A catalogue of blunders relating to the NHS 111 computer system are being linked to at least one death each month, The Daily Telegraph can disclose.
One a month. There’s 40 odd thousand deaths a month in the UK. Depending upon who you believe iatrogenic (ie, fuck ups in treatment) deaths are 5% to 25% of the total.
If 111 is only killing one a month then they;’re doing rather well.
If 111 is only killing one a month then they;’re doing rather well.
If. I doubt it is. I expect it is killing more. But if it isn’t, it proves the old military rule that you can kill other people in cruel and unnatural ways; you just can’t kill them in new cruel and unnatural ways.
The old fashioned doctor incompetence/alcoholism/sleepiness is clearly fine. Computers? Not so much.
It really depends what the problem is.
See, I don’t mind 1 person a month dying. Doctors fuck up far more often than that. I do mind that there’s a “catalogue of errors” when the state pays gold-plated prices for software.
I’ve worked on systems (mostly in the security area) that have no known bugs. Maybe there are bugs in there, but we built it to be bug free, tested everything we could think of, passed it to testers who found nothing, and then had a few live bugs that got fixed and fairly quickly reached the point of having nothing to address. And stayed that way for a very long time. It’s expensive, but when people throw around numbers in the tens of millions for say, a call centre system, that’s what you should get.
Judging by the story, it’s not really a software issue. The problem is that the “highly-trained advisers” operating the system are actually call-centre staff with no clinical background, paid barely above minimum wage.
In our experience they take a lot of time questioning you and then recommend you go off to A&E anyway.
You can trace the current malaise in the NHS, especially A&E, right back to the Labour decision to let GPs off out of hours service. If you’re ill, not falling down dead call an ambulance ill, but seriously ill that if its not treated correctly soon you may well be dead or have serious health implications, and you are out of the normal GP hours (or even in them but close to the cut off, as I discovered with my father recently, the GP refused to come and visit him as it was too close to her leaving time) then you have two options – do nothing and pray, or go to A&E. Out of hours service is useless. Might help if you have flu or toothache, but for anything serious all they’ll do is say to either call an ambulance or go to A&E if you can get there yourself. Hence the stress on both of those services.
So all the serious long term conditions that GPs used to manage and treat in the home, and prescribe drugs for themselves, are now ending up at A&E if they have a crisis out of office hours. Which happens a lot. The system has been fucked so that female GPs can go home at 6pm and not be ‘on call’ the way GPs used to be when they were predominantly men, and the male doctors can play golf at weekends without ever having to think about their patients.
GPs have gone from people who were in their profession as a calling to help people, at whatever time of day that happened to be, to office drones who show up at set times, collect their bulging pay packets, and think nothing of their patients when out of the surgery, indeed they have no patients that they see regularly, just random people who are registered to that surgery but have no fixed doctor. My Grandfather was a GP from the 40s to the 80s, and he ran a practice with one other partner, at any given time he or his partner were on call. 24/7/365. No days off. He would have known every patient and their history.
Well done John Reid you fucked 65 million people up the arse. Thats pretty impressive, even for a Socialist.
If I was an enterprising doctor I’d be setting up as a private GP. Fixed fee, say £100/month (more if you have existing serious health issues), gets you a personal doctor. Will come to your house at any time of day if needed (extra fee for night visits to deter time wasters). Private prescriptions, the full personal service, just like doctors used to be. You’d be coining it in. Work like a dog for 10-15 years, retire a millionaire.
Social Justice Warrior,
That’s not a problem at all. That’s precisely what you want with any diagnostic process. You filter out low level crap that can be dealt with without using experts. “I’ve taken too much arnica” is “no, you’ll be just fine”. You can train a monkey to say that to someone. That also means that you free up money to pay for more skilled resources, and that’s something that this sort of report can never tell you – with that saving, how many lives were saved that wouldn’t have been?
