‘Ambulances sent out for nosebleeds’ by NHS 111 staff

Untrained phone handlers may be squandering resources by ‘flagging up’ minor cases as emergencies

AMBULANCES are being dispatched to treat people with “nosebleeds” by medically untrained NHS 111 call handlers, according to paramedics.

In one case, an ambulance allegedly raced for 40 minutes with its blue lights flashing to treat what the crew had been told was a “catastrophic bleed”, only to find nothing more than a scratch from a kitten.

The incidents in Somerset have raised concern that the 111 operators, provided by Vocare, the private medical firm, are squandering NHS resources by wrongly categorising calls as more serious than they are.

Patients who call 111 are sometimes transferred to an ambulance service operator for assessment, but not if the 111 handler has already flagged the call as Category 1, reserved for life-threatening emergencies.

Speaking anonymously, one South Western Ambulance Service (SWAS) paramedic told the BBC: “Almost every person we go to who called 111 says they didn’t want an ambulance, just advice or a doctor, but 111 insisted they would send an ambulance.”

He said the call-handlers “aren’t medical and make all sorts of things Category 1, which they are not”.

“An example is that all nosebleeds recently have been classed as Category 1 as they’re considered a risk of ‘catastrophic bleeding’ – clearly nonsense.”

The allegations follow a report last year by Nuffield Trust, which found that “risk-averse” operators were piling pressure on ambulance staff by escalating 111 calls as a matter of course.

According to the SWAS website, Category 1 “is intended for patients in cardiac arrest or peri-arrest situations where there is a need for immediate intervention and/or resuscitation”. The trust has not met its response time targets for this type of call for several months. Vocare has denied any failures and said its staff followed procedures determined by the NHS.

However, a SWAS source told The Daily Telegraph that 111 operators were wrongly incentivised because they were assessed on how quickly they dealt with calls for help.

“If 111 triage a call as Category 1 we have to respond – we cannot secondguess it,” the source said.

Vocare said its call operators underwent six weeks’ systems training and were backed up by a qualified clinician such as a paramedic or nurse who could then take over the call.

By this stage, however, an ambulance may have been dispatched, it has emerged. A spokesman for Vocare said: “It is important to stress that our team members are all trained in the processes that the NHS has defined, including when calls are escalated to paramedics.

“NHS England is aware that the NHS Pathways program always defaults to the safest route for the patient, and this sometimes results in an ambulance being called when another less urgent option may be more appropriate.

“Somerset Doctors Urgent Care is working with the NHS to add an extra level of clinical assessment for patients who call 111, to get them to the right place at the right time.”

Meanwhile, Somerset Clinical Commissioning Group, which oversees the Vocare contract, said it had received “no information to date [to] suggest that the NHS 111 service is inappropriately diverting calls to the 999 ambulance service”.

According to the NHS website, people need to see their GP or go to A&E if they have a nosebleed that lasts more than 20 minutes. Nosebleeds usually have trivial causes but sometimes indicate a more serious problem with blood vessels in the head.

They can also occur after taking blood-thinning drugs such as warfarin.

‘They didn’t want an ambulance, just advice or a doctor, but 111 insisted they will send an ambulance’