Aibu: 111 being the gatekeeper for a&e will result in deaths.

[MrsHookey]

Proposals are in place to ensure that A&E appointments will be made through 111 going forward. AIBU to think this is a disaster and many additional deaths waiting to happen? Their algorithms are not up to clinical nuances, diverse people, disabilities etc. www.theguardian.com/news/audio/2020/sep/28/did-the-nhs-covid-helpline-fail-hundreds-of-families

Yep !
I remember back in March I had to call an ambulance for DD7 and it took forever to get through the whole she hasn’t for covid situation and then 1 hour and 45 minutes for someone to come to a child going septic.

YANBU.

I've not read the article but I heard it mentioned on the radio last week, with the suggestion that A&E will become an appointment only service. It's ridiculous. A&E is emergency/unscheduled care, people can't plan when to have their heart attacks, strokes, cardiac arrests or acute abdo pain.

I did wonder how it would be managed, I'd assumed people would phone A&E and be triaged and then told whether to come in, go to their local pharmacy, conract the GP etc. That would have been bad enough but at least there would have been emergency clinicians triaging. For 111 though, with non-clinically trained personnel to be taking that call and making that decision is a disaster. Either everyone is going to be advised to attend A&E or they're not going to ask the right questions and acutely unwell patients are going to be left at home, unable to self present to A&E.

The trial plan is to have life-threatening conditions go to A&E directly. Then 111 for non life-threatening conditions. Patients that turn up at A&E without an appointment will be seen, but likely after those who have appointments. Having said that, if someone turns up in a dodgy state without an appointment, they'll still be whisked through!!

I think it may help, if capacity on the phones is increased.

Scares me. I have spent my whole life healthy, not so much as a cold and even as a kid my parents never took me to the hospital. For me to visit a doctor things would have to be BAD but a couple if years back I got sepsis and remember calling 111 thinking it was flu to begin with. The call taker was great and their job is immeasurably hard but they could only tell so much over the phone. I didn't even know what was happening to me and I was telling them my medical history which was of a healthy young woman in her twenties. When I called back after after first call I felt a bit of a nuisiance but had this feeling of impending doom, the only time I've ever felt it and I knew I was really unwell and should be worried. I was rapidly getting so much more unwell. Not sure what happened after as I didn't make it through the second call, but fortunately I was living with my mum at the time who was on hand to get me emergency help. Ever since then I realised how urgent it really is when people are calling for medical assistance and mainly how crucial it is to have other human beings around you in such an emergency. Phone calls can be structured and dealt with by the most competent professional but these are real life scenarios and there's not always time for triage or discussion and referral. It's terrifying but I'm not sure what the alternative is either.

@Lougle

The trial plan is to have life-threatening conditions go to A&E directly. Then 111 for non life-threatening conditions. Patients that turn up at A&E without an appointment will be seen, but likely after those who have appointments. Having said that, if someone turns up in a dodgy state without an appointment, they'll still be whisked through!!

I think it may help, if capacity on the phones is increased.

Ahh this explains it much better! It doesn't sound quite as daunting when it's broken down like this. Perhaps this could be the alternative, any improvement is going to be a good thing at the mo

I think the link relates to a different story OP.

I think the idea of appointments for non life threatening issues is a good one. I also can’t fault 111 from personal experience. People turn up at a&e with minor injuries or requiring antibiotics on a weekend and these type of issues are best redirected so a&e can function better. They also don’t want patients with covid/suspected covid rocking up at a&e unannounced.

Yanbu

The pilot is still seeing 111 send ridiculous non-urgent things to emergency departments including on one shift haemorrhoids and a wart on a finger. Algorithms are never perfect.
Those people dialling 999 were being transferred directly to the hospital, where necessary.

An increased risk is ambulance staff with quite limited training not transferring to hospital and outcomes not being assessed to monitor effectiveness.

@Lougle

The trial plan is to have life-threatening conditions go to A&E directly. Then 111 for non life-threatening conditions. Patients that turn up at A&E without an appointment will be seen, but likely after those who have appointments. Having said that, if someone turns up in a dodgy state without an appointment, they'll still be whisked through!!

I think it may help, if capacity on the phones is increased.

This seems a good idea to me. A and e will not be shut to genuine emergencies. Those who need urgent help but not emergency can be triaged over the phone and told when to come in. That will help with social distancing.

Absolutely. People have already died from being given incorrect information from 111; if they become gatekeepers for A&E it could be absolutely disastrous.

Most times I've called 111 they've told me to go to A&E anyway. I would have liked to have had an A&E appointment in these non life threatening situations rather than just rocking up and having to wait for hours in A&E.

Life threatening situations (heart attacks, heavy bleeding, etc) obviously need to go straight to A&E. I don't think anyone's suggesting otherwise. But things like possibly-broken fingers could go via 111 and be given an appointment I'd have thought.

We've had some pretty awful incidents with 111, that this really worries me!

I never use 111. They're crap.

