HaHaHaHa….this is gorgeous!

NHS 111 is to blame for almost all of the last year’s rise in Accident & Emergency admissions, one of the country’s most senior medics has said.

Dr Cliff Mann, president of the College of Emergency Medicine, said it was “absurd” to suggest patients were wrong to go to casualty units, when large numbers were being directed there by the telephone service.

Speaking at a session of the Commons health select committee on Wednesday, he said the NHS needed to change its systems so they work better for patients.

He told MPs that the 111 phoneline, which was supposed to help patients and relieve pressures on hospitals has had the opposite effect.

“The reason these people are attending these emergency departments is because we told them to,” he said.

“Of the 450,000 extra attendances in the system in the last year, 220,000 were advised by NHS 111 to come to the emergency department and another 220,000 had an ambulance despatched to them by NHS 111.

“If you put those figures together you have more than 95 per cent of the rise in type 1 [major A&E unit] attendances. I don’t think we should blame people for attending the emergency department when we’ve told them to go there. It’s absurd.”

Earlier this month, emergency medicine experts said that when nurses handled calls on the helpline’s predecessor, NHS Direct, they had the experience to know when an A&E visit was not appropriate.

It came as figures emerged showing that NHS 111 sends an extra 50 per cent more patients to A&E at the weekend, when GP surgeries and other clinics are shut – increasing the strain on already stretched hospitals.

The general idiocy of politicians planning a health care system, eh?

23 thoughts on “HaHaHaHa….this is gorgeous!”

  1. OK, we’ve increased the amount of A&E admissions, but what was done wasn’t absurd. It’s only absurd if you look exclusively at A&E departments rather than the whole process including NHS Direct.

    They cut a lot of admissions, but it didn’t make things any more efficient. Instead of someone going to A&E and seeing a nurse, they were on the phone to a nurse. And that’s depriving wards of nurses.

    What they’ve done is right, and what everyone does with helplines – put cheap staff on the frontline, train them in the most basic stuff, turn those around and pass the hard stuff on.

  2. I rather think it is absurd.

    You originally plan to have a party in the local village hall. You then decide that’s a bit expensive, so you decide to have it at home.

    After the first 50 people squeeze into your lounge, you start to get a few complaints.

    “Just grin and bear it!”, you cry, “and stop complaining about the lack of foresight and planning!”.

    If you are going to direct half a million people to use a service, best plan for that service receiving half a million new customers, no?

  3. I think it’s absurd to expect anyone to make a sensible diagnosis (or assessment) over the phone. I know they do it in the Outback, but we don’t live there.

    It’s as though body language, facial expressions, unmediated tone of voice etc mean nothing.

    There’s lots of problems – time wasters, hypochondriacs, the free-at-the-point-of-not-really-need NHS etc etc – but allowing for all that you might as well have a yes/no tick box system online, because as far as I can tell that’s pretty much the service that 111 provides. They do the box-ticking so you don’t have to.

    And anything which even sounds half-iffy, are you going to tell the IP to take an aspirin and go to bed, in the current climate?

  4. “The general idiocy of politicians planning a health care system, eh?”

    Not just politicians, Tim, anyone.

  5. I think it’s absurd to expect anyone to make a sensible diagnosis (or assessment) over the phone. I know they do it in the Outback, but we don’t live there.

    It’s as though body language, facial expressions, unmediated tone of voice etc mean nothing.

    There’s lots of problems – time wasters, hypochondriacs, the free-at-the-point-of-not-really-need NHS etc etc – but allowing for all that you might as well have a yes/no tick box system online, because as far as I can tell that’s pretty much the service that 111 provides. They do the box-ticking so you don’t have to.

    And anything which even sounds half-iffy, are you going to tell the IP to take an aspirin and go to bed, in the current climate?

  6. I did think there had to be a reason why A&E was falling apart this winter when it wasn’t a particularly hard or cold winter, with any big health epidemics. There didn’t seem to be an obvious reason why so many more people were ending up at A&E this year than any previous ones. And now we know why it is – not the evil Tories starving the NHS of money, or selling it off to their private sector mates, but the inability of a State run system to predict how the changes they introduce in one part of the service will affect others.

    Can some one tell me why we are paying GPs £100K/yr NOT to provide an easily accessible 24/7 point of contact for the NHS?

  7. I don’t think it’s fixable what with doshing out perverse incentives to highly organised labour, trying to control stuff via boxticking, inspection regimes that are quite mad. How do you replace it with a rational quality regime that serves all efficiently land equitably ike the Singaporeans without every trougher screaming?

