"111 service"

About: South East Coast Ambulance Service NHS Foundation Trust / NHS 111

(as a relative),

Recently, my son & his partner had reason to contact the 111 service during the night, for their 15mth. old child. She had been ill with an 'on going' viral infection for about a month. They needed advice & medical reassurance that there were no further complications with this child because she'd taken a "turn for the worse". An out of hours doctor was at the local hospital less their two miles from their home. Having given the 111 service the details, after the "question & answer" setup, operated by medically untrained person, [as I understand, from my own use of this service ]they were told to take this child to the A&E. 20 miles from home. Had there been someone trained to answer that call, to probe a little bit "out side" the routine questions, they may have come to the obvious conclusions that a consultation with the doctor would probably have saved the upheaval of a visit to A & E. and /or if the child needed to be seen they could have visited the doctor locally. Unfortunately because neither parent were medically trained, they didn't insist on speaking to a GP. but had they done so, then the outcome may have been different and the journey of 20miles might not have been necessary.

Ofcourse, there are many lives saved by prompt action of 111, but equally there are wasted journeys to already overrun A&E departments, which was infact the case and having seen a medic, no treatment was given & they returned home. That visit could have been done local to them.

I think the 111 service should be "managed " by registered nurses as first contact level, not by persons who read off a prepared set of questions, and that trained nurse should be able to advise or get the client a doctors consutation. immediately

How many young parents are told to 'watch & wait' when a "chat" to a GP, on call would alleviate so many anxious moments or an 'action plan' could be put in place.

Perhaps my views will be controversial but it is my opinion that parents who call the 111 service about a child should be able to speak directly to a a doctor, IF it is established at the first contact WITH A TRAINED NURSE the child doesn't require an ambulance and it's not a medical emergency.

Although the 'out of hours' service run by our local authority & GPs wasn't perfect and probably didn't suit the doctors, to me it was much more personal for the patient and in our family situation would have saved an a visit to hospital.

The 111 service may well be responsible for much of the increase in the work load in A&E departments. Perhaps the D. O. H should rethink their strategy on this.

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Response from Louise Hutchinson, Patient Experience Lead, South East Coast Ambulance Service NHS Foundation Trust

Dear Carmary

Thank you very much for taking the time to provide feedback about the NHS111 service, which we very much appreciate. It must have been a worrying time for your son and his partner when your granddaughter took a turn for the worse, and I am sorry that you felt our system was over-cautious in this instance, with the Health Adviser advising them to take her to hospital.

You are quite right that the NHS111 Health Advisors are not clinically trained, although they do undertake considerable training before they start the role, and do have clinicians on hand in our call centres should they need advice or support. However, the decision arrived at by any remote triage system, be it NHS111 or 999, is based on the information provided by the caller. In your granddaughter's case, based on the information provided during the call, the triage system - NHS Pathways, which is owned by the Department of Health and is evidence based - must have determined that the best care for your granddaughter at the time was for her to be seen in an A&E department. Triage systems do err on the side of caution, and rightly so when one cannot physically see the patient.

As mentioned earlier, the Health Advisers who take NHS111 calls are not clinically trained but do have clinical support should they require it, and this is the model that is commissioned and funded by Clinical Commissioning Groups.

I do hope this information will be helpful, but if you would like us to look into the specifics of your concern we would be very happy to do so, and you may contact us by email at pet@secamb.nhs.uk or by telephone to 0300 123 9242.

Thank you again for your feedback, and I do hope your granddaughter is recovering well.

Yours sincerely, Louise Hutchinson

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Update posted by carmary (a relative)

Yes, I understand the reason for the advice given to my son BUT it is.my view ..as you can see from my original story, that HAD the person dealing with the call allowed my son to speak with a GP,perhaps a visit to an already busy A& E might have been prevented. This is surely the problem...,at what point do these Health advisers seek further advice? I appreciate that because no one can see the patient then those taking the call must make a decision.However, some where in the system there should be a person,,trained.. who can talk to the caller,especially if that caller has requested to speak to a GP... further questions by a qualified nurse/doctor would establish what action was necessary.; and since they were that concerned about my grandchild..concerned enough to ask the parents to go twenty miles to an A& E..then perhaps an ambulance should have been called..after all.anything could have happened to the child on the 20 mile journey....in a car, driven by anxious parents.

I have experienced 111, and had to be very firm in requesting GP contact and as a result of that consultation, I was able to be seen locally. Far better for me, far better for the person I was looking after and far better for an over stretched A&E.

I thankyou for your response but feel the system will continue to send people to A&E unnecessarily. It's the nature of the beast!!