NHS to revamp 111 helpline after sustained criticism of service

The NHS is to revamp its heavily criticised 111 telephone helpline to ensure that many more people get to discuss their illness with a nurse, doctor or other health professional rather than a call handler.

GPs and mental health health nurses will also start to play key roles after the overhaul, which is intended to improve public confidence in 111 so that fewer patients visit A&E or a GP’s surgery.

The changes, which will be unveiled later this month, are part of a major effort by NHS England to better integrate 111 with its other urgent and emergency care services, including ambulances, out-of-hours GPs and walk-in centres. It envisages the improved 111 service being a central part of such care, which it wants to become “the front door of the NHS”.

NHS 111 has faced sustained criticism since it replaced NHS Direct as the health service’s telephone advice line in 2012 as part of then-health secretary Andrew Lansley’s controversial shake-up of the NHS in England.

Simon Stevens, NHS England’s chief executive, last month admitted that “substantial changes” to 111 were needed. A&E doctors claim it has not kept the pressure off emergency departments while NHS ambulance services believe call handlers order ambulances for too many patients who do not need one.

NHS 111 uses far fewer nurses each year to answer callers’ queries about their symptoms than NHS Direct did. Despite that, the number of people seeking help from 111 has risen from 5 million a year when NHS Direct existed to 14 million now.

But under the imminent overhaul, which is due to be phased in across England from next month, about 30% of callers will speak to a health professional through a newly created Clinical Assessment Service.

“It’s clear the current 111 system isn’t working as well as it could due to a lack of trained clinicians,” said Anna Crossley, the Royal College of Nursing’s professional lead for acute, emergency and critical care, who has helped devise the revamp.

“A script and a call handler can’t replace the knowledge of a skilled, experienced nurse, someone who can spot serious conditions and ensure people receive the treatment or advice they need.”

NHS England expects the changes not to make 111 any more expensive to run because health professionals will be seconded or loaned to it, mainly by hospitals. But costs may rise if more staff end up being paid overtime for shifts answering calls. Callers should also be able to speak to a paediatrician, dentist, cancer nurse or social worker, depending on the nature of their problem and the staff available.

Stevens is likely to cite the revamp as proof that he is making good on his pledge to transform patient care by 2020, when he launches his long-awaited “delivery plan” later this month.

The Royal College of Emergency Medicine, which represents A&E doctors, said the overhaul of 111 should ease the strain on overcrowded emergency departments.

“The improvements being made by NHS 111 are very welcome,” said Dr Taj Hassan, the college’s president. “We know that currently at least 8% of all calls to NHS 111 are referred to emergency departments – a figure the college suspects to be significantly higher – and we hope by introducing more clinicians to the service, this figure can be reduced.

“From an emergency medicine point of view one of the key problems with NHS 111 was that staff, often with a limited medical background, work with a computer system providing a virtual checklist to help diagnose the patient’s problem,” he added. “With access to further clinical support being limited, when the call handler was still unsure of the problem they would, understandably, refer the caller to A&E to be on the safe side.

“The new service will have expanded clinical back-up for call handlers to refer to for guidance, or to pass the caller on to an experienced clinician, meaning better quality of care for patients. These ‘clinical hubs’ will not just support patients and NHS 111 call handlers, but also provide support and advice to clinicians and ‘field staff’ such as paramedics.”

Dr Helen Thomas, NHS England’s national medical adviser on integrated urgent care, said: “During 2017 we will make it possible for up to 30% of NHS 111 callers to have a telephone consultation with a clinician who will have access to medical records and be able to book them into an appointment if required.”

NHS to revamp 111 helpline after sustained criticism of service

ABC requires down Catalyst heart ailment episodes right after evaluation criticism

Two episodes of the Tv science plan Catalyst will be removed from the ABC’s site following an internal review located the system had breached editorial standards on impartiality.

The controversial Catalyst plan on statins and heart illness, The Heart of the Matter, was attacked by well being experts even before it aired last yr.

The presenter of ABC radio’s Well being Report, Norman Swan, warned “people will die” as a result of the Tv program’s messages about heart medicines.