On top of that, reading the article in more detail, these are human errors, diagnostic errors, and I can tell you personally that I have experience with this right up to specialist level – an ENT that wrongly diagnosed what was causing my illness. Patients die all the time because nurses give the wrong dose of a medicine (which is why in America, hospitals frequently have robots doing dispensing).
dearieme,
NHS Direct was one of those times where the state did something that echoes the private sector, with no idea of WHY the private sector did it. “Oh, insurance companies have call centres instead of branch offices, let’s do that with the NHS” without understanding that insurance companies could do that and that it massively reduced staffing (as you don’t have people sitting around waiting for customers).
It was counterproductive. You take nurses who do a lot of the stuff they do by being physically present with the patient and put them behind a phone. They couldn’t look at the complaint, so had to refer them to A&E, where they’d then see another nurse.
111 might work, because at least you can use non-nurses. That said, some of it is still about looking at a patient, measuring a temperature etc. We’d probably do better to spend money on home diagnostic equipment that people could plug themselves into that would tell them what to do.
That’s not a problem at all. That’s precisely what you want with any diagnostic process. You filter out low level crap that can be dealt with without using experts…
I’m surprised that you say that, because it’s apparent from the story that it’s precisely the problem. Automated diagnosis of non-urgent problems by unskilled staff works fine most of the them. About once a month it fails fatally, because the unskilled staff don’t recognise that this one is actually an emergency.
I suspect that the system would work better if there were more medical staff on hand for the “advisers” to consult when in doubt. But there aren’t, because they cost money, and so would reduce the profits of the companies running the service.
‘the call handler focused on the patient’s diabetes rather than their breathlessness.’
DAMN SYSTEM
‘A patient in the South region died from severe respiratory distress a week after contact with 111, during which the logs state a call handler inputted the wrong answer into Pathways.’
HOW COME THE DAMN SYSTEM DIDN’T KNOW THAT AND GIVE THE RIGHT ANSWER?
‘During a separate call in the Midlands and East, selecting the incorrect option meant the computer system did not prompt the call handler to provide instructions to the caller to carry out CPR on the patient.’
WHAT A STUPID SYSTEM
Surreal. The system gave them what they asked for, instead of what they should have asked for. How you gonna fix that ?!?!
“I’m surprised that you say that, because it’s apparent from the story that it’s precisely the problem. Automated diagnosis of non-urgent problems by unskilled staff works fine most of the them. About once a month it fails fatally, because the unskilled staff don’t recognise that this one is actually an emergency.”
And doctors never do that, right? Well, yes, they do.
Personally, I wouldn’t be surprised if a barely skilled human operator with good software wouldn’t outperform a clinician, or do nearly as well as a clinician with software. Doctors know what questions to ask and what the diagnosis is a result, so why not record that? Have a team of clinical experts distilling all of that and sharing it.
“About once a month it fails fatally, because the unskilled staff don’t recognise that this one is actually an emergency.”
And doctors actually know very much?
My father is in a nursing home and (thanks to a series of incompetent/uncaring, take your pick, medical staff) has a very nasty open sore on his foot, which has gotten progressively worse.The GP covering his nursing home eventually deigned to come and look at it the other day, having blankly refused the previous week, as I think he considered it was beneath him, and was overheard admitting to the staff nurse that ‘I don’t really know much about these sort of things’. The GP then proceeded to lie to my mother, telling her he’d arrange an appointment at the chiropody clinic for a week later (in itself an inexcusable wait), when in reality he arranged it for 2 weeks later. And didn’t tell them it was at all urgent, so they just thought it was a routine appointment. It was only because my mother kicked up a fuss that they agreed to bring it forward.
GPs – I wouldn’t piss on them if they were on fire. Arrogant jumped up pricks (or bitches, depending on the gender). I’ve yet to meet one who didn’t act like you were something unmentionable he’d stood in.
111 is a transition. It won’t be long before its all done by AI and apps on our smart phones.
@stigler
It’s been tried and is still being tried, not surprisingly the doctors haven’t been very cooperative and their status in the health service means complaints about lack of participation don’t go anywhere