Tuesday, September 01, 2009

FAO Tom Reynolds/Brian Kellett

I'll admit it, I bought your books. I even advertised the first one in the sidebar of this blog, but not it's shouty time.

I just read the second book. Can't remember you mentioning NHS Direct in the body of the book but *sigh*, in the glossary, the old 'NHS ReDirect' trope is trotted out. Get fucked eh? In the grand scheme of things you're not exactly a neurosurgeon. This is what pisses me off. This is what's trotted out by you green-suited stretcher carriers over and over again:

"Hurrrp durrrp durrrp NHS ReDirect tell you to call 999 if you have a cold/stubbed toe/hamster bite"

My turn to say something I've said over and over again:


You go through your entire fucking book, in fact both of them, saying that the public are liars, degenerates, time-wasting scumbags who piss you off, you want them dead, you want to punch them. Then, one of them mentions the words "NHS Direct" and suddenly these scumbags are paragons of virtue who would never lie. Why do they utter the magic phrase to you? Because YOU FALL FOR IT EVERY BASTARD TIME.

The people at NHSD have to deal with timewasters too. They have to deal with abuse, with being followed home from work, spat at outside the building, stalked in a dark car park, with people breaking into their building and hiding in the toilets. They don't have security cameras, or backup. Most of them are women, a lot of them are disabled.

They deal with the crackheads, the alcoholics, but unlike you if someone says "I have chest pain, I'm having a heart attack" THEY can't give them an ECG. They have to take their word for it. Then you turn round and call them incompetent because St Joe Public would never lie to get an ambulance, would he?

Most of the calls the service takes don't even involve symptomatic callers, did you know that? It's a HEALTH INFORMATION service. But the ones that do call them are old people, sick people, people who are too fucking scared to dial 999 when their arse falls out and they bleed all over the floor of their sheltered housing. They're new mums with blue babies who've been called 'neurotic' by Ambos and GPs, parents who live on rough housing estates who call asking for home care for Billy's injured leg because if they call for an ambulance Billy will be whisked away while Social Services grill his mother.

Take the service away tomorrow and you lot will be fucked. You think you don't have enough ambulances now? Just wait till EVERYONE with toothache, EVERYONE with cold, EVERYONE who has a query about chickenpox is calling you. Just fucking wait.

And if you really want someone to blame? Try lazy bastard GPs who get £100k a year for 9-5, and keep 'forgetting' to turn on their surgery answering service after hours. But then they're not an easy target are they. And that's the kind you like.

You can't make your own candle burn brighter by pissing over someone elses. Grow up.

To everyone else - I moved on. Thank God. I loved working for the service but between the public, the management and cocks like this it wasn't worth the high blood pressure.

Wednesday, March 28, 2007

C'est moi! (slight return)

Have you missed your little phone monkey? I'm back on track(ish). Family member is fixed, my little scare over being 'outed' is over and done with, and the days are brighter. What's not to be happy about?

Dental access worsens

New dental contracts f***ing useless

I must be psychic, because before I was a twinkling in Blogger's eye I predicted this. The knock-on effect is that people see the news and (for unknown reasons) phone me and a) decide they need a dentist now, and b) berate me for the lack of access.

I need a break from this. Maybe in a secure psychiatric hospital or a pen full of wild, shrieking hyenas. Speaking of which, I received this 'delightful' comment on my "NHSD almost killed my baby!" post. If anyone could translate I'd be delighted! Read on gentle citizen, and marvel at the consequences of 'Care in the community'

