Tales from Tragedy Towers - Life at NHS Direct

FAO Tom Reynolds/Brian Kellett

2009-09-01T22:53:00.004+01:00

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:

NHS DIRECT NEVER EVER EVER TELL ANYONE TO CALL A FUCKING AMBULANCE. IF SOMEONE IS HAVING LIFE THREATENING SYMPTOMS THEY ARE PUT STRAIGHT THROUGH TO AMBULANCE CONTROL.

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.

C'est moi! (slight return)

2007-03-28T01:10:00.000+01:00

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?

Oh noes!

2007-02-19T03:39:00.000Z

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*

How can I help?

2007-02-01T21:36:00.000Z

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.

Crystal Bollocks

2007-01-28T21:12:00.000Z

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:

D&V, LHS ABDO PAIN, FEVER - 2 DAYS

PAIN/SWELLING POST XLA YESTERDAY. SX WORSENING

PV BLEED, PELVIC PAIN TODAY -TOP AT 10/40 4WKS AGO, LMP 3MTHS

SLIGHTLY SOB ON EXERTION, DX CHEST INFECTION& RX ABX 3 DAYS AGO

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:

Yes, a flu-ridden kitten using the NHS Direct Freeview service.

Attention readers!

2007-01-23T19:50:00.000Z

http://www.tragedytowers.co.uk

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

2007-01-23T00:14:00.000Z

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"

Ouch.

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!

The Bigger Picture - Redux

2007-01-22T04:09:00.000Z

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..."

me - "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!"

NURSE!!

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.

The Bigger Picture

2007-01-21T19:39:00.000Z

Sometimes it helps to be in possession of all the facts. Last year I took a call from a woman in her mid-thirties, she had mild lower back pain but excruciating thigh pain. She sounded intelligent, funny, one of those callers who make the job a pleasure. Something didn't seem right to me though, I occasionally get these hunches and like to act on them, just in case I'm right. Thigh pain and mild lower back pain only got her a P3, but I had the niggling feeling this was more urgent. Was she sure she hadn't had a recent accident? Could she please try and think of any prior conditions she'd had with similar symptoms? Was there anything at all out of the ordinary that I should know about? She couldn't think. I toddled off and discussed it with the CS, that's how weird I felt. CS said if it was just thigh pain, no calf pain, no shortness of breath or difficulty urinating/defecating then she should be fine to wait for a callback.

Got back to my desk, got the caller back, wrapped up the call and just as I was about to finish the call she came out with this gem:

"Actually, I knew I'd forgotten something! I was supposed to have a baby two weeks ago. Could that have anything to do with it?"

Supposed to? Er... So I asked her "Um.. what happened?", carefully leaving the question open in case the baby had died or something.:

" My due date was weeks ago, stubborn little bugger this one!"

WHAT? NO! If you miss your due date it doesn't just roll round to the next month, it has to come out! So, as calmly as possible I asked if it would be alright if I transferred her straight to one of our nurses for a 'chat'. Lovely, sweet, very-pregnant lady said:

"Thank you so much. Maybe she'll be able to explain this weird pressure sensation too. You've been so helpful"

I'll blame the hormones. Thank heavens for hunches.

I get tons of pregnancy related calls. The following scenario has happened at least ten times to me. Another friendly, polite caller, very calm and complaining of severe lower back/abdo. cramps, passed a mucus plug, felt 'wet', alternating constipation and diarrhoea, 40 weeks pregnant. I asked, as is my job, if there was any chance she was in labour? Her reply almost knocked me off my chair:

"Oh heavens no, don't worry, it's not due till Monday!"

What could I say to that? I pointed out that it was Saturday, and also not uncommon for babies to arrive a couple of weeks either side of their estimated arrival date. She said:

"But it can't come today, who'll look after my other three?"

Wow. I know nature can make some women blank out the trauma of childbirth, but just.. wow. She was the first caller like that, not the last by a long-shot. I transferred her to a nurse, gave a run-down of the symptoms, and hoped we wouldn't have a telephone delivery on our hands!

NHSD almost killed my baby! or How to access your GP OOH service

2007-01-20T18:36:00.000Z

GP OOH Services

At evenings and weekends your doctor's surgery will usually be closed. Rather than a GP from your surgery staying up 'on call' all night, surgeries in your local PCT (Primary Care Trust) will usually be contracted out to an OOH provider. These are centralised services, often based at local hospitals, Primary Care or Urgent Care Centres (PCC and UCC) who have a staff of doctors and call-takers. If you need a doctor when the surgery is closed you will need to call your OOH service. You may be triaged or you may get straight through to the UCC/PCC, they will arrange to see you if necessary. home visits are rare and usually limited to the terminally ill or housebound. OOH services prefer to bring the mountain of patients to Dr Mohammed, so you'll be advised to visit them at the PCC/UCC. You'll be assessed, treated, and medicated if necessary.

