Row as NHS chief says: Ring 111 hotline before you can be seen at A&E
Trips to casualty like a day out for some patients, she claims
PATIENTS should be made to call a hotline before they are allowed in to casualty, a health chief has said.
Helen Thomas, an adviser to NHS England, claimed trips to A&E were too often seen as a ‘day out’ – with some people even bringing picnics.
She said some health trusts were open to starting pilot schemes where patients would have to prove they had called the 111 non-emergency number before going to casualty. She claimed the plans – known as ‘talk before you walk’ – had been discussed by Health Secretary Jeremy Hunt.
Campaigners condemned the idea last night, saying casualty units could not turn people away. And NHS England insisted no plans for any such rationing scheme existed. Officials initially claimed Dr Thomas had been ‘misquoted’ by Pulse, which reported her comments.
But when the health magazine provided a recording showing their report was accurate, the officials said Dr Thomas was simply wrong.
Speaking at the Urgent Health UK conference in Solihull, she had said: ‘Jeremy Hunt has mentioned to some of my colleagues that maybe we should have a “talk before you walk” and we may well pilot that. It’s been done in other countries where they’ve actually said you can’t come into an emergency department until you’ve talked on referral or you have to have a sort of docket that you’re given by having talked on the phone that you do need to come.
‘That’s politically quite a hot potato but there are places where they have said they are willing to pilot it. If we could pilot it in just one area we would get some really interesting information.’
Dr Thomas, a GP with 25 years of experience working in Dorset and Plymouth, said that, of every 100 patients who go to A&E, only 20 have called 111 beforehand.
‘With that other 80, there is an opportunity there. Some of them will need casualty but there is an awful lot that won’t,’ she said. ‘My sister said she took my mother the other day and there were people with a picnic.’
To laughter, she added: ‘ It’s almost becoming a day out for some people, it’s just unreal.’
Dr Thomas said illness was often self-limiting with children regularly recovering while waiting to see an emergency doctor: ‘That is not good to be doing that to patients. They wait for four hours, their kid gets better, and they go home. We are not getting it right at the moment.’
But Rachel Power, of the Patients Association, said: ‘Will the parent of a child who has fallen and broken their arm, for instance, really have to call 111 or get a GP referral first? Are they even likely to knowbe people bouncerssuch away?’a baron the exists? door, Will turningthere Hospitals have been trying to persuade more patients to visit their GP, pharmacist or call a helpline rather than going to struggling A&E units. But this is the first time a senior official has suggested that patients having calling first could be a requirement of admission.
The NHS 111 service was launched in 2010 with the aim of cutting costs and reducing pressure on A&E departments.
But it immediately ran into problems, with overly cautious call centre staff initially sending too many people to hospital. The service has also been responsible for a string of blunders and fatalities.
In December 2014, William Mead, a 12-month-old baby, died of sepsis after a 111 call handler in Cornwall failed to realise how ill he was. Chris Moulton, vice president of the Royal College of Emergency Medicine, said there was no evidence Britons attended A&E more often than their peers in other developed nations.
He added: ‘This is blaming the patient for problems in the system. Most of those needing hospital care have complex conditions, they are older people, those with cancer and those who need genuine care.
‘These people that they are saying they want to divert are not the ones filling the beds.’
Professor Helen Stokes-Lampard, who is chairman of the Royal College of GPs, said: ‘Our understanding of this proposed pilot scheme is that it will involve phone referrals to A&E via NHS 111 – it will not involve patients having to make additional visits to their GP before they can attend A&E.’
An NHS England spokesman said: ‘To be clear there is no pilot and there are no plans to introduce this in the future.
‘It is wrong to suggest or imply that the NHS will do anything other than continue to provide A&E care for all patients who need it. Nor are there any plans to prevent patients from visiting A&Es alongside the other options now available for non-urgent care such as NHS 111 or urgent treatment centres.’
A Department of Health spokesman said: ‘There are absolutely no plans to pilot this approach – patients can be reassured unprecedented planning has gone in to preparing the NHS for this winter.’
Dr Thomas is national medical adviser for integrated urgent care at NHS England.
‘We’re not getting it right’ ‘Done in other countries’