Should I Complain? NHS 111

[Lilwelshyrs]

I had a bit of a nasty fall off my horse yesterday. I hit my head, and skidded on my back. I honestly don't know exactly how I fell as no one saw it, but crucially, I was wearing a helmet, I didn't black out and there was no blood. I had to get up and get my horse - we were in a big field on our own.
I took the evening off of work and my DH was with me for the whole day.
This evening I went back to work and a few of my colleagues said I should probably go to A&E as I was complaining of a sore back and whip lash. As the end of work was only a few hours away and I managed to successfully commute into London, I figured I'd try NHS symptom checker. I would answer a few questions and then it would say the service was "currently unavailable".
So I thought, why not try 111?

I work in London but live in Sussex...
So I'm asked all the usual - home address, doc etc. Then the guy asked if I was safely at home to which I explained I was at work. He then asked me the usual questions - chest pain? No.
Hard of hearing? (Pardon?) No.
Loss of sight? No.
Then "have you had any neck pain?"... "Yes, and it's gotten worse since the fall".
He puts me on hold.
He asks me if my workplace is hard to access? I said no.
He puts me on hold.
He then comes back and tells me an "urgent ambulance" has been booked and is on its way...!

Eh?! What?! Why was I not asked? Am I about to be bundled into an ambulance like I'm some emergency case and then left in a London A&E which will have patients in far greater need of assistance than what I need?!
He never asked me about concussion or if I had blacked out upon impact of the fall, hadn't asked if I had felt nausous today and crucially hadn't asked if I was able to get myself to A&E (yet I had miraclously made it from Sussex to London without the need of assistance?!).
I thought 111 was to weedle out the non-emergency from the emergency? I felt he didn't ask me the right questions and I nearly wasted valuable ambulance services!

AIBU? Should I complain? Has anyone had this happen to them?!

FYI I am on the way to my local hospital which should be much quieter and will be assessed quickly with my DH in tow.

Ahem.

What should happen imo is that at that point he should have put you through to a triage nurse. If He was following his protocol he did nothing wrong but there is no harm in raising a query in to the protocol.

Maddening. They don't have triage nurses anymore, that was NHS direct. 111 can ask their supervisor (last time I heard they were going to be nurses) but they are not triaged or assessed as they were with nhsD. If the call handlers algorithm says call an ambulance they do.

111 is a very blunt instrument compared to NHS direct, and plenty of people didn't like nhsd either!

in December I called my dr out of hours - maybe it doesn't go through to the same place? anyway - I had a call handler who went through the list of questions - it said that I should go to a&e and when I queried it they got a nurse to call me back and she advised that she was a triage nurse who arranged an out of hours appointment with gp at the ooo clinic (in the hospital but at least it wasn't a&e on a friday night!)

Anyway my opinion is still that they should have a protocol that when the case is considered serious it should be escalated to a medical professional to decide the most appropriate course of action - surely it is more cost effective and would mean less stress on a&e.

Does sound odd only as in i have rang them before with chest pain, and had the option to refuse an ambulance (which I did), and then spoke to a doctor
BUT if you fall and have neck pain, you should be checked. If you rang 999 you would get an ambulance so same outcome whether 111 or 999
It's a bit different to tripping up and hurting your finger because it's a trauma and from a height

Making an assumption that I don't have medical training?

They do have trained professionals -nurses/paramedics or both.

They are recruiting for my local centre around 10 miles from me.

I worked for 111 fir a while. I was one of those dreadful call handlers.

I don't think you have anything g to complain about but there is a mechanism for complaints. They will listen to the call and look at the assessment.

And yes our service had banks of nurse practitioners, doctors and other health professionals.

In the vast majority if cases callers were transferred to a nurse after basic info taken or queued fir call back by a clinician.

They sent an ambulance to my house for an anal fissure. So embarrasing. I didn't even ask for one!

Rjae Your information is woefully out of date. NHS 111 call centre staff all have access to a nurse/doctor to support them if they are unsure. The contracts for each service actually set out the specific ratio of clinician to call handler staff and the last stats I saw for three different NHS 111 services had more clinicians available than specified by the contract.

NHS 111 uses the same type of triaging tools that NHS Direct used and the majority of ambulance services (in England anyway) use called NHS Pathways. There's a massive range of testing and conditional algorithms behind the advice or priority set for a call by a call handler en.m.wikipedia.org/wiki/NHS_Pathways.

It's a fact that nurses, paramedics and clinicians do not make good call handling staff. Taking down urgent information an prioritising a remote triage etc in very tense and emotional circumstances that call handlers do is a skill in itself that should not be rubbished. I certainly couldn't do it

My only experience of 111 was a good one - my son has occasional back problems and when it goes into spasm there is very little to be done except administer painkillers and wait it out. Unfortunately it happened whilst he was with us on a quick visit from uni and he'd forgotten his medication. I rang 111, explained that he needed urgent pain relief (11pm on a Fri night, typical).

