A leading specialist on the health of children has queried the effectiveness, and indeed safety, of the NHS 111 helpline for young children in particular.
The Royal College of Paediatrics and Child Health president Prof Neena Modi has suggested that the system is fundamentally inadequate, as staff received insufficient training in order to carry out duties effectively.
Modi is of the belief that it would be extremely difficult for qualified doctors to assess small children by telephone calls alone, let alone members of the public with no formal medical training.
NHS England acknowledged the importance of thorough training but stated that the royal colleges helped produce the protocols.
Yet reports have flooded in from throughout the health service indicating mistakes that have been made by NHS 111 services and employees.
In particular, a report published just last month by NHS England indicated that the service led to numerous chances being missed to save a 12-month-old child, William Mead, from Cornwall, who ultimately died due to blood poisoning.
Untrained staff on the NHS 111 service had failed to recognise the importance and seriousness of a chest infection and ultimately failed to refer Mead appropriately.
NHS England has said call handlers for the 111 service should be trained on how to recognise a complex call and when to call in clinical advice earlier.
Commenting on every issue, the aforementioned Modi stated her scepticism about the NHS 111 service, and particularly questioned its ability to deal with the health complaints of younger children.
“It is uncertain – because studies have not been adequately conducted – whether or not the telephone triage service, such as NHS 111, is really going to be safe and effective for very small children. Even a clinician trying to make an assessment over the telephone would find it much more difficult in a smaller child than in an older child. Then when you add in the lack of clinical expertise, it’s going to be even more difficult.”
Modi also expressed her empathy with the position that people staffing the NHS 111 service find themselves in, placing the emphasis firmly on the authority to tackle the problem.
“I feel really sorry for the call handlers because they are being placed in a position that really it’s questionable that they should be placed in.”
The Conservative-Liberal Democrat coalition government proposed that NHS 111 could replace the existing NHS Direct telephone helpline in England back in August 2010.
This suggestion proved controversial as it was seen by some critics as a “cut-price” replacement, due to likely replacement of NHS Direct with NHS 111 telephone advisors lacking professional training in healthcare.
NHS England responded by stating that the 111 clinical protocols had been designed “with and by the medical royal colleges, including her own”.
“It’s important all staff working in children’s services, primary care, NHS 111 and out-of-hours GP services are trained in the latest sepsis guidance regularly. We’re also ensuring when people call NHS 111 they are supported by a wider range of doctors, nurses and other clinical staff, thereby improving around-the-clock care,” the organisation added.
Following problems with the NHS Direct helpline, the NHS has been forced to pay out over £1 million in compensation.
Patients were given poor advice by operators on the helpline, which has since been scrapped.
This resulted in numerous successful legal actions being carried out, with one particularly unfortunate case grabbing headline attention.
One unfortunate patient has a testicle needlessly removed owing to incorrect advice proffered by the now defunct helpline.
Investigations have revealed that in almost all of the cases NHS Direct accepted that there was either a failure to properly diagnose symptoms and illnesses, or a delay in advising people to seek hospital treatment.
Other serious incidents related to false advice included a patient being permanently blinded, while further victims were left in unnecessary pain, with numerous individuals requiring subsequent operations to correct damage.
Perhaps the most dramatic case of all was related to the brain of an unfortunate NHS customer.
The patient suffered life-altering brain damage because they did not receive treatment quickly enough.
In total, the NHS has paid out £1.4million on 13 cases where it has accepted a patient was given negligent advice over the last four years.
And this figure is expected to increase further still, owing to the length of time that it has taken to resolve some of the complex legal cases necessitated by this problem.
Campaign groups including Patient Concern said the failures were due to the NHS trying to save £22 billion on government orders.
There have also been accusations from critics that the NHS is essentially dumbing its services down by significantly cutting staff numbers.
The Government has scrapped the NHS direct service and introduced the 111 number for less urgent cases, with this new system intended to improve the service to patients.
Commenting on the issue, a spokesman indicated the belief of the NHS that the new service had offered significant improvements over the previous system.
“Every effort is made to ensure that patients receive appropriate clinical advice, improving the healthcare options for millions of people around the country. The NHS 111 number is playing a major part in helping reduce pressures on other parts of the national healthcare system. It is high quality, robust and safe.”
Earlier this year, media reports indicated that over 100 call centres were facing major organisational problems.
It is increasingly clear that staff shortages are central to these difficulties, with only one nurse left to cover an area of 2.3million people on one occasion.