Sadly many people don't understand this. They remember the days when they 'called out' a GP. They remember this with rose-tinted specs, forgetting the long wait as one GP treats the whole community, the inability to fill the prescription he wrote you until Boots opens on Monday, the sound of breaking glass as someone broke into the GP's car. Ahh, halcyon days indeed.

Joe Public - "I need a doctor out now"
Me - "NHSD offers nurse assessment and advice only. To access your GP OOH service you need to call them"
JP - "But my doctor is closed, they put me through to you!"

But - they put me through to you

No. Just no. I'm fed up of hearing how "NHSD almost killed my baby" because people cannot follow instructions. If you call your GP when the surgery is shut in 99% of the cases you will hear this message on the answering machine:

"The Surgery is now closed. In case of emergency please dial 999 and ask for an ambulance. For medical advice only please call NHS Direct on 08454647 (this bit often repeated, up to three times!). If you have a medical problem that cannot wait until the surgery opens, please call [OOH Number]".

Variations on this include:

"The Surgery is now closed. In case of emergency please dial 999 and ask for an ambulance. For medical advice only please call NHS Direct on 08454647 (lather, rinse, repeat). If you have a medical problem that cannot wait until the surgery opens, please hold to speak to an operator"

or

"The Surgery is now closed. In case of emergency please dial 999 and ask for an ambulance. For medical advice only please call NHS Direct on 08454647 (repeat ad nauseam), If you have a medical problem that cannot wait until the surgery opens, please press #1"

If you're very lucky, dialling your surgery number at weekends may automatically divert you to your OOH provider.

See. No-one was put through to anywhere. In virtually all cases the caller will have taken the very first non-emergency number given to them (ours) and hung up. I'll verify it myself if necessary. I do wonder why they feel the need to give our number twice (or even thrice!) and then hastily garble out the OOH number, no wonder people get confused. Ahem.
I called to get someone's OOH number once, the message gave our number three times, then there was a 'click' sound as if the line had gone dead, but no dial tone. How curious! After waiting 90 seconds the speaker came back on the line and gave the OOH number in a disaffected, barely audible fashion. The original caller wasn't the only one who was upset, I reported the practice to my supervisor and the complaint was forwarded to the relevant PCT. Another fairly frequent occurrence is that the receptionist at the practice will forget to put the answering machine on over the weekend. Even GP receptionists are only human (no, it's true!). If this happens it's easy enough for us to find the relevant OOH service for the caller.

So now you know, if you want your GP then call them, not us! If you want your GP then call them. Don't call us and then scream and shout because you had to wait for a callback. Like I said, if the receptionist at your surgery has forgotten to turn the answering machine on then just call us and ask for the OOH number. Ask at your GP surgery, and keep the number in your mobile in case of emergencies. A GP is the only way of getting a prescription or a diagnosis. We are here to provide 'Health information and advice'.

I've posted this because I'm fed up to the back teeth of people saying "I called NHSD and they made us wait 4 hours for a doctor" or "They failed to diagnose my baby's [illness]" We have no doctors, we don't diagnose, and (the most important thing of all) we can only go on the information that you, the caller, gives us. We don't have access to your medical notes or history. If you fail to disclose something, or exaggerate your symptoms (you'd be surprisd, trust me), we cannot be held responsible if an inappropriate outcome is reached. While we can pass your details to your OOH provider after an assessment if you need to see someone urgently, it's easier for you to access Out of Hours services, and you have a right to use them if you need to. Don't waste their time with ingrown toenails and cold symptoms, but it will almost always be quicker than calling us for advice if someone is genuinely ill. Even if you know it's your local NHSD that deals with your OOH provision, don't call on the 0845 number, use the dedicated OOH number. It might get through to the same place (it probably won't now that NHSD has gone national) but it's a different service and the calls are treated differently.
Even unregistered patients or visitors from other parts of the country can use their local service if they need to see a doctor.

What a load off my chest. Hopefully I won't have to live in fear of hearing "NHSD almost killed my baby/granny/dog!" Then we can get back to the business of giving information and advice, not delivering babies and saving the world!

* The information in this post applies to England only. Scottish OOH services are now handled entirely by NHS24 (the Tartan NHSD) and Welsh services are often handled by NHSD Wales.

NHSD Explained - part 2

2007-01-19T23:55:00.000Z

See 'Help' post below for the first part of this post.

Streaming - what is it?

Occasionally you won't need to be called back by a nurse. We 'stream' calls to other places when it's blatantly obvious we can't help you, and waiting for a callback would put you at risk, or be pointless.