"Hi. Today i called nhsd and when called back i was told that my son should be seen by a doctor as he has a very bad case of chicken pox which has spread to the inner eyelids which can be harmful to the cornea. She said that she would send the details straight through to my GP surgery that if i wasn't called by the doctor within the next hour to ring my surgery myself,she was very nice and i was happy with the service until 2 minutes after the phone went again and the woman said that she also was a nurse with nhsd so i said that someone had just called and she practically made out that i was lying as i was still on her screen so couyldn't have been called back! So i told her what had been said in the last phone call and she actually asked me if "I WAS SURE I HAD TALKED TO SOMEONE?" To which my reply was "Yes i am sure,I am not thick!" Eventually she believed me after i asked her also who the hell was it who could have called thenas i hadn't rang or asked for anyone elses advice besides nhsd!She then said that the advice was wrong that the details wouldn't have been sent to my gp as they are shut,that i couldn't get a home visit as there wasn't anyone to do home visits! To go to casualty but as i seemed like a mother who doesn't oer react that i could wait until the morning to see the gp,which i don't really want to do as he is still contagious and he is covered from head to foot. Anyway i rang the gp helpline myself,rang the number from the answer service...NOT nhsd and a DOCTOR rang me back within 5 minutes and said to call my surgery first thing to be seen and that he would send a message thrugh to them to say he had talked to me and had advised me to call them first about my son being seen.It was good advice and fast i don't see nhsd advertising that they charge ONE POUND PER MINUTE for your call! Also Read this...Government watchdog ICSTIS last night indefinitely suspended the licence of health helpline NHS Direct following the reporting of more than 3 million complaints in the last 2 years. The Premium Rate service offers callers the chance to speak to NHS staff about any concerns they have regarding their health at only £1 per minute* leading to an overall 0.002% reduction in visits to GP surgeries over the past 4 years, while also being linked to a 600% rise in hypochondria."We've suspected for a long time that NHS Direct uses this phone system to exploit the insecurities of the weak and line its own pockets," stated ICSTIS's Gregory T Mullet. "But now we have collected a dossier of evidence that suggests their only function is to make as much money as possible by keeping you on the phone for as long as possible."The dossier includes a list of tactics for prolonging people's phone calls (without necessarily prolonging their lives), which include:Using an automated touch-tone 'screening process' consisting of upwards of 100 questions ranging from "do you feel nauseous" to "have you, or a member of your family, or anyone within a 100km radius of you, recently travelled by boat from the Niger delta to Bamako in Mali and so been exposed to tsetse fly or their larvae, subsequently developing symptoms of African trypanosomiasis?"Asking deliberately confusing and technical questions such as "has your left fronto-pyramidal cortex experienced an increase in its QT interval leading to electrostasis beyond 1.112 millimoles per microgram?"Requesting that callers hold whilst they go off to perform "some tricky emergency surgery or something".ICSTIS claims that some questions asked in the diagnostic phone interviews have answers that are so obscure that they are nearly impossible for the callers to get right. "One caller was asked whether there was anything unusual in his stool samples. He had no idea that the correct answer was a beige 1.4 litre 1975 Austin Allegro and spent 5 hours attempting to guess an answer they would accept," said Mr Mullet.He also alleged that the public were still being encouraged to call NHS Direct by being given the impression they would be able to speak to a doctor or nurse, when in fact all performance targets had been met months before and everyone was on holiday. "In my opinion people who suspect they may be ill should go to their GPs or local A&E departments. That's all that NHS Direct will tell you to do anyway, after fleecing you for an hour or two."When asked to respond to these allegations, Dr Douglas Ramsbotham of NHS Direct said, "We are well versed in dealing with complaints and will give you a full diagnosis of the problem after we've asked you a few questions to clarify your enquiry. If I could just pop you on hold for a moment I'll be right back..."---------SAYS IT All REALLY and yes i was asked the questions even though i have had 3 children with pox before and am pretty sure it wasn't anything else!

Posted by Barbakent to Tales from Tragedy Towers - Life at NHS Direct at 10:11 PM "

I promise that was the whole comment, verbatim.

The beginning? I have no idea about. Details are sent to GP OOH at evenings and weekends, there's always someone there. In fact the only time we send anything anywhere is out of hours, I mean, no point doing it if the doctor is sat in his office! The middle? I dunno, I guess 'Barbakent' stumbled across, what we on the interwebs call 'satire' and became confused. (the piece she quotd is actually very funny) The end? I'm sorry the kids are pox-ridden, but that's modern youth for you.

Oh and finally, little Voldemort? That was definitely his name. Not Waldemar or any other Germanic moniker. You see, we have to check spellings. It's not the oddest name I've encountered. Here are a few:

  • Indyanna
  • Twins called Molly Holly and Polly Dolly
  • Baby (he was 4 years old)
  • ShonyLeigh (a boy)
  • Derica (guess what her daddy was called?)
  • Dyson

Ah. I love the Burberry Generation, don't you?

