111 failed to diagnose

[Shedidnt]

www.mirror.co.uk/news/uk-news/calls-nhs-111-helpline-probe-21216411?fbclid=IwAR3SMrfs8ptX0YbrlJozTL_PyeRzd2f6ijkqZsg_7P3EFkEi3F3Psbg2aAg

Am I correct in thinking that the warnings we are all given about not going to A&E needlessly is the cause of these deaths, and we're dealing with Joe Soaps and their questionnaires on 111 rather than trusting our own judgment?

Personally I feel that 111 is a useless service. I've had experiences where I've needlessly been sent an ambulance, and also cases where they found feck all wrong and said to make a GP appointment, where I ended up in Resus an hour later.

There is no perfect system and sadly, some rare cases will be victims of it. You could argue that without 111, there would be thousand of extra cases showing up at A&E, which would put a lot of pressure on it, creating even longer times, stress on the staff, and that too would result in misdiagnosis and people dying as a result.

I do tend to agree though about the reliance on strangers rather than our own. Sadly, some people will think that with a fever of 38.5 and a cough, they are dying and need urgent care, whilst others will believe that with a fever of 42 and spitting blood is not an emergency and worthy of just waiting at home to see it better. It's the former that put pressure on the system, but no matter how you tell these people that they don't need urgent care, they will not listen.

These deaths are tragic. However, the numbers are relatively small within the 111 system. When it comes to life and death situations unfortunately misdiagnosis can happen whether that is face to face or not. As NHS blaming articles about people sent home are generally all the rage for the Mirror anyway.

But congratulations on enjoying swallowing the point of the article which is to fling hate at people doing their public sector job. This is just one of the many we get to see whilst the media tries to convince everyone paying for healthcare will be better so we ought to look forward to no NHS like good little citizens.

I think that when it comes to medical care, you should only have medics involved.
If you trust 111, you're going to take the result of their algorithm as gospel.
I'd trust my mother or father more than I'd trust 111.

111 was better when a medically trained person answered the phone (nurse etc) rather than the decision tree nonsense). If I suspect one of the kids needs A&E I will answer their questions so as to get the decision I want them to make. But I bet quite a few actual emergencies do slip through the net (thinking of sepsis and how temperature drops create a false sense of recovery)

YANBU in my opinion. I’ve had cause to use 111 several times in the last year (whilst carer for a seriously ill relative) and had similar experiences to you. I’m sure People have good experiences too, when the 111 service has identified medical emergencies etc, but for most people I believe it is just another barrier they need to negotiate before they can access medical care. I wonder how the elderly, vulnerable and confused negotiate these systems when they have no one to advocate for them.

I work for them (as a Joe soap) but where I work we're part of the Ambulance Service and there hasn't been any big stories like this where we've failed to recognise warning signs thank god.

We always tell people we can't diagnose anyway, we can only advise based on what people tell us.

I sort of agree with you. Advising people over the phone using computer algorithms is always going to be problematic. Where I work we don't have pathways, our system is way more blunt and less sophisticated BUT this actually works in our favour I think. We are actively encouraged to seek advice from senior nurses who are floor walking if we don't think the outcome is right. There is another senior nurse looking at each record that is queued for advice so they can change the outcome if they think it's wrong.

I'm not sure what we would replace 111 with really though. Take away the advice element of it and let people make their own judgements? In terms of out of hours, have receptionists like the GPS where you just try and get an appt? It would certainly be safer if we had nurses front ending the calls.

I rang 111 for dd once. The got a nurse to ring back. Who after further questions said she needed a doctor to ring me back.

The doctor never rang back.

I emailed 111 the next day and complained. They investigated and said they had no record of me ringing so couldn’t do anything. Which is bonkers that there was no record because the nurse rang me back at one point.

I’ve no faith in them.

The thing is that people die from mis-diagnosis when they are seen by a GP or even in hospital, no system is completely safe. It would be incredibly expensive to have every 111 call taken by a clinician and frankly there aren't enough around for that to even be a possibility. Obviously these are heartbreaking cases but the same things happen in all parts of the health care sector.