Pharmacy stream - self explanatory. You've got a meds query but are asymptomatic, or you've run out of meds and are asymptomatic. Maybe you're away in a different part of the country and need to find out where to fill your prescription. Pharmacists are the people to speak to about medications.
Dental stream - for non-urgent dental problems, usually not terribly painful or merely cosmetic. Callers will usually be advised to call their own dentist. If they're not registered then we'll give them details of local dentists.
GP stream - if you've got symptoms that obviously need treatment then we'll tell you to call your surgery asap. Not much point in waiting for a callback from a nurse to be told exactly the same thing.
Urgent Dental stream - if you've got severe dental pain then we'll give you the number of an EDS so you can be treated. This one's quite important as EDS places are very limited, and while you waited for a nurse callback all the appointments would be snaffled!
A&E stream - you or someone else is injured (broken arm, head injury), or so ill (vomiting blood, loss of vision) that they need to be seen in A&E. We always advise that if the patient's symptoms worsen en route that the driver pulls over to a safe place and calls 999
999 Ambulance stream - suspected heart attacks, cyanosis, unconsciousness and serious accidents get you an ambulance. We'll call control and give basic details and then transfer you to them.

You can, of course, refuse a stream. We don't offer some of them at certain times, after all there's little point referring you to your GP if the surgery is about to close or it's already shut. Refusing a 'streamed endpoint' will earn you a place in the callback queue. Pharmacy and dental will be downgraded to a P3, GP and Urgent Dental to P2, A&E to a P2 or P1 after discussion with a CS, 999 refusals are transferred to the first available nurse.

OOH Services

As you may, or may not know, NHSD is contracted by some GP and Dental Out of Hours services. This means that as soon as your surgery is shut and you call your OOH number, you'll get through to us. (Other services include Primecare and Dencall). We will introduce ourselves as being from NHSD so that you know who you're dealing with, however the way your call is processed is different than regular 08454647 calls (Triage calls). With GP OOH services you will be triaged as normal, then your details may be sent straight to your on-call service or placed in the callback queue with the rest of the calls. If your call is queued then it will have a shorter callback time than normal triage calls, you will effectively be queue-jumping. The callback time will usually be within the hour for both P2 and P3 calls for GP services. The calls are labelled as GP/Dental OOH in the queue to differentiate them from Triage calls.

Now technically, NHS Direct is supposed to be a one-call service out of hours. If you call and the nurse advisor thinks you need to see your GP urgently then they can send the details straight to your OOH service, so that you don't have to make a second phone call. This is done using a computerised 'technical link' service built into our software. Your OOH service will then call you back and arrange for you to be seen if necessary, maybe even arrange transport for you if you need it. It's a great idea, but it confuses Joe Public. Next time Joe's ill he decides to call us because his doctor is closed. He can't understand why his last call ended with him being seen by a GP at his local Urgent Care Centre, yet when he calls asking for a doctor he is told that NHSD is staffed by nurses. It's a very common mistake, maybe 1 in 6 calls on an OOH shift.
The most common problem by far is when Joe or Josie calls, and irately says "But I called my GP and it put me through to you" when I tell them that to actually see someone that they need to call their OOH service. So read my next post for an explanation, as simple as possible, to clear up confusion.

(Wow. This is a far more Herculean task than I'd envisioned. Part 3 coming soon, my fingers are aching now! (I've written this all in one go, no drafting or editing here!)

Ouch. So we'll make it a date for Sunday then? )

TTFN!

Help!

2007-01-19T00:35:00.000Z

I'd be much obliged if people signed this petition It's a campaign about the proper use of the 999 system. Cheers!

As my gift to you I will guide you through NHS Direct, what it's for, how it works, and when to use it. I'm doing this because people often seem confused about what we do. They think we can make home visits, that we have GPs on staff, or that we're a finite resource. None of the above are true.

What is NHS Direct?

NHSD is a telephone advice service staffed by qualified nurses. They often have a background in midwifery or general nursing, but we also have former district nurses and practice nurses. They're very experienced, and there are a lot of nurses who are unable to carry on more 'traditional' nursing roles due to injury or ill-health, and have been able to return to nursing through NHSD.
The nurses are there to give health advice about common symptoms, medicine interactions, and home care advice. They cannot diagnose or prescribe, as they never see the patients. They are assisted by CAS - the Clinical Assessment System. This is a series of computerised algorithms specific to particular symptoms. It prompts the nurses to ask questions about the patient's symptoms until a final disposition is reached. The dispositions include 'Home Care', 'Routine GP Appointment', 'Pharmacy Advice', 'A&E immediately', '999 Ambulance' etc. There are too many to list! The nurses can also fall back on their years of experience, as well as advice from colleagues or the Clinical Supervisor. The CS is a senior nurse who manages the other nurses, and can give advice to other staff who may be unsure about a call.

I'm a Health Advisor. We are usually the first person you speak to when you call NHSD. It's my job to prioritise/triage calls so that they can be dealt with in order of urgency, just like at an A&E dept. We can also give interim care advice to help you deal with your symptoms while you wait to speak to a nurse. Depending on the urgency of your symptoms we can sometimes refer you straight to your GP, A&E, or Dentist/EDS without your ever speaking to a nurse. Sometimes it might even be necessary for us to call an ambulance for you. As well as all of this we can also find you a GP, Dentist/EDS or Pharmacist in your area, or arrange for one of our Health Information Advisors to call you back if you have a more complex query.

