A helpline in crisis and doctors who refuse to put patients’ interests above their own
Published in The Daily Mail (May 6th, 2013)
For weeks there have been many stories emerging of patients left hanging on the phone, fearful or in pain; urgent calls going unanswered; ambulances rushing off on wild goose chases; and paramedics dispatched to treat the most minor ailments.
Now we have the heart- rending saga of Kim Green, who waited on the line for the best part of an hour as she sought help for her dying husband, unable to provide pain relief as spasms racked his cancer-ridden body.
Her tragic tale highlights in the most horrendous way possible the scale of the problems caused by the botched launch of the National Health Service’s 111 helpline.
Mrs Green is right to be angry. The agony of those awful minutes must add terribly to the burden on this brave widow from Buckinghamshire as she prepares to bury her husband this week.
Sadly, her case is just one among many. For although this service has been running for only a few weeks and is still to be fully rolled out across the country, it has already emerged that three patients may have died due to its failings.
A further 19 cases involving poor care are being investigated — and there are widespread fears these are just the tip of the iceberg. Many more may emerge after this Bank Holiday weekend, with GP surgeries closed for three days.
The horror stories over the chaotic new service, largely manned by the sort of scarcely trained call centre staff who might just as easily be answering car insurance queries as matters of life and death, are the latest bad news to afflict the increasingly sickly NHS.
Indeed, this crisis encapsulates all the problems we have come to associate with our embattled health service: poor management, overstretched resources and patients desperate for competent care falling victim to bungling and topsy-turvy priorities.
The 111 call-line was intended to ease soaring pressure on Accident and Emergency units: a free 24-hour number for patients with urgent — but not life-threatening — symptoms.
Instead, the service — which is being offered by a hotchpotch of providers, including private firms, ambulance services and remnants of the old NHS Direct — has been plagued with problems.
This has caused an outcry from patients sick and tired of a system that seems designed to make seeing a doctor face-to-face ever more difficult.
Seven of the 46 services are not yet operational; others have been suspended or hastily bailed out by other parts of the NHS.
More than a quarter of the contracts for the 111 lines were awarded to a private health care provider called Harmoni, which has already been criticised by a coroner for the ‘wholly inadequate’ actions of an out-of-hours doctor in relation to a seven-week-old baby who died of pneumonia.
Others who have used Harmoni’s services have complained of being fobbed off or made to wait as they desperately tried to get medical advice.
Despite widespread concerns over the launch of the 111 service, Sir David Nicholson — the shamed NHS chief who should have been sacked over the Mid-Staffordshire scandal — ignored pleas to delay the roll-out. He later admitted he had again ‘let patients down’ by not intervening.
Astonishingly, more than eight out of ten of the people answering the phones to worried patients have no medical training, while computer systems have repeatedly crashed.
Ambulance crews in some areas say workloads have doubled because so many calls are wrongly flagged up as emergencies. One team in the South-West rushed out to be confronted by a case of hiccups; another by a cat with diarrhoea.
Such absurd incidents sound almost amusing — yet this could not be further from a laughing matter, with doctors warning that lives are being put at risk as heavily stretched services come under even greater strain.
The medical unions are right to raise the alarm over the shambolic introduction of this shockingly inept service.
Yet this is a symptom of a far deeper ailment in the health service — and doctors cannot avoid their share of the blame. For at the root of it all is the selfish zeal with which they ditched the old-fashioned approach of family practices offering round-the-clock care to patients.
The saga began with the disastrous deal Labour ministers struck with GPs nine years ago that, incredibly, saw them earning more than before in return for working fewer hours.
This new contract allowed GPs to stop treating patients outside office hours, in return for a supposed £6,000 salary cut. Nine out of ten family doctors instantly stopped providing emergency cover — yet average pay rose by one-third thanks to various simple targets they were set.
As a result of this ridiculous offer, Britain has the world’s best-paid GPs, earning average salaries of more than £100,000. Yet four million more patients are using hospital A&E services each year.
This flooding of hospital emergency units is the single biggest operational challenge for the cash-strapped NHS.
Much of the upsurge has come from worried parents who are being denied access to their GPs or who are reluctant to rely on locums who have no knowledge of their family and are possibly from abroad.
Little wonder that emergency hospital admissions of under-fives jumped more than 50 per cent over the past decade.
According to one recent study, that represents a ‘systemic failure in the NHS’ — and certainly, few children today enjoy the security so many of us had as youngsters of being cared for by a friendly face when sick at night.
But the biggest pressure on A&E units comes from those patients with long-term conditions associated with ageing, such as diabetes, dementia and heart problems, who account for more than two-thirds of health spending.
These are the old and disabled who always bear the brunt of failure in the health system. They would be far better dealt with by community doctors familiar with their cases, rather than patched up in the frenetic emergency departments of hospitals — let alone relying for help on unskilled call centre workers at the end of a 111 phone line.
The harsh truth is that amid the whirlwind of health service reforms in recent years, doctors have put their own interests above those of their patients — and daily we suffer the consequences.
Even the NHS’s deputy medical director admits GPs should never have given up responsibility for out-of- hours care.
It is impossible to turn back the clock to the days of Dr Finlay, when a single phone call would have seen a GP arriving at your door. But — despite presiding over the present shambles — the Coalition Government does seem determined to force doctors to resume having overall responsibility for their patients at all times.
This, after all, is in keeping with the logic of its controversial reforms of NHS bureaucracy, which hand GPs more control over health spending.
The Government has already begun the process of reversing Labour’s bungling with the launch of a review into out-of-hours services.
Ministers tell me they can’t afford to cave in on this issue because otherwise hospitals will simply be swamped with patients — most of whom should be dealt with at community level — when they do not have the resources to deal with them.
In the meantime, the Government must move fast to fix the lamentable launch of the 111 helpline and to make sure that the NHS is never again shamed by someone left hanging on the phone for help while their dying spouse suffers in agony.