been told to prioritise routine calls over advising on serious cases so they can hit targets;
■ 111 staff believe the service is ‘completely unsafe’. Ministers promised to examine the Mail’s evidence while MPs and experts demanded an urgent inquiry.
Patricia Marquis of the Royal College of Nursing said: ‘The move from NHS Direct to NHS 111 has been a sadly predictable episode. Nursing expertise was removed and cheaper staff with little or no health experience were left to manage as best they could.
‘A script and a computer programme simply can’t replace the advice of a skilled, experienced nurse, who can spot signs of serious conditions and ensure that the urgent help is given. Urgent action is needed to stop the system being completely overwhelmed.’
Staff at 111 centres have three weeks of classroom training before they are permitted to answer calls
from patients – although they are supervised at first. They use a computer system in order to establish whether or not patients are in need of urgent medical treatment.
Health officials insist the hotline works well nationally, with regional variations.
But a whistleblower waived her anonymity to tell how former colleagues who are paid less than cleaners are making life-ordeath decisions with little clinical support.
Speaking out at risk of her future employment, Irsah Tahir said sometimes only nine call centre workers were available to take calls from a health region covering 2.3million people across Derbyshire, Leicestershire, Nottinghamshire and Northamptonshire.
‘The service is completely unsafe,’ she said. ‘I find it terrifying – it’s just chaos.
‘The whole time I was there I felt it was just a matter of time before something happened. We were always short-staffed. There were never enough nurses. I’m not medically trained and I just don’t think I was equipped to make those decisions. The amount of times I would go home in tears with the stress of it – it was just horrific.’
To expose the scale of the problems, Miss Tahir took videos and photographs inside the Derby 111 centre where she worked until earlier this year.
One alarming picture – taken at 1.15am on April 4 – appears to show that 75 per cent of patients who had called since midnight had had no reply. The lives of some might have been in immediate danger.
Because they are not clinically trained, staff should always have a clinical person such as a nurse on duty, national guidelines state. At times there was just one nurse available for the service covering four counties – meaning the nurse was overwhelmed with patients.
In a short video Miss Tahir took on April 3 she tells a colleague she has a patient who needs an ambulance but, like her, she cannot get through to the nurse for help.
Emails unearthed by the Mail reveal the desperate efforts of bosses at the Derby centre to fill their staff roster.
In one message on May 11, they tell workers – some already on six-day weeks – that there are ‘lots of vacant hours all week and weekend if you can help. Please call’.
Incredibly, the managers say that cover is also required ‘today, any hours from now until 23.00’.
Bonuses of up to 50 per cent of salary were on offer. Another begging email offers double pay for giving up holidays. Concerns about staffing and patient care were raised in May 2014 at a meeting of Derbyshire Health United, which runs the service.
A local NHS commissioner said anonymous sources had warned about staffing levels.
But the DHU directors said they had already spent extra funds hiring staff and this ‘had to cease’.
Statistics suggest many of the problems experienced in the Midlands are reflected around the country. Nationally, the service missed its key target of answering 95 per cent of calls in under a minute for the first seven months of this year.
Keith Vaz is writing to Health Secretary Jeremy Hunt to demand an urgent inquiry. ‘This is both shameful and shocking,’ said the senior Labour MP. ‘There is little point in having a service of this kind – that is supposed to relieve the pressure on doctors on the front line – if it is not fit for purpose.’
Liz Kendall, who is also a Labour MP for Leicester, said: ‘There should be an immediate investigation into what this whistleblower has said. Jeremy Hunt should get a grip on this problem and start to take some responsibility.
‘If we have a situation where properly-trained nurses are not able to deal with many of these cases properly, then patients can’t get the right advice and their health could be at risk.’
Andrew Bridgen, Tory MP for North West Leicestershire, said: ‘I will be taking this up with the secretary of state immediately. It is clear the East Midlands 111 service is in crisis and is in desperate need of extra resources. Staff are under tremendous pressure. This is letting down my constituents. We need the 111 call centre to be manned sufficiently to cope with the demand.’
Stephen Bateman, chief executive of Derbyshire Health United, said the service was found to be ‘safe, effective, responsive and well led’ in a Care Quality Commission inspection.
He said: ‘Like all frontline NHS services we are challenged to consistently deliver national targets against increasing patient demand, especially at periods of peak demand at weekends and bank holidays.
‘We continue to review with our commissioners how we might fur- ther improve our services.’ He rejected ‘assertions relating to staff ratios’, saying there was one nurse for every four call advisers.
‘The recruitment and retention of staff remains a challenge for Derbyshire Health United as it does for all NHS 111 providers across the country,’ he added. ‘This is due to a combination of increasing patient demand and the nature of the role of working unsocial hours. The NHS 111 service operated by DHU is continually recruiting staff as demand on the service increases.’
An NHS England spokesman said: ‘Across the country NHS 111 continues to offer a prompt and safe service, with growing numbers of patients phoning 111 when they might otherwise have gone directly to A&E. While 111 is performing well nationally, there are regional variations.
‘Where there have been issues, we have been working closely with local CCGs to ensure these are addressed. If performance is consistently below standard, this will be taken into account when local 111 contracts are reviewed early next year.’
Health minister Ben Gummer said: ‘Ministers will look closely at evidence of any problems to ensure that all patients throughout the country are getting the consistently high standards they deserve.’
He said 111 had significantly more cases than NHS Direct did.