The idea is that instead of 111 telling people to go to A&E, 111 will make an appointment for them. It might not even be in A&E. it means A&E won’t get log jammed at peak times. Instead of being triaged at the A&E and then told to wait, you will be able to do it on the phone and then turn up when they have time to see you. Walk-in will still be an option, just an uncomfortable one if you are not a priority.

Acute emergencies will still be prioritised either via 999, 111 or the walki in triage. They will still be seen first.

People need to let the NHS change because it doesn’t work as the service it has developed into. And that’s not just about money

Ok, so walk ins will still be triaged and seen.

I'm not sure how it's different to the way 111 works now then?

I wouldn't be happy. They are not reliable and not able to deal with people being black/disabled/learning disabilities. It's a computer says no philosophy. Last week I was really ill but their computer said no and I hadn't the energy to deal with this. Thankfully, I had a friend who was a healthcare pro and advised me- if I had gone with the advice of 111, I would have been in hospital. All my kids - with disability- would have been in jeopardy and would have needed to be sorted.

The only trouble with this is 111 take ages to phone back. The last time I phoned it took 7 hours for a practitioner to call back. I then got told to go to A&E - no appointment given probably because I was quite ill without realising it.

I think it's a hard one OP as there is just jo funding for a and e type services any more. So the alternatives are -
Increase tax- not going to happen in the current climate

Pay per use type thing- even excluding repeat users and people who can't pay, there is a mentality that NHS must be free at the point of use and even people who can afford it shouldn't have to contribute a tenner so again never going to happen

Leave the situation as it is with people turning up for a cut fingernail and a cold and clog up the system, ultimately resulting in deaths from overstretched system though maybe not directly

Try and get people to use the service as it is intended ie accident or emergency. As it stands something like a third of GP appointments are taken up with the cold virus and I have no idea what proportion of a and e admissions arent accidents or emergencies but I'd guess its very high.

Something does need to change and I can see why they want to try and cut out the patients that are in the wrong place, I'm not sure how you do this though

The last time I called them, I was told 3 hours later by an ICU doctor that If I had listened to them, my child would be dead. So I think this is a terrible idea unless they invest a hell of a hot more into ensuring they don’t fuck up so massively in future.

In my experience 111 seem to tell you to go to A&E whether it is appropriate or not so I can't see that helping. I have had several robust discussions with them over the years when they have tried to send ambulances when all I really wanted was access to the out of hours GP. Having looked after my child's long term illness for a long time, I am well aware of when hospital admission is needed and I would dial 999 if I needed an ambulance.....but they seem to hear "rare condition" and panic, whatever the actual reason for the all.
If it is to work, then they are hoing to need a lot more experienced clinicians available to talk to people as the initial screening questions are far from infallible.

I was a 111 call handler. I'd love to say this will work but it won't. We had to read a script for every call. Sometimes it would work well. What I hated was that we were not permitted at any time to use our common sense. I know call handlers are not medically trained but there was zero room for deviation from the script. I had callers that I knew from the outset needed to go to A&E bit the algorithm made me ask more questions than necessary, sometimes meaning they needed to wait for a call back from a nurse or paramedic which could take hours.

I've had to call 111 myself and I'll be honest when I say I lied throughout most of the call just to get the result I needed.

Most people that I worked with were either thick and happy to be told what to do by a computer or using it as a part time job.

The long term staff were complacent.

There were a few really lovely people where I worked that were genuinely brilliant at their job but like I said, the algorithm.

I typed another paragraph of what it's 'really' like there but I'm wary of comebacks.

If you need to go to A&E, go. Ultimately, they have a duty of care once you arrive. I hope to God that will never change.

I don’t really understand why anyone ever thought that the 111 service was a good idea. What is the point if the call handlers have no medical training and are just following a script? I called it once or twice and thought the questions were ridiculous.

Do you have more information? There isn't much written on that link.

@MrsHookey

I wouldn't be happy. They are not reliable and not able to deal with people being black/disabled/learning disabilities. It's a computer says no philosophy. Last week I was really ill but their computer said no and I hadn't the energy to deal with this. Thankfully, I had a friend who was a healthcare pro and advised me- if I had gone with the advice of 111, I would have been in hospital. All my kids - with disability- would have been in jeopardy and would have needed to be sorted.

So you were ill, 111 advised you to go to hospital, some random friend who's not a doctor said something else and in the end you needed no real medical intervention at all?

So 111 are a bit over cautious?

Better safe than sorry?

@Notcontent the questions were ridiculous. I found that the people most at risk, the elderly and vulnerable, downplayed their symptoms because they didn't want to be a burden.

On the other hand, Kim who had a toothache was advised to get to A&E asap. Some people know how to work the system.

It's an awful system.

If you ever need to call 111 and don't agree with their advice, do what you feel is right.

Too many people have died unnecessarily because of this service. That includes call handlers that have committed suicide because they feel overwhelmed, unsupported and bullied by their superiors.