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.
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.
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.
Giving something away, I deal with NHS 24. I dont blame the staff but I must say I have never, as far as I can recollect, been to a correctly diagnosed "emergency" while I have crashed in quite a few urgent calls.
The system is all wrong. It is just not practical or possible to triage over the phone. In any situation never mind when dealing with distressed/concerned relatives or anybody without any medical knowledge.
people have, are and will die because of this system
Posted by
Iain MacBain - or maybe not!!?? |
8:42 am
I've just read through your archives and my heart breaks for humanity. Who are these people?? Poor you - though it makes for unbelievable reading. Wish you'd written more but then I'd probably fail the exam tomorrow.
Posted by
Lioness |
11:13 am
I really appreciate NHS Direct. I used to live by myself, and there is nothing more terrifying than waking in the middle of the night, ill, alone, wondering if you should call an ambulance, call a cab or crawl back beneath the sheets.
You lot have never patronised me, never been anything less than civil. You have dispensed good advice when I was vomiting so hard I broke out in a rash (you probably don't have meningitis but it might be a good idea to check) and when I was simply suffering from migraine.
I appreciate your work and as an intelligent, educated, scientifically literate adult I understand that no system is perfect and even if I had a live in consultant, she would not be perfect either.
Posted by
Pepperpot |
7:46 pm
Hi, just want to let you know who fab you blog is. I can identify with absolutley everyhting you write about, and some of the stories are so similar my own experiences it's scary. I'm a call handler for scotlands' NHS24, and I've passed your blogaddress to alot of colleague. With regard to the tragic 'cock-up' you referred to, yes, it's has had a huge impact on morale, but things have improved. There is no such thing as a perfect nhs service, and wether it's telephone triage, out of hours gp's, ambulances of acute hospital wards, mitakes will allways be made. We can only do what we can to make sure it doesn't happen again. My partner is an ambulance dispatcher, so with regard to nhs24 calls not being emergencies when sent, could I remind paramedics that when any call through nhs24 is warm transferred (which is a large number of them) to a 999 call taker, their own AMPDS system reprioritises the call according to information given, regardless of the reason for being passed through. So an ambulance dispatched by this method has been assessed and prioritised by ambulance service, not nhs24. Obviously Nurse ordered urgent cases may not necessarily be precise, but they either have to err on the side of caution, or order on the basis of the information given. As we all know, patients VERY OFTEN don't tell you the whole story. Also, GP's get it wrong too, and you don't need reminding that urgent cases run out of time and can sit without a response for hours before an ambulance gets there, by which time the paitient is seriously ill, and as has happened, is dead. NHS24 came about because GP's refused to work out of hours anymore - unlike NHSD, NHS24 is now the only access patients in scotland have to an out of hours service. It is for emergencies that cannot wait until own gp surgeries open, and unfortunately, like 999, it is chronically abused. People with ingrown toenails and have vomited once but feel fine now demand gp home visits immediately. Nurses are supposed to sort the dross (alot of it!) from the emergencies, which is quite difficult if everyone calling chooses to ignore the message that says the service is for urgent and emergent calls that can't wait until normal gp's are open (with recommendation to dial 999 if life threatening. I'm a student nurse myself, and couldn't do the job our nurse advisors do. Yeah, as a call handler I get shedloads of abuse and often really emotional calls (the terminally ill, blue babies, child protection issues, you name it). THe most frustraitng calls are the 'regulars'. They phone about 20 times a night with absolute nonsense, or ongoing problems, and take up valuable nurse advisor time. I'm at the point where I actually know several of them by voice alone, they don't need introduce themselves. But they can't be prosecuted for abusing the service. So every service has it regulars, its dross, it's mistakes, it's successes. Unfortunatley the successes are rarely highlighted, and others are made scapegoats in the media. And who's central to this entire process? The patients. It's time we all took a but more responsibility for ourselves and our health, to take the pressure off stretched resources and get help to those who need it most.
Posted by
Unknown |
10:30 am
Apologies for the atrocious spelling, didn't bother checking it before posting....
Posted by
Unknown |
10:32 am
Like you say, the service is grossly misunderstood. The lack of publicity of what the service offers never ceases to amaze me. I'm call handler myself, and can understand how, from Joe Public's point of view, we differ from what is publicised.
One thing i've noticed in my time here is that people will be reluctant to accept anything if its not what they expected/want to hear. That is, eg when someone is ringing at 3am for their daughter with toothache, and we tell them there are no dentists available through the night, instantly, the service is useless and we get all the usual abuse regarding how crap we are.
Amen to the part about agency staff. I (ironicaly) started through an employment agency and from my time starting here, realised how useful and effective the sevice offered can be if you try hard enough. The latest influx of new starters rarely seem to grasp or comprehend the importance of delivering the service to callers, and tend to be quite monotamus, sticking strictly within the questions posed, disregarding everything other than what we need at our end. Saying that all agency are disinterested would be wrong, there are some people who really strive to do their best for callers as far as possible.
Your blog is great, keep your chin up and keep blogging please.
Posted by
Bertus |
6:16 am
Hi
Your blog is great - please keep posting. We need people like you to tell us what's going on. Hope you're Ok.
Posted by
Unknown |
11:54 pm
Hi, i must say i think your blog is brilliant! I work for nhsdirect, i've just recieved my xmas rota and stumbled accross you whilst googling " i hate nhs direct"! To say it wasn't good would be a huge understatment. I hope yours is better than mine.
I agree with alot of what you say. The easy part of our job is the patients, ok we get the odd mental health or abusive one but the majority are genuine people wanting advice. I'm happy to help these people. However due to recent changes our "induvidual figures" are now scrutinised by our tl's (who prob haven't taken a call for several years). My happy go lucky empathetic approach has lessoned somewhat since being told i now have to do 80 calls a shift, i'm not allowed to used "not ready" unless absoutely neccessry. believe it or not i was even reprimanded over having 7 toilets breaks in a shift (i'll remember to e mai the entire office next time i have a water infection thou so don't worry)!
please keep your bloggs coming, they have made me feel less like a "moany old women" of the nhs...
Posted by
Anonymous |
9:26 pm
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