Swan, whose criticism of the system has been vindicated by the independent Audience and Client Affairs Unit report, had said the system created him “genuinely angry” simply because it may well influence Indigenous Australians, who are particularly most likely to suffer from high cholesterol.

“If you have been an Aboriginal man or woman watching that plan you would believe: I really do not need to have to be on cholesterol-reducing medication, I really don’t need to have to be concerned about it,” he stated in November.

ABC managing director Mark Scott explained on Monday that although the plans were engaging and attracted massive audiences, all the ABC’s plans should get “absolute care to comply with our rigorous editorial policies”.

The independent report identified that a “principal pertinent perspective” about the effectiveness of statins was not presented in the 2nd episode, but cleared the very first episode of any breaches.

“However, notably in the initial episode, we think a real attempt to generate content in accordance with the Code was undermined by the tone and framework of the system,” the report said.

Because of the interlocked nature of the two plans, both would be eliminated from the ABC internet site, Scott said.

“While acknowledging the value of public well being troubles relating to the efficacy of heart disease treatment and the contrasting opinions of extremely-experienced scientists, the A&ampCA has concluded that the second episode breaches ABC requirements on impartiality,” the report explained.

“The plan highlights the dangers of reporting unorthodox and controversial perspectives, notably exactly where there is a tendency to presume that the mainstream see is nicely recognized and effectively understood and does not need the same degree of explanation as the unorthodox place.

“This is a matter that ought to be a emphasis of interest even though plans are in production to boost their quality.”

The special was made and presented by Catalyst employees reporter Maryanne Demasi, who has a PhD in health care research.

The National Heart Basis complained that Demasi’s statement on the ABC radio plan PM that the foundation had “signed off” on the program’s evidence was untrue and deeply offensive.

Demasi advised PM presenter Peter Lloyd: “The Nationwide Heart Foundation agreed that there would be men and women that are not at higher chance of heart illness becoming medicated for these drugs and they would query no matter whether or not these sufferers must be on these medicines.”

The report mentioned: “While the comment was created in a live radio interview, it was nonetheless a misleading oversimplification which failed to acknowledge the clear and critical locations of disagreement amongst the Nationwide Heart Basis and the total proposition becoming presented in the programs.”

A correction will be created on the radio program’s internet site.

ABC requires down Catalyst heart ailment episodes right after evaluation criticism

Healthcare leaders urge end to "relentless" criticism of NHS

Leaders of essential NHS organisations have demanded an finish to what they describe as relentless criticism of the service which exaggerates the extent of poor care and sees GPs and hospital medical professionals “unfairly bashed” for problems past their control.

An open letter signed by the leaders of ten NHS organisations, published in the Guardian, calls for “a much more measured see of how the NHS is carrying out” as an alternative of emphasising past failures. The signatories blame ministers, NHS bosses and the media for producing an atmosphere in which demoralised and frustrated workers really feel the support is facing continuous attacks that give a distorted picture of its overall performance.

“As we move into 2014 can we, as organisations representing the NHS frontline, call for a new web page to be turned as we start off a new yr?” they write.

The letter comes after twelve months in which the services had to contend with the fallout from a series of care scandals such as these at Mid Staffordshire, Morecambe Bay and Colchester hospitals, and a host of inquiries recommending enhancements to care, as properly as some intense criticism by Jeremy Hunt, the well being secretary.

“If you pay attention to some of the NHS system leaders – ministers and the leaders of organisations this kind of as NHS England, the Care Quality Commission, Check and the NHS Trust Advancement Authority – you get the impression that all NHS care is like Mid Staffs and that is clearly not the case,” said Chris Hopson, chief executive of the Basis Trust Network, which represents most of England’s hospitals.

“We are actually concerned that when you hear these method leaders talk you get a relentless focus on the negative [and] on identifying all that is poor, and then coming up with truly quite harsh blame and recrimination. Ministers, for perfectly understandable motives, have picked to focus on the areas in which care failures have occurred, and those are crucial. But it would be genuinely excellent if they also publicly recognised that the huge vast majority of NHS care is great or extremely great,” he extra.