BTW there are definitely not enough doctors available to take these calls the volumes are massive. Some of it is caused by issues in primary care when people can't see a GP and things escalate, unfortunately the whole system is under massive pressure.

@Mascarponeandwine

If I suspect one of the kids needs A&E I will answer their questions so as to get the decision I want them to make

why do you even bother calling? Just go straight to A&E if that's what you've already decided to do

It shouldn't exist in the first place.
You should have out-of-hours GPs and A&E or you GP.
This 111 nonsense does not exist in any other country that I'm aware of - happy to be corrected.

I phoned them when my then toddler daughter was ill.
Serious heart condition
Horrendous vomiting and diarrhoea (she has rotavirus)
Listless and difficult to rouse

They said they’d get someone to phone us back and just never bothered.

She’d been in A&E the day before and not admitted, they told us just to carry on trying to get dioralyte into her.

Eventually after a couple hours we managed to get someone from the GP surgery to do a home visit. He told us to take her back to A&E immediately, she was admitted to high dependency. My mum spoke to the GP a few months later and he said he didn’t think she would make it when he saw us at home, I’m so grateful he came out to see her.
111 never phoned us back.

I think 111 is a pretty useful service. They’ve made me a GP appt when I wasnt sure I needed one (and wouldn’t have been able to get one myself). They have also sent an ambulance for my baby, who really didn’t need one and resulted in an ambulance journey to A&E and a 4 hour wait until 3am. There is an element of them having to cover their arses which is a bit of a floor to the system.

That the system is under massive pressure is no excuse. Bin 111 altogether.

Those stories are absolutely devastating, and I agree that they should provoke investigation and a potential review of the system. However, on the few occasions that I have used 111, I have found them to be extremely helpful. I think that issues can be found at any point in the system - I once took my son to a walk-in centre, because we were worried about his breathing, and just wanted someone to check his SATs (he has asthma), but didn't want to use A&E unnecessarily. The receptionist told us that nobody would even examine him for at least three hours - no triage. So we went to A&E, and were seen very quickly. That doesn't mean that walk-in centres are no use, just that this particular centre wasn't useful in this case.

I do agree though, that 111 is far more effective when you speak with a trained professional, rather than someone following a questionnaire form.

I've actually found 111 pretty good most of the time.

We used it this weekend when our GP surgery told us DS couldn't get an appt because we phoned after the morning triage (hadn't realised an appt was needed at that point). We now have a 2nd line antibiotic for him. .

We've never had anything serious, but we normally get an appt at OOH's and come away with antibiotics.

As an appointment service, I have no issue. What I have issue with is them not being qualified to diagnose.

@Violetroselily because 111 can let children’s A&E know you’re on the way and it makes the wait shorter (in this county anyway)

@Shedidnt 111 is a gateway service to actually get an out of hours gp appointment made for you. However if their decision tree says you don’t need a gp appointment you’re stuffed.

Sexnotgender, clearly you should have had a call back and something went wrong there but I am surprised you didn't ring your surgery as a first port of call with a very poorly toddler who has health conditions. 111 were only ever going to be able to get you advice and she clearly sounded like she needed to be seen.

I agree with don't disturb, it's amazing how many people call thinking they need an ooh gp for things that could clearly wait. I know our nurses take a huge amount of pressure off by giving them more appropriate advice.

If I felt my child needed an appt with a Dr and then I couldn't get one through 111 then I would go to A&E.

I don't say that lightly. If it were antibiotics for an ear infection for instance then I would try and wait. And manage pain etc.

I have gone to my GP and just from a physical examination she knew that I needed A&E. All I had was abdominal pain. But she knew from where the pain was, that it wasn't something simple. An algorithm can never compensate for that. That's a GP with a physical examination, seeing you, hearing what your problem is and drawing on their 10 years of university and however many years experience. I think it's criminal that we accept the result of an algorithm.

But we can't see a GP!!!!

That's not going to change. If anything it will get worse due to the choices people have made.