I have personal experience of the inefficiency and risks attached to incorrect advice from NHS 111. One of my relatives was ill after a delivery, with fever and I wanted to ring 999. I was stopped by the relative who demanded I ring NHS111. The advice for a post partum sepsis was to ring her GP, and was not to attend hospital. There are too few full time GPs to run a proper out of hours service…. There are so many part timers that any form of continuity of care, particularly when we are terminally ill, has virtually disappeared. Experimental technology is being used in reality. There is a real need to bring experienced diagnosticians closer to the initial presentation, whether it is by phone, in GP or in A&E (or whatever it is named). How do we get rid of NHS 111?
So it is no surprise to read about the problems reported by Jon Ungoed-Thomas and Jack Taylor in the Sunday Times 5th Jan 2020: Toddlers died after NHS 111 helpline said they were not in danger – The urgent medical care service faces calls for an independent investigation after a number of child fatalities
The NHS 111 helpline for urgent medical care is facing calls for an investigation after poor decision-making was linked to more than 20 deaths.
Experts say that inexperienced call handlers and the software used to highlight life-threatening emergencies may not always be safe for young children. At least five have died in potentially avoidable incidents.
Professor Carrie MacEwen, chairwoman of the Academy of Medical Royal Colleges, said: “These distressing reports suggest that existing processes did not safeguard the needs of the children in these instances.”
Since 2014 coroners have written 15 reports involving NHS 111 to try to prevent further deaths. There have been five other cases where inquests heard of missed chances to save lives by NHS 111 staff; two other cases are continuing and one was subject to an NHS England investigation.
The latest coroner’s report issued to prevent further deaths was published in November. It concerned Myla Deviren, 2, from Peterborough, who died from an intestinal blockage in August 2015….
,,,Researchers examined 2,191 patient safety incidents involving children receiving NHS care between January 1, 2005 and December 1, 2013. The majority of the 659 incidents involving diagnosis, assessment and referrals — including 10 child deaths — occurred during calls to NHS 111.
The report stated: “The safety of software used to triage children over the telephone is unclear, particularly its sensitivity to detect signs of serious illness in children.”
The NHS Pathways triage system, used by NHS 111 and in about half of ambulance services, is one focus of the inquest into the death of Shante Turay-Thomas, 18, from north London, who suffered a suspected allergic reaction.
Leigh Day, the legal firm representing Shante’s family, said she was assigned an ambulance with a response time of two hours (category 3), but a 999 call to the London ambulance service with suspected anaphylaxis would trigger an ambulance with a target response time of seven minutes (category 1).
NHS 111 is operated by various providers, and NHS Digital supports the NHS Pathways triaging software. The 24-hour service is free to use.
Professor Jonathan Benger, acting interim chief medical officer at NHS Digital, said: “NHS Pathways supports the remote assessment of more than 17m calls each year and is a safe and robust system.”
NHS Digital said that since 2016 there had been changes to improve identification of patients at risk of critical illness; where a clinical safety issue is raised, an assessment is made within 24 hours.
NHS England said serious safety incidents involving NHS 111 were “thankfully rare” and more than half of callers received advice from qualified clinicians.
Professor Martin Marshall, chairman of the Royal College of General Practitioners, said: “Patients need to be reassured that valuable lessons have been learnt if we are to maintain public trust and confidence in NHS triage systems.”
Dr Chaand Nagpaul, chairman of the British Medical Association (BMA) council, said: “There is clearly much more to do be done to ensure there is adequate assessment, expertise and support on hand for those who contact the service.”