Don’t be surprised the NHS 111 service failed – the workers saw it coming


by Guest    
10:30 am - August 3rd 2013

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by Anonymous

The NHS Direct service, which has received much negative coverage since launch, will pull out of 111 contracts and hand over to other providers.

Does this surprise me? No – it serves an example of the negative consequences of the privatisation of the NHS.
 
As a former employee I know first hand that although this service fails its patients, they are not the only victims. The ‘call handlers’ whose job it is to speak to patients have been failed by the service too.

I worked for NHS Direct for four months, and during this time I was ‘trained’ to handle calls on the old service, and the new 111 number. I had no medical background, and five weeks of training on a computer questionnaire health system was deemed adequate to begin taking calls from the general public.

Focus was placed on the quantity of workers as opposed to the quality of our knowledge.

My first live call was a disaster. The patient was a stroke victim, and I did not recognise the signs. Trying to contact a clinician for advice was useless due to the long queues because of large call volumes. It was only when a manager intervened (a previous call handler with no official medical training) did I recognise the signs. Instead of being taken offline and being given the further training that I obviously needed, I was instead informally disciplined and told to keep my head down.

Staff morale was low, and the wages were terrible. I worked for an external agency that was employed by the NHS to provide staff and the agency paid us up to 60% less for doing the same job as those employed by directly by the NHS.

Shifts could be changed within a twenty-four hour period; no paid sick leave, pension options or incentives. Because of this and poor management, no counselling or emotional support much of the staff did not care about the job or the patients.

Confidentiality breaches were common; with many staff unaware what decision to make would often invite others to help. Calls from the mentally disturbed and elderly were handled incorrectly by some staff members who had not received enough training to correctly handle these calls. Abuse calls required a flag to be raised but many staff simply could not always recognise the signs and would decide not to take action.

I participated in commissioner calls in order to deem the 111 service safe for a live launch. The calls were conducted in a casual and unprofessional manner. A call which I was tested on involved the caller speaking in a ludicrous French accent to determine if I knew what correct procedure to follow on the computer system. Even though the centre was deemed ‘safe’ it was obvious that given the circus like atmosphere on the day of the final tests that the staff were unprepared.

During my time as a call handler I tried to do the best that I could with the limited resources available. But because of the emotional and mentally draining element of the job I decided to leave, as did many other staff.


The writer is LC contributor who wishes to remain anonymous.

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Reader comments


Surely not, we all know that privatized healthcare companies are much better than the NHS (tongue firmly in cheek)

What an indictment.

This should be on the front page of the Sun, for widespread coverage.

I will, if I may, spread it as far and wide as I can.

People need to know that companies (and why would other companies be different) and playing around with the health of sick and vulnerable people, and treating their staff with such disdain.

Do they not see that having to deal with this day in and day out, without proper medical knowledge, would create an intolerable strain. I wouldn’t last the first day.

Companies tender for these contracts from which they can make a lot of money. They cut costs to the minimum with never a thought to the consequences. They are, after all, not in the least interested in the patient outcome. Dead or alive, they make their money.

I am reminded of the idiotic situation we found ourselves in a few years ago when retirement homes ran out of money and couldn’t cope, and the taxpayer had to step in, regardless that the directors of the company had made millions.

It’s no use appealing to a Tory government to do something about it. They and theirs are covered by private health insurance. It’s a problem for little people of no account.

3. the a&e charge nurse

The only surprise is that call centres have not been out sourced to India

The mantra for Labour at the next election surely has to be to take back this service into public ownership.
Perhaps whilst they are at it they might also consider nationalising the Trains, Energy, Water and the Banks.
Its about time these institutions acted in the interests of everyone instead of the sectional interests of the ever growing rich.

Maybe if Sunny gets a break from fighting racists he might mention it to the shadow front bench!

4

It’s very unlikely that Labour, who contracted ATOS, will nationalize anything, they are still trying to attract tory/lib dem voters.

5. jojo

I wasnt holding my breath

7. the a&e charge nurse

[4] ‘The mantra for Labour at the next election surely has to be to take back this service into public ownership’ – that would fly in the face of 30 years of maneuvering by the political class.

