A crisis on NHS 111 has left vulnerable patients unable to get the help they need, while staff struggle to cope with the volume of calls, putting pressure on other overburdened areas of the emergency care system.
Staff say that as call numbers rise, their jobs have become like “working in a sweatshop,” with targets for call numbers that come before patient safety.
Over the weekend there was a spike in calls to 111 regarding symptoms of strep A following the deaths of seven children in the UK, staff said. The independent.
Dr Adrian Boyle, president of the Royal College of Emergency Medicine, warned that a lack of clinical staff on NHS 111 means call managers are more likely to refer patients to emergency departments.
He said the independent that non-clinical staff “rightly err on the side of caution and may often direct patients to the only service available at the time: A&E.”
Dr Boyle added that NHS 111’s online services were “poorly assessed” and “risk averse” adding: “NHS England is in a difficult position due to the health service’s historical and long-standing lack of resources, but 111 is not going to be your savior. Illusions that patients should or can go elsewhere should not be government policy.”
Leaked emails viewed by the independent from NHS 111 in London reveal that the service has been at the highest level of pressure for weeks, with a source saying that almost 800 patients have been left in long queues to return calls over a weekend.
NHS 111 is supposed to protect 999 and A&E call centers by directing patients without emergency needs to other services, but figures show that almost one in six callers give up before reaching an operator. Some who manage to get through have to wait more than 12 hours for a call back, which should take a few minutes.
An email sent in November asked staff in charge to send patients who needed a call from a doctor to the nearest urgent care or urgent care center instead of putting them in a line.
He also asked staff to flag patients facing a 12- and 24-hour call to their GP for Monday, pharmacy or the ER if their symptoms worsen.
He told call handlers: “It’s extremely important that we’re using other services to make sure we’re not putting any extra pressure on our [Clinical Assessment Service] tail.”
In another email sent this month, managers said the service was “extremely overwhelmed” and warned staff not to place patients who need primary care advice in the clinical assessment service queue unless urgent.
A call handler said the independent: “The pressure is very high, we answer call after call, it is an endless process. Patients are not happy because they don’t get their callbacks on time and they keep calling.
“It’s a clandestine workshop…[Managers] it only matters the number of calls we have taken per hour and the focus on the duration of the calls. Patient safety is out of the window…it’s completely ignored.”
They said even priority one and two patients, who should get calls in 15-30 minutes, are waiting hours.
It comes as NHS 111 staff, typically among the lowest paid grades for the health service, will join thousands of ambulance and health care staff in striking before Christmas.
Rachel Harrison of the GMB union said call managers were facing “overwhelming demand”.
Meanwhile, at A&E, the latest data uncovered by the independent reveals that 183,000 patients had to wait more than 12 hours to be admitted to a ward in October, up from 143,000 the previous month. NHS sources said they were concerned this month that number could exceed 200,000.
Mathew Westhrope, manager of NHS 111 in the east of England, said there was no point in having more call controllers to help patients if there were no services to direct them to.
He added: “111 is on the front line, it is the point of contact for the majority of the patient population… We run a signaling service and we are trying to get people to the right places, but the reality is that there is no longer there are enough places for demand. When services (like GP services) shut down, that puts more pressure on 111. So out of hours absolutely becomes the kind of hotspot.”
999 emergency call centers are also being pushed to the limit as internal NHS data, seen by the independentreveals that nearly 100,000 calls took more than two minutes to answer, should take up to 60 seconds, with demand skyrocketing to nearly a million calls.
The UK’s Health Security Agency sent out a scarlet fever alert on Friday following the deaths of children, amid a four-fold increase in infection.
Parents are told to contact NHS 111 or GP services early if they suspect children have scarlet fever, as early treatment is important to avoid worse conditions, such as sepsis.
Westhrope continued: “There has been a large increase in overall demand for [over the last week]a significant proportion of the cases I have treated have been of poor children and one of them was a confirmed case of scarlet fever.”
“Given that we’re dealing with sort of ongoing concerns about COVID, increasing concerns about strep A/scarlet fever and everything else that was around before that, then you know, people aren’t going to feel well this winter and I’m worried that they won’t let’s go give all the attention to all the people all the time because it’s just not practical.”
Another NHS 111 call manager said over the weekend that they had seen a spike in calls related to strep A symptoms, with numerous callers mentioning warnings made in the news.
One mother, Holly Ramsey, said the independent in late November, she waited 12 hours for a call back to her children, who were then treated with antibiotics for suspected strep A.
Ms Ramsey had to go to NHS 111 online and ask to be called back after calling NHS 111 to be told there was a high demand for calls.
But the automated online service, which looks at symptoms you’ve entered, directed the mother-of-three to A&E, which she said she knew was too “drastic”.
After contacting NHS 111, she had to wait 12 hours to be called for advice about her six-year-old twins, and a further 12 hours when her five-month-old daughter also showed symptoms.
She got a GP appointment for the next day, at which point they were given antibiotics as the doctors suspected scarlet fever, but then Holly fell ill and had to wait another 17 hours for a call back.
Ms Ramsey said: “What really bothered me is if I hadn’t had my mother helping me and a husband, with the kids, I don’t know what I would have done. She was so sick that she couldn’t get out of bed and she couldn’t even speak because of the pain in her throat. It’s horrible knowing that they don’t return that call.”
Dr Boyle said NHS 111’s online services were “poorly assessed” and “risk adverse” adding: “NHS England is in a difficult position due to historical and longstanding shortages of health service resources, but 111 is not going to be your savior.” . Illusions that patients should or can go elsewhere should not be government policy.”
NHS England said: “The NHS in London, like across the country, has been under great pressure this autumn, with recent figures showing there were over 235,000 calls to NHS 111 in the month of October.
“However, there are measures in place to increase capacity and we have prepared for winter like never before, expanding the use of 24/7 control centers throughout the capital for urgent and emergency care and recruiting additional 111 call operators. ”.
NHS England recently launched a campaign to get the public to make more use of 111 Online, saying hundreds of call managers were being recruited.
DHSC and the London Ambulance Service have been contacted for comment.