Health Information Advisors perform an important role in NHSD, one which the public are often unaware of. If you've been diagnosed with an illness, or there's a public health alert, or you need to know who to contact for information about any part of the NHS then the HI Team can help. They can send literature to you in the post, direct you to approved websites, and give you details of helplines and support groups in your area.

How does it all work then?

You call 08454647 (0845 606 4647 from a textphone). When you get through I'll say "Good Evening, you're through to NHS Direct. My name's SSM and I'm a Health Advisor" The first thing I need to do is take your telephone number, and the address you're calling from. This is important in case we get cut off, or I need to send an ambulance. It seems impersonal, but it's necessary.
I'll ask for a brief summary of your problem, ensure the patient is visible to you, then take their name and date of birth.
I then have to ask five routine questions. This is necessary for every symptomatic call, so please do not bitch at me. These questions ensure the patient is conscious, that their airway, breathing and circulation are not compromised, and that the patient does not have a petechial rash that could indicate meningococcal septicaemia.
I will then ask questions more specific to the patient's symptoms.
These questions will enable the call to be given a priority (more on that soon). After I've accepted the priority (or upgraded/downgraded on the advice of a CS) I can complete the patient's chart
If there's an existing chart for that patient I can link them up, if not I'll create a new one. I'll confirm the address and phone number, ptient's ethnicity and gender, and GP details.
On the final screen I'll put in a call reason, the caller's name and relation to the patient, and a few notes.
I'll give an estimated callback time, but always advise that the caller should call back if the patient's condition changes or worsens.

OK, Priorities. Callers get very upset about this. Obviously if someone is in grave danger then they are a high priority call and need to be dealt with asap, but most people don't understand this at all. I'd say a good 70% of callers think that diarrhoea is more serious than a heart attack.

P1 - caller in immediate danger, with severe breathing difficulties, heavy bleeding, chest pain, threatening suicide, in labour, meningitis symptoms, ingested toxic substance and vomiting/in pain etc. - these calls are dealt with immediately/by the next available nurse
P2 - minor injuries, abdo. pain with diarrhoea and vomiting, fever, calf pain, mild chest/upper back pain, over 20wks pregnant with pain or bleeding, urinary problems, severe sore throat, heavy flu symptoms, swallowed toxic substance/foreign body but asymptomatic etc. - estimated callback within an hour, but in reality between 10 and 90 mins depending on how busy the service is.
P3 - cold symptoms, stubbed toe, mild headache, vomiting, complex meds query, 'man flu', pregnancy symptoms under 20 weeks, teething, nappy rash, hives, heat rash etc. - callback time is anything up to 4 hours, but can range between 30 minutes-6 hours if it's horrendously busy.

We also have D1, D2 and D3 - dental priorities:

D1 - sudden facial swelling, heavy bleeding, unable to breathe, severe facial injury (next available nurse)
D2 - Severe dental pain, pain relief tried and not working (within an hour)
D3 - pain for more than 2 weeks, pain relief not tried or giving relief of symptoms, loose fillings or crowns (the possibilities are infinite)

OK, explanations and 'When to use NHSD' in my next post, I'm exhausted from all the typing, I feel like I'm at work!

Stay tuned.

An Apology

2007-01-17T01:59:00.000Z

People of Britain, I am apologising to you on behalf of all at NHS Direct, the NHS as a whole, and the UK Government. I am sorry we have robbed you of your coping skills, I apologise most humbly for destroying your critical thinking abilities, and wholeheartedly wish we could consign the last ten years to Room 101.

Yours, SSM.

-----------------------------------------------------------------------------

OK, seriously. What the fuck have we done to the people of Great Britain? My little, tiny multiple choice quiz will test your powers of reasoning.

1) Your toddler has a temperature of 37.2C. He has no symptoms, he does not feel unwell, he is playing, and chatting away. What should you do?

a) Open a window, make sure he's lightly dressed and drinking plenty of fluids
b) Monitor the situation, keep watch for any emerging symptoms as a raised temp. can often be a sign of underlying problems
c) Ensure your kid is wrapped from head-to-toe in woolly clothes and blankets, turn the heating up to full, then call NHS Direct. Scream and shout about meningitis, threaten to go to the papers because you're given a 20 minute callback time, then hang up and go to A&E

2) Your teenage daughter calls. She's been to your mum's house for tea with her grandparents. She's worried, Gran's had a chest infection for three weeks, but today her skin looks grey, and her lips and nose are blue. She seems to be struggling for breath. You live next door to them, what should you do?