  8. Interested: There’s lots of problems – time wasters, hypochondriacs, the free-at-the-point-of-not-really-need NHS
    I agree and amongst this lot there will be a decent proportion who avail themselves of the 111 facility but who would hitherto have waited for their ‘ailment’ to go away of its own accord.

    If the 111 operator then suggests that it’s a good idea to go to A&E, it’s a racing certainty that this advice will generally be followed so you end up with people who would otherwise have got well by themselves, pitching up at hospital.

    As always, the politicians are guided less by an understanding of human nature than by the lure of the new and the siren voices of focus groups and the result is a disappointing mess.

  9. Must admit have never used the 111 service. I either go to GP if its not serious or A&E when it is.
    Been to A&E with the wife a few times when a time sensitive problem has cropped up, twice they admitted her for days. Local walk in centre is OK for some stuff but pretty bad at dealing with anything complicated or requiring procedures to be followed….

  10. They didn’t plan to receive thousands extra being directed to A&E. They planned on thousands fewer. You can almost hear some Whitehall dickheads voice. “Weed out the non-serious eh! Save a fortune”. That doesn’t work very well with truly non-serious stuff like ringing up the shite-useless HMRC call lines. As for peoples health. It should not require a genius to realise that without a face to face looksee from experienced medical staff, you can’t easily tell if something might be serious or not. Lots of nasty stuff starts off in a low-key manner. And telling some poor sod–“Take two asprin and go see your GP” only to have him or her Dead by Dawn is a recipe for media feeding frenzy. It has happened enough times in other non-lethal areas for it to have been entirely predictable.

  11. Tim A,

    > what was done wasn’t absurd.

    Depends what you mean by “what was done”. Others above have picked apart the inadequacies of the planning itself. But the other thing that was being done was that politicians and healthcare staff were publicly blaming the patients who’d turned up unnecessarily.

  12. S2,

    I’m referring specifically to the idea of what was done about staffing of NHS Direct, and the switch to non-clinical staff, not the rest of it.

    I would like to know why the NHS had a crisis in 2 quiet weeks. The statistics for the weeks ending 28/12/2014 and 4/1/2015 show that total attendances are lower than any other week since Feb 2014. Why wasn’t there a crisis in July and August 2014 when attendances were 10% higher?

  13. It isn’t immediately apparent that the 430,000 cases referred by 111 are an absolute increase, unless I’m missing something. 111 has referred that many people, but do we know:

    1) How many NHS direct referred in the matching period
    2) How many of the people (in the absence of 111) would have rocked up at A&E of their own volition.

    I’m minded to go with “President of the College of Emergency Medicine has axe to grind against outsourcing of NHS Direct” until proven otherwise.

  14. Question: which person or what agency bears the liability when no recommendation is made to seek emergency service, and the caller has a stroke, heart attack, or dies?

  15. “Can some one tell me why we are paying GPs £100K/yr NOT to provide an easily accessible 24/7 point of contact for the NHS?” Tony Blair.

    As for “why the crisis?” I offer two reasons. Our local teaching hospital has been wrestling for months with a bloody awful new computer system: the staff all say that it’s reduced the number of patient appointments that they can make. Secondly, shroud-waving: there’s an election coming up.

  16. “Can some one tell me why we are paying GPs £100K/yr NOT to provide an easily accessible 24/7 point of contact for the NHS?” Tony Blair.

    Single-payer law. Because no solicitor or barrister does anything worth more than minimum wage.

  17. I’m minded to go with “President of the College of Emergency Medicine has axe to grind against outsourcing of NHS Direct” until proven otherwise.

    CM does a decent job of fighting his corner, whatever your view of Consultants (mouth stuffed with gold, etc etc).

    As for the outsourcing of NHS Re-Direct: Harmoni (& by default, Care_UK), take a bow. Good job this Gov isn’t handing more contracts to them… oh.

  18. Natural instinct to Cover Your Arse.

    Person told to go to A&E, is fine – no consequences.
    Person is not told to go to A&E, drops dead, even if unrelated – front page news.

    You can understand why the person on the other end would refer. You can also understand why the idiots in Government did not understand this.

  19. I’m not entirely convinced by this bit……..

    “…emergency medicine experts said that when nurses handled calls on the helpline’s predecessor, NHS Direct, they had the experience to know when an A&E visit was not appropriate.”

    When I went to A&E a few years ago and said NHS Direct had sent me there I was greeted with “Oh God not another one, those ***** s know nowt…”

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