Labours commitment to market solutions has become almost as deeply embedded as the tories – ‘Cameron’s Law’ (aka the health and social care bill) is just the latest bit of the privatisation jig saw.

This article more or less nails the bigger picture
http://www.guerillapolicy.org/health/2013/08/04/shadow-politics-the-nhs-is-more-than-a-logo/

Perhaps it was inevitable given the involvement of private firms that staff without an ounce of clinical training should be discussing amongst themselves the best course of action for a caller who may be suffering a stroke?

The thing that is perhaps most frightening is that no one seems surprised that this has happened. It’s just dear old England.

While they will spend any amount of money on nuclear weapons they seem to resent every halfpenny spent on keeping “ordinary people” alive…and we shrug our shoulders.

This would have the French threatening to burn Paris (which is why it won’t happen there). As long as you let the SPIVs away with it, they will do it.

@7. the a&e charge nurse: “Perhaps it was inevitable given the involvement of private firms that staff without an ounce of clinical training should be discussing amongst themselves the best course of action for a caller who may be suffering a stroke?”

A rough chronology of the NHS 111 service, as far as I understand:
NHS Direct (organisation) was established to provide NHS Direct (service), with medically trained operators responding to phone and internet requests for advice. That was c. 1998. The average cost of responding to a call was £25. The intent was to provide advice for non-emergency or borderline problems.

NHS Direct (service) establishment preceded a number of cock-ups such as GP contract negotiation which meant that conventional NHS resources were unable to respond to demand. The managerial answer was to extend the scope of NHS Direct (service), eventually rebranding it NHS 111. NHS Direct (service) was reworked to provide a “triage” service for conventional services, using cheaper non-medically trained operators. The relaunched NHS 111 service sought regional tenders from operator providers, of which NHS Direct (organisation) was the largest. Payment per call was driven down to £10 or £15, depending on region.

The words used in official documents to describe NHS Direct (service) and NHS 111 (service) are similar. However significant changes have occurred over 15 years: public perception of what comprises an emergency (which widely varies amongst the public), and what government and NHS managers perceive to be an appropriate response.

Thus there are two managerial considerations, in which public/private provision is incidental.

1. On cost, government and NHS managers wishfully concluded that something wider than the original NHS Direct (service) could be delivered more cheaply. The only way to save money was to employ non-medically trained operators, because the major cost is time. It doesn’t take much thought to determine that if NHS 111 was to provide a greater care function, more capable operators would be necessary. Note that it does not matter (in terms of care provision) whether operators are employed by a public or private organisation; they just have to be good at their jobs.

2. On scope, government and NHS managers decided to “fix” fundamental problems (inadequate A&E services, declining GP cover) by reworking a service which was not originally intended to provide immediate care. Something that was established to provide tips about sprained ankles or location of an emergency dentist morphed into first point of contact with the NHS. Surrounding this extension of scope is the belief that a menu driven system can replace skilled people.

About the word “triage”. In call service context, triage means that an individual is handled by a low skilled person until the operator determines that the problem is beyond his/her ability and passes it to a more skilled operator. In medical context, triage means that patients are rapidly assessed by a skilled person to determine what happens next, often passing the patient to a less skilled doctor or nurse. It is very different from call service operations. But we can see how a manager might be confused about such an important word.

10. Churm Rincewind

@ (9) Charlieman: Congratulations on an excellent summary of the situation.

You quite rightly point to the fact that these arrangements were put in place to address the fundamental problems of inadequate A&E services and declining GP cover. However, A&E services are provided by hospitals, which are geared towards the treatment of acute conditions and are generally inappropriate and costly mechanisms for delivering generalised and holistic treatment for (what may turn out to be) relatively trivial conditions. To that extent A&E departments will always be inadequate.

The real question is why NHS-paid GPs increasingly decline to provide full health cover for their patients. And yes, I can see that GPs no longer wish to care for their patients outside normal working hours. But we might take the view that within reason it’s part of the job.

11. John Burton

@ 10 Not quite sure why you feel GP’s should have to take care of patients out of hours. Pilots and lorry drivers have restricted hours of work but its ok for a doctor to see patients when knackered?