a) Wait four hours and phone your own GP. Then phone your mum's GP. Then phone NHS Direct, complain that it's taken fifteen minutes to get through, ramble about your own granddaughter's recent measles scare, fail to answer questions directly, don't disclose that you live next door to your mother, then laugh when you're told the symptoms are very serious.
b) Go and see your mum immediately, confirm what your daughter has told you, and then call for help if necessary.
c) Dial 999

3) Your 4 year old has just come in from the garden, he's eaten a bit of mud after his big sister dared him to do it. He's upset, he trusted her and it was nasty! Oh my, what to do?

a) Comfort him, tell Big Sis to apologise and give him a cuddle, remember to tell all his future girlfriends about it.
b) Freak out. Strap the boy into his car-seat, phone NHS Direct on your way to A&E, scream "DO SOMETHING!" frequently, try and induce vomiting.
c) Keep an eye on the nipper, try and take his mind off it, these things happen, big sisters can be evil!

Now, these things seem like common knowledge to me. If your answers were 1C, 2A and 3B then I fear for you. These are all real examples from the last week at work. 1 and 3 actually happen every single shift.

Sorry Britain. We didn't mean to make you a nation of idiots, we were only trying to help. Can you forgive us?

Jingle Blargh

2006-12-28T01:02:00.000Z

I'm so glad that's over. Words cannot describe my 'Christmas'. I'm exhausted to the point of tears (and spent my break locked in the lavs at work yesterday, sobbing like a small child). Here are my highlights:

being called a 'vile racist' for saying the 'C********' word, when explaining why someone could not see an emergency dentist for a loose tooth at 22:00 on the 25th
drunk people, needing ambulances, but not knowing where they were on holiday
trying to understand why someone would call at midnight on the 25th, when we had an 8 hour callback time for non-urgent calls, because she was concerned that her skull was not perfectly smooth like an egg

Dear reader, I only wish these stories were fabricated. After four days of this mindbending idiocy I have lost all faith in humanity. I intend to spend the next three days drinking until the room spins, and eating curry!

Everyone's a f***ing comedian.

2006-12-17T20:30:00.000Z

Yep, you heard it, there's nothing like a bad situation to bring out the ~~idiot~~ best in people. You'll be surprised at what people laugh about when they're on the phone to me. Often callers aren't aware of how serious some conditions can become, some people are just naturally stupid.

Here are some things that I consider to be funny:

silly images of cats performing human tasks
a litter of puppies being menaced by a cat
Harry Hill on You've Been Framed
Old people trying to understand Bluetooth

Things that I fail to see the humour in include:

18 year old students called Tabitha, from the Home Counties, in stitches because their friend Araminta has taken seventeen temazepam and can't stop walking into walls and talking about penguins
A drunk woman chuckling about her two year old boy who can only walk in circles and has "forgot all his words" since a garden gate fell onto his head at a family barbecue three days previously
The babysitter who accidentally gave her 11 year old charge two tramadol for her period pain instead of paracetamol, and finds it endlessly amusing that the child in question keeps scratching her own nose and falling over
The father who rubbed Karvol on his baby's face and was very entertained at the fact that "The skin is all red, like he's pissed or something!"

and finally:

The mother who sat and watched her toddler drink the contents of a Glade liquid air-freshener, and giggled because "her breath smells exactly like lavender!" When asked why she'd allowed this to happen, she exclaimed "It's made of natural ingredients!"

*sigh*

I fear for the human race, I truly do!

Interlude

2006-12-10T20:17:00.000Z

A cheery insert, because occasionally I get to have a laugh. People assume that because we answer their calls that we've been lobotomised and drugged. We were also raised in lab conditions and know nothing of the outside world.

Sadly I can't disclose exact details, it'd almost certainly unmask me, but you'll get my drift! I'll obscure it by using fictional symptoms and a made up name.

Me: Good afternoon Worried Well, my name's Lowly Callgimp, how may I help?

Curiously Afflicted : Oh yes, I mean you won't be able to because you don't know about this sort of thing, but I'll explain it anyway.

Me : [thinking 'Thank you Oh Gracious One'] Oh please do.

CA : Well I have this condition, it's incredibly rare, so rare you won't have heard of it. It's not fashionable enough to be on telly all the time HAHA! Anyway it causes diminishing eyelashes, blue dandruff, swollen toena....

Me : Oh yeah, Von Wallpaperen's syndrome?

CA : [stunned silence] I.. I hadn't finished.

Me : Is it though?

CA : YES. How do you KNOW? I expect it was in one of your women's magazines, was it?

Me : I've had it for years.

CA : No you HAVEN'T, you can't have!

Me : I have, I promise.

CA : I don't think so, prove it!!

Me : OK I have to take crushed up blue smarties, and I've had a pelmet fitted.

CA : I don't believe you. You're reading from a screen.

Me : [sighs] I really have, I promise, so fortunately I know a bit of background. Tell me your exact query and one of our Health Information Team can research it for you.

CA : It doesn't matter, GOODBYE!

[click]

Aww. I guess it's not much fun finding out you're not a precious, unique snowflake after all.

