Star comment: The NHS 111 service dilemma
The National Health Service in Shropshire is under enough pressure without ambulance crews being sent on fools’ errands and our A&E units being clogged up with patients who could be better dealt with elsewhere.
When people call the number, the call handlers have to decide how to deal with them. Of the 2,710 calls in August, 13.66 per cent were referred to the ambulance service. By our maths, that’s about 370 cases.
In the words of Dr Julie Davies, of Shropshire Clinical Commissioning Group: “There is some concern about an apparent higher rate of disposition to A&E and the ambulance service from NHS 111 activity which may be having some impact on A&E performance at Shrewsbury and Telford Hospital NHS Trust.”
The inference some may make is that the 111 staff are doing something wrong. But is that fair?
Assessing a patient over the phone is necessarily going to be more problematic than if you assess them in person. They will have a list of questions to ask and, for all we know, there is a big sign up on their wall with the words: If In Doubt, Take No Chances.
Talking on the phone also means you are only talking to one person at once. Call handlers are deprived of the advantages of receiving the information of the group, the hubbub, where others, like loved ones, may chip in with comments which might prove very useful in making an assessment.
There have been enough tragedies within the NHS in which the first point of contact failed to appreciate the seriousness of a case, with the upshot that there is a considerable incentive to play things safe.
We also need to know whether these figures for Shropshire are untypical, or whether the level of ambulance referrals is much the same elsewhere.
With the approaching winter, our hospitals and the ambulance service are going to be severely stretched.
If the 111 service needs tightened procedures, more training, or whatever, then fair enough.
It could be that the entire concept of giving medical advice over the phone is fundamentally flawed.
Yet there is an alternative which is perhaps even more worrying – that they are doing their job properly, the concept is not flawed, and the tidal wave arriving at A&E is reflecting a genuine level of legitimate demand on an NHS which simply cannot cope.