At the time of the contract change GP’s had had enough of working 24 hour days and believe me it happened because my wife was a GP and my life was a misery as I suffered much of the sleep deprivation and was often an unpaid call handler despite having to do my own job next day.

GP’s were getting (from memory) approximately another £4000 a year for being responsible 24 hours a day. This sum was then deducted from those who opted out (nearly all doctors did opt out for obvious reasons). The politicians had not realised this when they tried to put a replacement system in place and were hit with the true costs and the reality that doctors were being paid so little.

This situation had come about historically because at one time a doctor’s out of hours responsibility was not onerous or frequent and the payment reflected that. Politicians of course kept stoking aspirations and promising 24 hour and weekend health care etc.

Despite giving up out of hours care she left the profession 3 years ago as she no longer wanted to practice without the necessary resources and time to see patients. I could bore you with the maths but there was just not enough time in her 12 hour days to practice medicine properly. She has never regretted the decision.

Since then a younger (former) GP partner has died and the other two are seriously looking to leave themselves. This is probably being replicated in every practice up and down the land. Vast amounts of experience and knowledge is being lost at the sharp end so the downward spiral will probably continue.

If you want proper 24 hour medical care you have to resource it properly and that does not come cheap. Time for politicians and population to have an honest debate; but of course that is not going to happen in our parliamentary system.

12. the a&e charge nurse

[9] ‘it does not matter (in terms of care provision) whether operators are employed by a public or private organisation; they just have to be good at their jobs’ – and being good usually has a cost implication, in other words getting the best of anything costs more.

Competition for NHS services is bound to be advantageous for private providers because their bids usually look good on paper, and they are often cheaper – cheaper because of dumbing down, or cheaper because any initial loss incurred securing a new service can be off-set against other arms of the organisation which are profitable.

The whys, and wherefores of phone services as a substitute for face to face clinical consultations have been discussed at length but I think it is wrong to say that the ethos of private vs public provision has no effect on the kind of service being offered.

This is SERCOs approach to out of hours GP services in Cornwall
http://www.theguardian.com/society/2013/jul/11/serco-gp-out-of-hours-substandard?CMP=twt_gu

I mean do we really want crap services while managers argue amongst themselves about who is to blame for contract deficiencies?
And don’t forget private providers of NHS services are well aware that they can hide behind a wall of commercial confidentiality.

The SERCO model of health care virtually guarantees that tax payers will have to subsidise contracts while paying more for reduced, and less effective service.

13. Churm Rincewind

@ (11) John Burton: You mistake me. Of course there’s no reason why GPs should give a shit about their patients outside normal working hours.

However, given that GPs in the UK are the best paid in the developed world (as per the OECD, and let’s not even get into the issue of NHS pensions) it would seem odd that they are disinclined to provide the sort of comprehensive care that was common in the past.

You say that the fault lies with the Goverment, who didn’t realise that doctors “were being paid so little”. What’s “little”? GPs in the UK on average earn well over £100,000 per year. That may be little to you, but I think it’s relatively handsome.

14. Charlieman

@12. the a&e charge nurse: “…I think it is wrong to say that the ethos of private vs public provision has no effect on the kind of service being offered.”

Well argued points, but pardon me for ignoring them.

“I mean do we really want crap services while managers argue amongst themselves about who is to blame for contract deficiencies?”

That’s an argument which applies to internal markets as well as to public/private providers. The fundamental is that any system designed around points scores has the capacity for fiddling. The provider may tick every check box but fail to deliver a satisfactory service.

“And don’t forget private providers of NHS services are well aware that they can hide behind a wall of commercial confidentiality.”

I hate to suggest things which prop up managerialism. But the wall of commercial confidentiality should simply be demolished three or six months after a tender comes into operation. Competitors know what the winner is delivering (staff talk, reps talk) so the only people in the dark are the ones paying for it.

This service is complete bollocks. I thought I would try it and I have known such a pathetic pile of crap. Nothing they told me was relevant and my kid knows just as much as this lot. If u (patient)don’t know most basic of info ie take an aspirin maybe its ok but for the other 99.9999999999999999% of the population, you’re better off treating yourself. Or talking of 999 give them a call and don’t talk to a clueless inept moron. Utter, utter waste of money.


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