Monday, February 19, 2007

Oh noes!

Fear not readers. I haven't perished, or been sacked, just been having some awful family problems. Yes, the NHS strikes again! A family member had a botched procedure and ended up very ill, so there's been a couple of weeks of very tense bedside visits, trying to get time off work to get my head round it, and lots of sleepless nights.

I'll be back very soon.

ps - an NHSD colleague posted on a message board I'd glanced at that someone called in about their sick son. /his name? Voldemort. *ahem*

Thursday, February 01, 2007

How can I help?

No, really. How can I?

The pressure and fall-out following NHS 24's fatal cock-up is increasing. Different organisation, different country, but the service is similar. Confusion is mounting, tempers are frayed, and people are leaving in droves because working for NHS Direct is becoming an impossible task. Call volumes are up, staff numbers are down, staff sickness is enormous. There is little help available staff-side, so people are leaving. It's heartbreaking to say goodbye to different people every week, dedicated staff who are leaving the NHS entirely to do any other job they can get.
I'm increasingly finding myself wanting to go back and listen to my calls, make sure I did everything right. Self-reviews have turned from a useful tool to an agonising nightmare, as you hope the random call you picked to analyse is worthy of a high score. I fret if my self-review and peer-review scores are less than 100%.

We hung on last year, through the daily news announcements of site closures, staff redundancies and cuts to the service. After a year of uncertainty we were given the all-clear at my site, and even earmarked for expansion. We were safe. The relief didn't last long. It's a different organisation since the 'Transformation'. There is mistrust on all sides, staff have to cope with the chaos caused by recruitment freezes and budget cuts while still trying to deliver the best service we can. The amazing camaraderie that once existed between all grades of staff has disappeared. The agency staff who seem to be infiltrating some of the call centres are disinterested, aloof, ever-mindful that their stay here will be a temporary one. The worker-friendly rostering policies have been thrown out of the window, consideration for disabled employees and those with families no longer exists, and a draconian new system is in place. Anyone who has better options is leaving for them, anyone who doesn't is forced to stay put and grow more resentful and stressed until they're ill themselves and have to go on sick leave. I'd hate to think what it's like at NHS 24 right now. Anyone?

The callers are no better. People want a safe service, everyone thinks they have meningitis or a DVT, so we have to rule out important symptoms, especially on third-party calls. If you are calling on behalf of someone else, you are with them, but they can't/won't talk then you will be asked six standard questions, no exceptions, no ifs or buts.

  • Is the patient awake, alert, and responding to you normally?
  • Has there been a change in their colour, especially a grey or blue tinge to the face and around the lips or mouth?
  • Are there any new or worsening breathing problems?
  • Has the patient's skin become very cold and sweaty to the touch?
  • Has the patient fainted or passed out?
  • Are there any clusters of tiny purple spots on the skin, or any rash that looks like bleeding, or bruising under the skin?

We have to ask them. Whether you're calling about a broken toe, a headache, a foreign body in the ear, it doesn't matter. If the patient is symptomatic then these questions have to be asked. Don't whine, don't be sarcastic, and don't lie. If I think you've misunderstood the question, or merely answered "Yes" or "No" to shut me up then I'll ask again until I get a definitive answer. I'm only trying to do my job. I don't want anyone to die. I don't want to turn the news on and hear that we've 'killed' someone.

If you're calling for yourself you'll be asked most of these questions too, if you're a female between the ages of 12 and 55 then you'll also be asked if you could be pregnant. We have to be very careful. Telephone triage is difficult, we can't see the patient, and callers can't have it both ways. A symptom that you might think is not important could be fatal, and that vomiting that you think is the worst thing that's ever happened to you, is probably not as severe as that crushing feeling in your chest and the pins and needles in your arms.

No service can be 100% safe but don't blame the staff, blame whoever thought it up.

Hi, you're through to NHS Direct, how can I help?

*The tone is 'annoyed' again because while I'm paid to be given grief from rude, arrogant, petulant callers, I'm not paid to sit here while my mouth bleeds relentlessly and makes everything taste like pound coins. No, I don't know why I'm bleeding. If I faint at my desk I'm sure someone will raise the alarm.

