111 hotline is not safe, warns top children’s doctor
Untrained call-handlers ‘can’t spot diseases’
ONE of Britain’s top children’s doctors has blasted the controversial 111 NHS out-of-hours hotline as ‘not safe and effective’.
Professor Neena Modi, president of the Royal College of Paediatrics and Child Health, said yesterday that even doctors find it difficult to diagnose serious illness in very small children, and it is much harder over the phone.
She said it was ‘very uncertain’ whether 111’s call-handlers, who are not medically qualified, could safely deal with infants.
Her comments follow a string of blunders and the Mail’s revelation of a damning NHS report into the death of baby William Mead, which also branded the hotline unsafe for seriously ill children.
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
‘I found the system to be chaotic’ OUT OF HOURS NHS HOTLINE IN MELTDOWN Daily Mail, September 29, 2015 NHS HOTLINE NOT SAFE FOR SICK CHILDREN January 26, 2016 LIFE AND DEATH CALLS ANSWERED BY TEENAGERS February 16, 2016
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.’
Her concerns echo the findings of a damning report last month, which found serious failings by both 111 and an out-of-hours doctor in the case of baby William, who died of blood poisoning in December 2014.
Both the call-handler and the doctor failed to spot that he was seriously ill with sepsis. The GP had to assess William on the phone without access to his medical records.
Even more damningly, the report said that although there had been a string of blunders, the sepsis might still have been missed if the call had been handled properly. This was because the 111 system was not sensitive enough to spot key signs of serious illness in children.
The Mail also revealed that chronic staff shortages mean that young call centre staff with just three weeks of training are being overwhelmed by calls. With no medical qualifications they have to follow computer prompts that often lead to a referral to a nurse.
But few nurses are on standby and at times there is only one to serve 2.3million people. It is also thought that half a million calls to the helpline went unanswered over seven months.
At the time Health Secretary Jeremy Hunt denied 111 was unsafe, and said reports it was overwhelmed suggested it was ‘a victim of its own success.’
Professor Modi insists it should ‘never happen’ that a doctor assesses a child over the phone with no access to records. ‘The first thing a medical student is taught is to take the history, understand the background then do the examination,’ she said. ‘When we try and take short cuts, things go wrong.’
And she criticised the lack of Government planning when the 111 service was launched.
‘The time to do an evaluation is not after you’ve spent millions of pounds of money in introducing a system. You want to do that upfront, beforehand,’ she said.
Professor Modi also ‘deplored’ the decline of family doctors’ out-of-hours services. ‘I think that has been a great, great loss for the country,’ she said.
‘If you were to be able to speak to a general practitioner who knew your family, knew you and your kids, they would have a much better understanding and insight into the seriousness of the condition.’
Her comments were backed by Tory MP Dr Sarah Wollaston, chairman of the Health Select Committee, who said William’s death ‘ highlighted the risks when unqualified staff use a computer algorithm over the phone to try to assess the severity of a child’s illness’.
She suggested that cases involving children and babies should be referred to a doctor or nurse at an earlier stage.
William’s mother Melissa, of Penryn in Cornwall, welcomed the professor’s comments.
She said: ‘I found the out-of-hours system that I used with William on the day before he died to be chaotic. I did not know that the call- handler wasn’t assessing my call properly. I assume I’m ringing a safe helpline.’