Health | The Guardian
The NHS 111 screening service was supposed to be our first line of defence. Already at breaking point prior to the pandemic, it has now been overwhelmed. In the first few weeks, too many people were unable to get NHS help, and consigned to suffer alone. If we want a safe and robust screening service in future, any future inquiry must surely learn lessons and lead also to a fundamental overhaul of 111.
Before NHS 111 was set up and before I became an MP, I used to work in an out-of-hours call centre. I understand just how stressful and demanding the job is for operators. And with allegations of inadequate social distancing and insufficient sick pay in NHS 111 call centres, it is clear just how hard the working conditions are.
That is why the right training and clinical oversight is so important. Even prior to the pandemic, operators could earn as little as £9 an hour and receive as little as six weeks of training. In the media, whistleblowers told of call centres without the nurses or GPs present to provide the right clinical oversight. Operators with only limited training were effectively left to make clinical decisions.
Before Covid-19, NHS 111 had already been linked to safety failings resulting in over 20 deaths. Horror stories include the death of two-year-old Myla Devirin, misdiagnosed with a stomach bug. At the same time, too many patients were also being referred unnecessarily to already overstretched A&E departments, making it harder for other critically ill patients to be seen. Since replacing NHS Direct in 2014, 111 has been outsourced to different providers, and been hit hard by a decade of NHS underfunding and privatisation.
To some, it was little surprise that when Covid-19 struck, NHS 111 simply couldn’t cope. In the first weeks, traditional and social media was awash with anecdotes of patients who simply couldn’t get through, even after hours on hold. The public had been told to avoid GPs’ surgeries and hospitals, leaving 111 or 999 as their only options. Waiting and callback times reportedly soared, and confusion reigned about the circumstances in which patients with Covid-19 symptoms should even call the service.
At the start of 2020, I warned of an impending crisis in the 111 service, and put forward to parliament a private members’ bill to legislate for better training and clinical oversight in call centres. That bill could be read in September.
The focus today is on muddling through the crisis, not justice. To be fair, the government has scaled up 111’s capacity as the pandemic has proceeded, as well as opening some specialist walk-in centres for symptomatic patients. Some rightly argue that 111 was never designed to serve as our first line of defence against a pandemic.
Why then did the government decide to make NHS 111 the public’s first and only point of entry into our national health service during Covid-19? In Britain’s hour of need, the screening service seemed to fail. The public could not reliably access medical help through the channels they were told to use. As a 111 nurse anonymously wrote: “for the first time in my 30 years of nursing experience … I genuinely fear that the NHS may not be on the winning side”.
We still do not know how many patients with Covid-19 symptoms tried to call 111 and failed to get through, or how long they had to wait. We do not know how many died, how many were delayed treatment, or how many patients suffered the virus at home alone without ever receiving a word of medical advice from the healthcare system that their taxes pay for.
The failure of 111 has doubtless aided the spread of the virus. We all live now with the heart-wrenching cost. Just this week, a care home insider in my constituency wrote to tell me that the care home he looks after has seen 11 residents and two staff members die.
An independent inquiry into the government’s handling of Covid-19, when it inevitably comes, will surely investigate the issues of preparedness, PPE provision, testing and critical care capacity. But if the British public are to have the safe and accessible screening service they deserve in future, that inquiry must also surely examine closely why NHS 111 was so overwhelmed, and what reforms are needed to make it fit for the future.
• Kate Osamor is the Labour MP for Edmonton
April 23, 2020 at 02:42PM Kate Osamor