Sunday, January 28, 2007

Crystal Bollocks

Me in my Vaudeville days

The skill that would help me most in my day-to-day work, and would almost certainly keep my sanity levels reasonably high, is clairvoyance. I wish I could divine the future, guess what was coming next. The Nurse Advisors have an easier time of it. They pick their calls from the queue. There's a surname, age, and brief call reason. We're instructed to keep call reasons short while giving as much info as possible, here are some examples:





So, from the top we have:

  • Diarrhoea and vomiting, with left-sided abdominal pain and fever for two days.
  • Pain and swelling after a tooth was extracted yesterday under local anaesthetic. Symptoms worsening with time.

  • Vaginal bleed with pelvic pain. Patient had an abortion four weeks ago, at 10 weeks gestation, and her last period was three months ago.

  • Shortness of breath on exertion, diagnosed with a chest infection three days ago, and prescribed antibiotics

So the nurse sees the call reasons, any notes we've made on the chart, then calls and speaks to the patient. On the other hand we're going into the whole thing blind. This wasn't as much of a trial when I took thirty calls a shift, now I could top eighty if I was on 'ready' all the time. When the 'beep' sounds in my ear, and I look at the phone display, all I know is whether the call is NHSD, GP or Dental. This could be how the first two hours of my shift goes:

  • "Where do I find a dentist?"

  • "My baby's stopped breathing"

  • "I've dropped a brick on my foot"

  • "Is there a chemist open tonight?"

  • "My dad has chest pain and blue lips"

  • "My testicle is swollen"

  • "Do I qualify for Tax Credits?"

  • "My hair smells funny"
  • "I've just taken 60 Seroxat"
  • "My toddler is choking"
  • "My son's just eaten plasticine"
  • "I've just been stabbed"
  • "I think I'm in labour"
  • "Is MRSA contagious?"
  • "My brother's making me have sex with him. I'm only 13 and my period's late."
  • "My sister's got a purple rash"
  • "I've just found out I have an inoperable tumour"
  • "I keep wetting myself"
  • "I've just been gang-raped and didn't know who to call"
  • "My throat hurts"
  • "My husband has AIDS and didn't tell me"
  • "I'm tired at nights"

  • "Is diabetes contagious?"
  • "I think I'm having a miscarriage"
  • "I've just woken up and my husband is dead in bed next to me"
Twenty-five sample calls there. I could have some of these people on the line for twenty minutes, some for three. The twenty-five I've listed have all been calls I've taken in the past, and sadly most of them are now fairly 'routine' with the exception of the gangrape. I'll probably get a random twenty out of these every single night, most of them will crop up more than once.

The stress of this often seems unbearable. To have to switch from trying to give someone a reason to ignore the voices and put the knife down, to explain why 'smelly hair' is not a reason to call your GP at midnight, is exhausting. I actually don't mind the 'big' calls where it really is life or death, or the queries about finding a dentist or chemist, but the sore throats and tummy bugs can really get me down sometimes. It's hard not to choke back tears when the fifteen year-old girl who took thirty paracetamol as a 'cry for help' two days ago calls with stomach pain and vomiting, or when the daughter of a man with inoperable stomach cancer and violent dementia calls, at the end of her tether, because she doesn't know where to get help. He's hitting her mother, but social services are reluctant to help. After all a psychiatric facility is no place for a dying man, but a hospice or hospital is no place for a potentially dangerous man, who means no harm but doesn't know his own strength. What do you say to the scared young girl who is terrified of telling her parents that she's pregnant again, or the lad who has caught an STI but feels unable to seek help because he's underage and gay.

I know we're an easy service to criticise, and it's simple enough to dismiss NHSD's employees as 'untrained operatives bashing away at a computer', but that really isn't the case. We're all only too aware of what can happen when it goes wrong. Even though NHS 24 is a different service to ours, uses different methods to assess, different algorithms and protocols, it's still telephone assessment and still carries risks.