Once in a Full Moon

2006-12-10T17:50:00.000Z

I occasionally get an eight hour shift so chock-full of idiocy that I wish for Armageddon. Calls so stupid, and upsetting, and laughable that I have to wonder what the Hell is in the water supply. Judge for yourself.

Sugar Baby Love

Me : Good afternoon, you're through to McDonalds, can I take your order?

Sugar Mummy : My little boy is three. He has terrible toothache, he's on the maximum dose of Calpol and Calprofen, but he's still crying.

Me: I'll ask a few questions, then we'll see how we can help him today. Poor little thing, toothache's bad enough when you know what's going on.

SM : Oh yes please, it's awful to see him in pain.

Me : [runs through ABCs, checks for recent injuries/dental treatment] OK, I've found an EDS in your area that will probably see him tonight, it opens at 6pm, [gives number]

SM : But that's two hours! He has an appointment for tomorrow morning, but he's in pain now, it's been going on for two months. Do you think it could have anything to with with the fact that all his teeth are black and sort-of stumpy looking?

Me : [choking back hostility] Call the EDS, they'll be able to give better pain-relief advice.

SM : OK thanks, haha, kids and their sweets eh?

[click]

Poor little fella. A future CMHT referral there I think.

Computer says 'No'

Me : Good Evening, House of Idiot. My name's Suicidal Ideation, and I'm not sure how I got here, how can I help?

God Help Him : Oh Hi yeah, I can't find the phone number for my GP. I need to see him tomorrow about some vaccinations for my gap year in nepal.

Me : Not a problem, which practice are you registered with? [opens NHS UK and enters patient postcode]

GHH : I don't know.

Me : Um.. do you know your GP's name?

GHH : [irritated] NO

Me : Which street is it on?

GHH : IF. I. KNEW. THAT. I. WOULDN'T. BE. CALLING. YOU. [dramatic sigh]

Me : Then with all due respect, how do you expect me to find it for you?

GHH : It's in SW6, duh!

Me : That and about 200 others. [starts reading down the list]

GHH : Oh wait, I know it's open late!

Me : [opens each individual practice page] Sorry but I've looked through 20 results, they're all only open until six.

GHH : Yes, that's when it's open till, I told you!

Me : [wondering what's sharper - the edge of my lunchbox or the monitor stand] Guess what? That's what time nearly every practice in the country is open until. I can't help without a single, identifying factor!

GHH : Well if I get malaria and die, then on your head be it!

[click]

Please Darwin, if you're up there?

Part two on it's way soon. (ie. after I eat some crumpets and bask in the glory of having Sunday off work)

Hiatus

2006-12-10T17:18:00.000Z

I've been neglecting my embryonic blog of late. Such is my dissatisfaction with NHS Direct and the NHS as a whole that I didn't dare write, for fear of the dripping venom dissolving my laptop. Current government strategies for improving the NHS seem to be:

getting rid of senior/supervisory posts - after all, it's not very democratic to have to answer to anyone is it?
replacing qualified staff with whichever penniless student, desperado, or chancer happened to walk into the recruitment agency first
'solving' the above by giving them so much training, for so long, that they can't cope on their own and leave after two weeks

New job titles are created so that no-one feels left out, in the last two years this has accelerated to the point where no three NHS workers have the same job title. If a patient calls we have no idea where to refer them. We can't say "We can't deal with this, it would be more appropriate to call your GP/District Nurse/Social Worker/CPN" No, that's too easy. Now they have a Community Mental Health Team, often a strictly 9-5 job, unreachable outside those hours. They have a Chronic Illness Management Nurse or liaise with an Expert Patient Panel.

This makes the whole system a joke. We have a new assessment system so that if a patient calls and it's blindingly obvious that they need to see their GP, then they'll be told to contact them (in hours) or we'll electronically refer them (out of hours) This makes the queue for nurse assessments much smaller, and saves people waiting hours to be told the blindingly obvious. However callers often tell me "Oh the secretary told me to call you, and that if I was ill I'd have to call at half eight tomorrow morning to see someone" My GP surgery works like this. You call at 8:30 am, receptionist takes your details, a nurse calls you back and telephone triages you, you go to the surgery and see the nurse practitioner, then you wait for two hours in the waiting room to see the next available doctor. So people don't bother, they use the OOH service instead, or call us, and both services end up like an old tart, stretched and abused.

Apologies. It just needed to be said. Back to ranting about the callers next, I promise!

PS - NHS Blog Doc is a must read for anyone else interested in the worrying state of the NHS, and interesting patient stories.

Glow in the dark - an open letter to the Russians

2006-12-10T16:55:00.000Z

Dear Russian operatives,

it is not often I recommend the American way of doing things, but next time you want to 'neutralise' someone who is irritating you, please use a gun. They're relatively easy to get hold of. I could pop down to my town centre and arrange to at least borrow one. Radioactive alpha particles might win you "Most Creative Assassination" award at this years Mobbo Awards, but won't someone pleaaaase think of the NHS?