Hopson mentioned every single chief executive and chair of a hospital believe in had informed him in current months “that employees come to feel that the NHS is getting unfairly bashed by a complete bunch of men and women, that whilst there are failures of care they aren’t as widespread as is getting implied, and I agree with that”.

Workers are irritated that NHS bosses, with the exception of NHS England’s healthcare director, Professor Sir Bruce Keogh, have failed to defend the services, highlight its achievements or maintain a appropriate sense of balance in the a lot of controversies that emerged in the course of 2013, Hopson additional. “That’s been sadly lacking.”

Dr Mark Porter, chairman of the British Health-related Association, said ministers had unfairly besmirched the reputations of GPs and hospital consultants. He expressed disquiet about “politicians blaming GPs for pressures on emergency care [or] attacks on consultants for failing to give out-of-hours care when we know a enormous proportion do just that”.

In his new yr message to doctors, Porter lamented “the perception in the media and elsewhere that physicians are element of the dilemma”. He asked physicians to “remember what happened when politicians created inaccurate and demoralising feedback blaming GPs for the pressures on emergency care, and we should be alert to these kinds of attacks on our professionalism and integrity, and fight them with facts.”

Even though he did not title Hunt, it was the health secretary who final June provoked the ire of many loved ones medical professionals by claiming that their abandonment of contractual obligation for overnight and weekend care in 2004 was the lead to of growing overcrowding in A&ampE units in 2013.

Dr Maureen Baker, chair of the Royal College of GPs, said the government should offer instant support for GP surgeries to support them deal with the growing demand for appointments, and in doing so “signal the commence of a much more productive partnership with GPs”.

The material and tone of some of Hunt’s speeches and media interviews about the NHS for the duration of 2013 triggered concern inside of the health department, with Lib Dem minister Norman Lamb between individuals worried that particular statements had been unfair and alienating employees.

The BMA is getting ready to launch a campaign to “encourage the worth of the profession, a worth that is not constantly reflected accurately by government or the media”.

Morale between NHS workers has fallen to a worrying minimal, warned Dr Cliff Mann, president of the University of Emergency Medication, which represents A&ampE doctors. “We want to make confident that we never finish up demoralising the really individuals that we need to keep our wellness services going at this challenging time,” he mentioned. Singling out NHS coverage by some of “the tabloid media”, he extra: “It’s quite simple to consider that there is often doom and gloom. But truly most operations go ahead on time and most individuals are seen by capable physicians who make timely and correct diagnoses.”

In spite of the target on bad care in some locations in 2013 – which some commentators have named the NHS’s “annus horribilis” – the outcomes of treatment method seasoned by individuals have been no worse than before and had enhanced recently for those receiving stroke, cardiac or trauma care, Mann extra.

Asked if ministers had been between those who had helped to create an unrepresentative image of NHS overall performance, Mann replied that “when it comes to the politics of this some men and women are quite selective about what they quote, so even though what they say is correct, it truly is only element of the reality. You can virtually constantly find a single information set to support your prejudices.”

Louise Silverton, director of midwifery at the Royal University of Midwives, explained the coalition’s controversial restructuring of the NHS in England last April, which gave NHS England operational accountability for running the services, meant “the secretary of state cannot complain if his government’s reforms result in an NHS he can not manage. All he can do is criticise. All choices are now taken locally by clinical commissioning groups and it is these who make a decision what our NHS will appear like and what services it will supply. Ministers require to end complaining about NHS employees and listen to their issues,” she said.

The Department of Well being stated Hunt had struck the appropriate stability among praising excellence and highlighting the require for improvement. “The NHS is full of brilliant folks who dedicate their lives to caring for our loved ones and ministers commit a excellent deal of time on the frontline thanking and praising them for their challenging function,” a spokeswoman said. “But in the light of tragedies this kind of as Mid Staffs, basically defending the status quo is not good sufficient, and we make no apology for pushing for higher requirements for patients.”

Hunt wrote to all NHS workers just before Christmas thanking them for their tough work more than the festive time period and asking patients to also offer their thanks.

Healthcare leaders urge end to "relentless" criticism of NHS