Unfortunately we aren't psychic or omniscient. At the end of every, single call the caller is told "if the symptoms change or worsen, or you're concerned in any way, call straight back" Why? Because we can only assess symptoms happening now, not in an hour's time, not even in ten minutes. People rarely call back if this happens, I might as well be saying "I am a purple seven-legged antelope. If you enjoyed this call please send me a pizza-cutting wheel and 37p". Why call back when you can drag the whole family to A&E, blame us for not picking up on a symptom that didn't exist an hour ago, and then write to the fucking Daily Mail about it.

The public are confused because of recent press coverage (spoke to five people yesterday, concerned that they'd "be killed" because of our 'incompetence') and think that NHS 24 and NHS Direct are the same organisation and then share stories about how awful NHSD are, and how they once had to wait two hours for a callback about the splinter in their thumb, and "Oooh it could've been me that died!" It's a stressful and demanding job, and one that attracts derision and cries of "close it down, waste of money".

We take approximately half a million calls a month, a figure that's rising steadily, yet one thousand NHSD staff have been made redundant and call centres are closing all over the country. The pressure to perform is immense, and people are leaving in droves. What would these six million people do every year if we didn't exist? I'm the first to admit that telephone assessment is not ideal, but no system is.
A patient could present at A&E with symptoms that appear to be flu, be fully examined by a doctor, and told to rest at home, take paracetamol and keep hydrated. They could die within two hours of TSS or meningococcal septicaemia. My local GP (now retired) was a great doctor, worked in the community for thirty years. He saw a man in his forties who was complaining of chest pain and nausea, doc told the man that he'd feel much better if he wasn't so overweight. He'd seen the man smoking on the High Street the day before, he reprimanded him. The man thanked the doctor, walked out through the waiting room and dropped dead. I know that grief is a terrible thing, and the natural instinct is to blame somebody, but telephone triage is not the cause of all ills in society.
We are the black sheep of the NHS, but when we're dealing with people who are ill, we can't predict the future. People are misdiagnosed at hospitals every day, people become unexpectedly ill and die suddenly, human beings are curiously fragile. Unfortunately we're on the bottom rung, so we take the criticism and accept the blows thrown our way, and move on and try to do our jobs.

I should stop watching the news, reading all medical blogs, and get round to finishing off that Christmas vodka. I'm depressed, a combination of doing my job, and of hearing how worthless said job is every time I see the news or read a website. January blues? I wish.

You're probably as miserable as I am now, so here's something to cheer you up:

Whaddya mean 'Humans only?' Yes, a flu-ridden kitten using the NHS Direct Freeview service.

Tuesday, January 23, 2007

Attention readers!

Yes, I AM gorgeous!

Thought I'd treat myself to a domain, to make up for my abysmal, Towers-bound Christmas and New Year! Ten minutes+Photoshop and I also have a picture to go with my shiny new address.

You can still access it through the usual Blogspot address too.


Beauty and the Bitch

It is an unerring law of Nature that any man left within 100ft of feminine beauty products will be compelled to try them. This inevitably leads to disaster for them, and amusement for everyone else.

Mr Smooth

11pm on a dull Thursday night. The familiar 'beep' sounds in my ear, signifying a call. I introduce myself, noting the background noise on the call, it sounds like a wolf being alternately drowned and garrotted. A female voice comes on the line, her tone calm, totally at odds with the background noise. Was she a sociopathic fiend, intent on wreaking vengeance on her male acquaintances?

"I'm calling about my boyfriend. I fell asleep after supper, this left him to his own devices. I realise this was a mistake. I woke up because I heard him screaming upstairs, I was terrified. He was naked with his er... testicles in the bathroom sink. The stupid sod had decided to 'surprise' me. He slathered his bloody balls with Immac, it's been on for 20 minutes! Can you hear him? Prat. Anyway, I just wanted to know if there was anything I could do to help him, I mean, you wouldn't let a dog suffer like that, would you?"

I managed to remain calm, professional, and snigger-free until I had to ask the question "Is the affected area larger than the size of the patient's hand?", at which point the caller and myself dissolved into giggles. Her answer?

"He likes to think so"


Dire Straighteners

Saturdays are rubbish. In Summer it's wasp stings and sunburn, in Winter it's colds and sore throats. Blech. After ascertaining that the windows wouldn't open wide enough for me to leap to my freedom, I decided to carry on taking calls.