Yours,

Sick, Sad Minion.

Oh it's been exciting at Tragedy Towers. There we were, sat taking calls at last after a telephony failure, when the little yellow Envelope of Doom appears at the bottom of our screens. Normally the EoD signifies something as dull as a message saying "BADGERDOC Out of Hours link not working, please advise patients to contact directly on Admin number" or "TENY site closed due to staff laziness so expect OOH calls from Scarborough on 0845 line". So I click EoD and see:

"URGENT! We have received word that BA have issued a press release to Sky News, further to the investigation surrounding Alexander Litvinenko. We have no further information at this time and the HPA (Health Protection Agency) have not issued specific guidelines for callhandling."

Oh well. It can't be that bad can it? I mean.. they'd have informed us in advance if it was going to be that bad, wouldn't they? I quickly nipped over to the BA website and read their press release advising anyone affected by the news to 'call NHS Direct on 08454647" I then clicked the link of affected flights, oh... only 220. I was beginning to regret my decision to schedule a late break that shift, there was no way I'd be getting one now, and hot, salty tears ran down my fat little face.

There wan't a supervisor in the place that didn't look like a plane had just landed on their gold-plated house. A colleague informed one of them that 220 flights had been affected, he choked back a cry and snapped "It's not official, the HPA haven't announced that!" No, he was right, if the HPA don't verify something then it isn't true. Ahem.

Countdown 3...2....1... "Good evening, thank you for calling NHS Direct. My name's Inappropriately Amused and I'm a Level 3 Operative, how can I help?"

Chaos ensued, tempers were lost, I began searching for Polonium on eBay.

Smile!

2006-10-05T20:04:00.000+01:00

Damn I forgot. We can't smile, we're British. Dental care in this country has gone down the toilet. In the last year it seems, to us on the frontlines , that the crisis is deepening. No-one can register with an NHS dentist, private dentists often require that the patient's entire family join a 'dental plan', and some stipulate that only the 'dentally fit' may register. Yes you read that right, only people who don't need a dentist can get one.

A good 40% of my calls on some days are dental. I speak to people who need to register because they've moved house and have unregistered with their previous practice, or people with snapped teeth, or sudden toothache.

I need to register with an NHS dentist in my area. Can you help?

Well I'll try. Firstly the tools available to us are, for the most part, no different than those available to you, dearest reader. We used to be able to search for which dentists were currently registering certain types of patients, ie. on benefits, under 18 years of age. Now we can only search for the nearest practice to your home postcode. So I go here: http://www.nhs.uk/England/Dentists/NearestSearch.aspx
I'll type in your postcode and try to locate a dentist that will register you. This is problematic for several reasons.

They've crippled the search to return a maximum of 25 results. In a densely populated area this is useless, as all 25 are likely to fall within two miles of your address. I suspect this is so we can't say "The nearest I can find to you is 63 miles away" We used to be able to tell people the truth, we can't now. This makes them even angrier. Some people are so desperate they'll drive 20 miles there and back, some won't go as far as the next street. If they moan about a 2 mile journey my stock response is "at least you don't live in Leeds" (try it on the dentist search applet)
Results are ordered by distance from your address as the crow flies. Geographical features such as major rivers and huge mountain ranges aren't taken into account. Sucks for you if you're not willing to swim across the Thames.
Results are not grouped by PCT. I might find a dentist in the next street, but if it's not covered by your home PCT you're bang out of luck.
Dentists rarely inform us when they stop taking patients, so information is often inaccurate.

If I can't find one within a decent distance then I'll have to give you the Dental Enquiries number for your local PCT. This is a poor solution as they often say "call NHS Direct". Lazy swines.

Owww my tooth hurts. What should I do? I need a dentist!

OK. I'll run through a quick assessment. I'll find out why your tooth hurts, for how long, if you're registered with a dentist, and which painkillers you've tried. Unless there are exceptional circumstances the following will put you to the bottom of the queue:

You've had pain (or claim to have had it) for more than two weeks.
You haven't tried anything to relieve the pain except crying and calling your helpful NHSD Health Advisor a c***
The painkillers are working for you.

If you've got a seriously bad case of tooth-hurty, then I'll be able to find an EDS (emergency dental service) for you. You will accept whatever details I give you. Whining that the EDS is 4 miles away will dump you at the bottom of the steadily growing dental queue. Asking "Are there any appointments sooner/later?" and you get dumped in the queue. It's for emergencies. Threatening me with "I'll go to A&E then!" will merely serve to make me laugh, and trot out my standard response of "That course of action would be extremely unwise, as you have not had an accident, and your pain - although bad, is not technically life-threatening." That threat cannot make me magically summon up a personal dentist for you. In fact, go to A&E if you must, they'll give you two paracetamol, 15ml of lukewarm water, and a card with our number on it.

