"Failure of emergency and urgent healthcare services"

We are writing to express our deepest concerns with the provision of emergency and out-of-hours care in our local area.

My friend suffered an acute back condition at approximately 13:15 in the afternoon which caused severe pain and incapacitated him.  He has a spondylolysis at L5 and has suffered similar attacks in the past, but never as serious as this.  As his legs had given way and he was unable to move, he had to lie on the living room floor.  There was no possibility of getting him into a vehicle to attend at local A&E.  Although we used the strongest painkillers we had in the house, by 13:45 the intensity of the pain and spasming, coupled with a difficulty in breathing, led to us calling 999 for the first time in our lives, but triage resulted in determining it as a non-emergency and we were asked to call 111 for the out-of-hours service.

We rang 111 and went through the triage process there, to be told that he would be referred to the out-of-hours service for a home visit within 6 hours (which would equate to 20:00).  Advice given was to continue pain relief and to stay lying on the floor.  No other advice was given or help suggested, so we had to find a neighbour who is a qualified nurse who was able to come in and help to move him upstairs so he could at least be in bed in more comfort while we waited.  He was unable to move unaided, could not stand, support his own weight or walk, so with help on both sides to move into a kneeling position, he was able to crawl on all fours upstairs.

At approximately 15:30 we received a phone call from a nurse on the 111 service, to go through triage again; she confirmed that the case was being passed to the OOH service but re-set the time clock so the 6 hours now became a potential end time of 21:30.  The nurse confirmed that we would get a call from OOH when they were scheduling the home visit. 

At 16:45 we received a call from a doctor who again went through triage and although we explained that he had finally been able to get some sleep, the doctor insisted on waking him to talk to him personally.  This resulted in a promise of a home visit within about 4 to 6 hours, but sooner rather than later, which gave a time frame of between 20:45 and 22:45.  Again, we were to expect a phone call in advance of the home visit to confirm timing.

At 21:00 we rang 111 to request an update as we had heard nothing, to be told that “we were in the queue to be called with an update, which was expected to be within the hour”.  Not unsurprisingly by 22:00 we had not heard anything but finally received a call at 22:20, but the service wanted to repeat the triage process for the fifth time.  At this point we explained that the home visit had been promised nearly 5 hours earlier, by the doctor.  It was not known by the service where this doctor was working from, which could be any clinical hub within the area of coverage, and it was therefore not possible to access their notes.  After discussion it appeared that this doctor had never updated the records to book the promised home visit, and finally it was agreed that a home visit would be instigated without repeating triage.  An OOH doctor was currently at Malvern Community Hospital and he would be the next visit.

 

At 22:40 we received a call from the OOH driver to confirm they had received the request to come out, within approximately 30 minutes.

 

At 23:05 the OOH doctor finally arrived and was able to attend to him, administering pain relief by injection and two different tablets.  Our doctor also advised getting an MRI scan based on their examination and the existing medical records relating to the pre-existing condition, and to speak to our own GP as soon as possible the next day.

 

The following day, with the pain relief he had finally been able to obtain, Tim was able to move sufficiently to visit the GP mid-morning, and was advised that although an MRI scan could be useful in diagnosis and treatment, the request had to go through an established process with ICATS, meaning that his attending physiotherapist had to make the referral. 

On checking this with Malvern Community Hospital, Tim’s attending physiotherapist was on leave for a week and no-one else could make the referral for her, thus automatically putting one week’s delay in the process, and no indication could be given as to the length of time the ICATS referral process would take, nor how far ahead the MRI appointment might be, although it would be several weeks away.

We were therefore forced to take the decision to pay for an MRI scan privately, and obtained an appointment to take place within 3 days.  Interestingly, as the referral from the GP was marked “private”, it was dictated, typed and sent out within 5 hours.

In summary, he was forced to wait 10 hours for attention, and about half of that time was due to the total ineptitude of the service in failing to update the system and thereby not booking the home visit.  As a result he had to endure pain for a lot longer, and as the final straw our GP was unable to make an NHS referral for the MRI scan and we have to pay the cost as a result.  It seems that the revamp of the 111 system has not had the desired improvements, and is still suffering from limited clinical support and the need for non-clinical call handlers to resort to online checklists, with the resetting of the time clock to avoid poor statistics.  We explained this to our GP but their hands are tied, and we have no other recourse.

It was interesting to read the promotional text on the NHS 111 website which emphasises urgency – can you explain how ten hours (five of them unnecessary, due to incompetence of the staff attached to the service) constitutes urgency?