"Hiya, my name's Ziggy, I've got a bit of a problem. I've got this really bad burn on my forehead, and it hurts.like you wouldn't believe. Can someone give me some advice about treating it? Hope I don't have to go to hospital or anything."

So I asked him how he'd burned himself, obviously different types of burns are treated differently. A chemical burn is quite different than a scald for example.

"Don't laugh, please don't laugh. My girlfriend's at work today and I'm dead bored, my mates are all out on the piss and I'm skint. I thought I'd kill some time playing on my XBox but it's no fun on my own. You know those things girls straighten their hair with? Well Julie got some new ones, dunno why 'cos she's got about three pairs, so I thought I'd see what's so great about them. I tried to straighten my fringe 'cos it's a bit curly and gets on my nerves, but I've gone and bloody burnt my face now! God, Julie's going to take the piss out of me forever *groan*"

Poor lad. I took his details and promised him a nurse would call him back. However, although I couldn't give him medical advice I did tell him to start straightening his hair about an inch away from his scalp. Not only would this help him to avoid future burns, it would also stop his hair looking lank and floppy!

St Valentines Day Massacre

Picture it, a Sunday night, quarter to eleven. Not much happening, a lot of toddlers with diarrhoea and women with period pains. My Kingdom for an interesting call.

"Oh my God this is awful, you have to help us, we don't know what to do! My boyfriend decided to shave himself..um.. 'down there' with my razor and he's cut himself, there's blood EVERYWHERE! He won't let me call an ambulance 'cos the hospital will send for his Dad, oh no, please help!"

Any attempt I made to get her to describe the injury only made her cry "I'm not putting my hands on his.. y'know..his...!"

The young couple in question were both fifteen. The boy had been bleeding for over an hour and was feeling pretty rough. I transferred them to one of our brilliant nurses, Carol, who tried her best to help them deal with this sticky situation. She managed to get the girl to assess the injury, and after some persuasion to call her boyfriend's Dad to take them to A&E. So everything was OK in the end!

Lads, let these stories be a warning to you. If you're going to do it, do it properly!

Monday, January 22, 2007

The Bigger Picture - Redux

Like I said earlier, some people don't give you the full story when they call. Sometimes they just forget, sometimes it's deliberate, but it always helps to have as much information about what you're dealing with as possible.

A while ago I took a call from 'Jenny'. Jenny was a bubbly, lively sounding 20 year old. Poor girl had been doing some DIY in her kitchen, she'd stood up too sharply and banged her head. The whole call was punctuated by slightly embarrassed giggles, she really was terribly sweet. She had a small cut from the corner of the cabinet (done it myself, hurts like hell but people are oddly unsympathetic! I now lie and claim I've been attacked by a vampire bat) I ran through the usual slew of questions that we ask on head injury calls. Is your vision impaired? Have you vomited? She said she'd vomited a few times, but this had actually been happening before the knock to her head. Oh really? People- you're going to love this :

me - "Wow, Jenny, it's not your day today is it? Vomiting, head injuries..."

Jenny - "...electrocution..."


Jenny - "Oh yeah, it's the funniest thing! I got a new cooker. The shop wanted £50 to install it, but I'm a student, I haven't got that kind of money. I mean, its electric so I thought I'd just do it myself, it's not like it's gas or anything!"

me - "Go on....."

Jenny - "Well I pulled the old one out, turns out they don't have like.. plugs on, it was attached to the wall. Well the men were coming to take it away so I had to get it out. I grabbed some big scissors to try and cut the wire, and the next thing I know I'm halfway across the kitchen! It was dead weird, there was smoke coming out of my shoe, can you believe it?"

me - "...... No. No I can't......"

Jenny - "My arm feels really funny since then, all tingly. That'll teach me to do DIY when I'm hungover. No wonder I feel so rough today, never again!"


See, I really do love my job? Who knew that cutting through live mains cables was a bad thing? Bless you Jenny, bless your smokin' little socks.

As ever this post is 100% true, with only the name changed to prevent the innocent. I could write a book filled with stuff like this.