I had a call back from a nurse who offered an ambulance to get him to A&E for it - I declined which they were fine with and I offered to go somewhere to collect the medication which couldn't be done as they couldn't prescribe without seeing the patient - fair enough. So they sent an OOH doctor out who was with us in a couple of hours, examined my son and gave him enough medication to get him through the night and a prescription for the following day.

We are in a rural area so maybe it makes a difference, but for us it was a good service - even when they were asking the irrelevant questions (is he bleeding, is he conscious) they apologised and explained they had to go through the list regardless.

OP just typed a detailed post about my crashing fall & subsequent horrendous NHS experience but deleted it as irrelevant really. Glad you're ok. Now to work on improving your seat & schooling the little blighter!

Ah well. The thing is, you called for medical advice/support. You could have just used a symptom checker but you asked someone to assess you amd at is very difficult over the phone. With or without medical training.
Erring on the side of caution is surely preferable to missing a potentially devastating injury.

The thing i would have learned from this would be to stay off the horse!

TheRealAmandaClarke nooooooooooooooooo!

I never said call handlers were rubbish, just that they don't have the medical training to deviate from their script. I also said they have access to medically trained staff as in supervisors. NHS direct had very effective call handlers too and the ratio call handlers to nurses was (at the time) higher. I believe now it is much lower and that was the plan when 111 took over because nhs direct was too expensive.

111 is more local so services are varied throughout the country and are locally commissioned. It's not a perfect service as the unwarranted ambulance calling out proves, but neither was NHS direct or any other out of hours service.

111 is great for out of hours general advice and making appointments, but I think it falls down on distinguishing between emergency needs and less acute problems. It's very difficult to telephone triage and always will be, that's why they err on the side of caution and it's why ambulances are called out inappropriately .

Huh? You could have broken your neck in the fall. The symptoms pointed to that. So he checked with someone and they said to get you in an ambulance ASAP to have it urgently checked out.
You would have something to complain about if you actually had a broken neck and the call handler told you to go home and rest and not visit a doctor or hospital.
Having said that, I really hope your are ok and that it isn't anything serious.

Honestly didn't think this would get over 100 comments lol.

If I wasn't on my own in a field with no mobile signal then yes, I might have said "hm, perhaps I will call for an ambulance", but I had no choice but to get up, go after my horse and get back onto the yard.

Again, as I keep saying, my point isn't that I felt they were wrong in calling me an ambulance, it's the fact that I wasn't warned this was going to be done!
I am allowed to refuse an ambulance and I did so at MY risk. I wanted advice - had the advice been to self medicate, then I'd have done that. I wasn't given advice, I was told an ambulance was coming.

And yes, getting schooling in the next few weeks! I'm taking him to my friends yard where they have a lovely school and having lessons for a week :)

Re: the list of questions.

Many people find this extremely irritating and I can understand that. An experienced call handler dealing with a caller can get through them in 2/3 minutes.
But you have to realise that there are many, many people who would not let us know about potentially life threatening symptoms unless they are asked about them. Honestly - people will phone because they have vomited but not mention the chest pain until you ask.

It's not a perfect system but it dies a good job for thousands of callers.

45,000 per day in December 2014

I used to work for the 111 service and although I have some medical knowledge as some of the call handlers/health advisors do (mainly from experience) there are plenty who do not and don't think about or know how to probe into symptoms properly. They are trained to completely follow and trust the questions that the system asks (which ALWAYS looks at the worst case scenario first and works its way back) and often a call handler will just go with the disposition that the system comes out with, even if it is a bit ridiculous.

As well as call handlers/health advisors, 111 also have on-site clinicians mainly made up of RGNs and if I had taken your call I'd have probably sought their advice before dispatching an ambulance (and definitely looked to ask a bit more in depth about your pain and what happened) although a clinician may well have said to get checked over by a paramedic anyway as then the responsibility falls on them (and clinicians tend to always be more cautious with neck/head injuries for fear of hemorrhaging in the brain or spinal cord damage from an injury).

While arguably it's no bad thing for someone to check you out where you happen to be to rule out serious injury I completely get that it's a waste of time to an extent because all the paramedic will do is offer to take you to A&E anyway. No need for an ambulance in my opinion at all but rest assured you wouldn't have taken away a service from a heart attack or stroke because the ambulance service would have downgraded that call when they received it.

I would also say, though, that common sense would dictate that you would get yourself checked over physically and I think you'd have been better served by actually going to A&E yourself as your friends suggested rather than ring a triage service who are only going to tell you to get checked over anyway!! If it was bothering you that much then surely common sense dictates you go and see someone?! But then I'm betting that a phonecall seems easier that spending a few hours in hospital ruling something out properly.....

In short, that call may well have been handled wrongly but to complain that a triage service offered a physical assessment for an injury that could potentially be serious, which is their job to do in fairness, seems silly to me especially when the sensible thing to do would be just to have saved yourself a phone call, applied a bit of common sense yourself, bit the bullet and just visited the hospital yourself in the first place.

...I was going to the hospital... Wanted some advice in case I was wasting time at my local A&E...

I'm not sure I understand why though, where else would you go to get assessed if not accident and emergency for an injury? Especially a head/neck injury?

(By the way I hope that you're feeling ok now!!! )