"Out of hours - 111"

About: South Western Ambulance Service NHS Foundation Trust / NHS 111 Torbay Hospital / Accident and emergency

(as a parent/guardian),

My very young son was poorly on the weekend. High temperature which we were unable to manage for 24 hours with Calpol and Ibuprofen. He was unable to keep down any fluids or solids due to vomiting, no wet nappies on Sunday and on Sunday afternoon unable to keep down with Calpol.

We eventually called 111 on Sunday afternoon, as we were concerned about dehydration. We spoke to a helpful operator, discussed his history of meningitis, current Gastro problems and informed them he was currently under the care of the doctor in Torbay. We worked through the triage and advised we would receive a call back from a GP, time period within 6 hours.

It took approximately 3 hours and we eventually spoke to a GP who felt it was potentially a Sickness bug, although he had no D of D&V but appreciated our concern re dehydration and asked us to attend Torbay to see Dev Docs. Upon arriving A&E/ Dev Docs was packed mostly children with sick bowels.

We were seen ahead of those waiting, called immediately through. It was then confirmed that he actually had infected ear drums on both sides, causing the temperature and sickness. The GP said he was a little dehydrated and gave us tips for getting fluids in him and prescribed amoxicillin.

The GP advised any further problems to call them back.

Next day he seemed to get progressively worse through the day. When in hospital at 11 weeks he showed signs of a reaction to Antibiotics, temperature and rash. Although it was felt at the time this could have been the meningitis and to try him again on antibiotics to see if a reaction occurred. By that evening, he had been crying for over 2 hours nonstop in severe pain, soaring temperature, rash and started to have mini twitching episodes (previously occurred when he had temperature).

My husband and I called 111 again. Unfortunately even though we were following up a previous call we still needed to have full triage which was quite lengthy when a child is screaming in the background, we were down for a call back within the hour.

We were called back within 20 minutes and attended Torbay again to see Devon Doctors.

The clinical service we received with Devon Doctors on the weekend was fantastic, and the operators at 111 were logical and although needed to ask seemingly ridiculous questions did so with a sensible approach to questioning us.

The main faults in the clunky service is the approximate time for a call back with the initial call, 6 hours. Even though I am an NHS worker and try to be sensible with my approach to services, at this point I was tempted to attend A&E. On Monday evening, I knew I would have to call 111 and potentially wait 3 hours for a call back. Again nearly attended A&E as felt it was such a lengthy process. Thankfully the turnaround was quicker. The service would benefit from having a follow-up call option, allowing patients to avoid triage as it is a reference to a previous visit.

I do appreciate the pressures on the emergency care system but can imagine that different parents would have attended A&E both times after calling 111, as a 4 hour wait in A&E (of course on a good day) is shorter than the 6 hour call back period we were advised.

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Response from PALS Dept, Torbay and South Devon NHS Foundation Trust

Thank you for taking the time to comment. It is always good to receive feedback; we try to ensure we share examples of good practice and also that we learn from any negative experiences.

Kind regards South Devon Healthcare NHS Foundation Trust.

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Response from Sara Coburn, Patient Engagement Manager, Governance, South Western Ambulance Service Foundation Trust

Good Afternoon Concerne Parents14

Thank you for taking the time to share your story. I hope your son is feeling better!

The reason you were taken through a second triage was to ascertain if there had been any change in your son’s symptoms. If there had been a significant change, this may have triggered a different response, an ambulance attendance for example. I understand that this was difficult while your son was so poorly, but this was necessary as it is very important that each patient receives the right level of care during each contact with us.

Unfortunately, I am unable to identify your call so I cannot comment fully on your conversation.

However, based on the information you have provided I think there may have been some confusion over the call back time; I think the outcome of the call might have been that you needed to speak to a GP within 6 hours. If this was the case then the NHS 111 service would have passed your call to the local GP Out of Hours service who would have contacted you as soon as they were able to. However, if this was not completely explained to you I can understand your concern and that you would have to consider if going directly to A&E may have been preferable.

I apologise for this issue and the stress it may have caused you. If you would like us to fully investigate this issue we would be happy to do this; please may I ask you to contact my colleagues in the Patient Experience Team on either 01392 261 585 or swast.patientexperience@nhs.net at your convenience.

Thank you, again, for taking the time to provide us with feedback.


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