Sometimes the EDS will require a nurse assessment before patients can be referred, this is usually for services that have very limited availability, and therefore can't see everyone. Please don't bitch to me about this. I don't have the address or phone number of the service, and no amount of whining can get it from me. Speak to the dental nurse, they're very patient and can often give you tips to dull the pain until a dentist sees you, it's their job.

I'm angsty after writing this. I keep hearing from callers that "A&E/my dentist/my GP/told me YOU could treat this!" We can't. They know we can't, and they know that saying that will get rid of you. I even get A&E staff calling and demanding to know why I can't find Patient X a dentist now, and why there's no EDS provision in that area. I really don't have the answer to that. Don't you think I'm tired of speaking to people who fill their own teeth with a Dremel and caulking, or knock them out on a cupboard door to stop the pain, or sick of being abused for everything that's wrong with the NHS?
Instead of asking someone perilously close to the bottom rung, why not speak to the Minister for Health?

Tak. Mówię po polsku

2006-09-20T16:31:00.000+01:00

We get a large number of callers who don't have English as their first language, especially since we became a national service rather than a lot of regional services cobbled together. Some people only know enough to tell us "No English" and give us their native language, others can make it through the initial assessment but can't comprehend enough to accurately answer the queries in the full clinical assessment. Often they'll have a family member or friend on hand to translate, but we can offer every caller an interpreter, if they feel more comfortable or it's safer, for them to speak in their mother tongue.
This next call was an absolute beauty. The caller was a woman who reminded me of Hyacinth Bucket so much that I was picturing her in a delightful floral frock, with immaculate hair, and a string of pearls. Her accent was so RP that she made the Queen sound like Jordan. She also had a touch of the probation officer from A Clockwork Orange and added a drawn out "Yes" (pronounced h-yeesssss) at the end of most sentences.

me : Good afternoon Moans 4U, I'm Trained Chimp and I'm a health advisor, how can I help?

HB : I'm calling on behalf of my lodger, yes? She's a student at my language school and she looks very poorly.. yes. Anyway she's Polish you see, and doesn't have a GP yet.

[takes patient details]

me : I can arrange for a Polish translator, it will only take a few minutes, and we can assess her symptoms and see how we can help her today.

HB : Oh no dear that's fine, I can translate yes? I have much experience with the foreign girls yes. Polish is not a problem, I speak many languages, yes.

me : Thank you so much, that would be great, it's always easier if there's a translator present with the patient. I need to ask a few routine questions first of all, to rule out any emergencies. Please just answer 'yes' or 'no' even if they don't seem relevant to you. Is that OK?

HB : Oh my yes. Begin.

me : Is the patient still awake and responding normally?

HB : She's Polish, yes.

me : Yes but is she awake, alert? Is she conscious?

HB : Of course, yes.

me : Does her skin tone look blue or grey, especially around her lips and mouth?

HB : No dear, she's blonde with blue eyes. Many of them are you know, yes.

me : Yes, but does her skin colour look different today? Are her lips pink?

HB : Oh of course dear, she's not dead you know ha ha!

me : Is she having any new or worsening breathing problems? Does she sound as if she's struggling to breathe?

HB : I'll ask her [I expect to hear Polish right about now]
"YOU BREATHING? YES? YOU KNOW PUFF PUFF PUFF"

me : *stunned* Excuse me, I thought you said you could translate my questions for her?

HB : Yes dear I am. Was I too quiet yes? Her breathing certainly sounds normal

me : Please, can I get a translator on the line? It would make this much easier.

HB : No dear I'm perfectly capable of translating a little bit of Polish, yes!

This went on for about twelve minutes. A normal call takes about four. She 'translated' everything I said, but here are a few stand-out lines that should help anyone who needs to ask a sick Polish girl some questions:

Where is the pain? = IT HURT BAAAD YEEEES? IT HURT TUMMY OR IT HURTY DOWN BELOW?
Does the pain go through to the back? = IT HURT WHOOOSH THROUGH HERE YEEEESSS? NOOOO?
Have you vomited anything that looks like blood or coffee grounds? = YOU VOMIT? YOU KNOW 'WWWUUURRRRGHH'? YOU WWWWWUUUURRGGGHHH RED STUFF, YES? NOOOO?
Is there any pain on urination? = WHEN TINKLE IT HURT? YEEESSSSS? NOOOO?

When I closed the call I added the following call reason "Abdo. pain and nausea - POLISH TRANSLATOR (speak directly to patient)" Fortunately it seemed poor Agnieska was only suffering from the adjustment to Mrs Bucket's cooking. That poor girl. Shouting broken English very loudly does not equal super linguaphile status!

Happy to help!

2006-09-20T01:10:00.000+01:00

Here are a couple of particularly special calls I've taken. The first was on a GP Out of Hours line:

Me : Good evening Hammer House of Hypochondria. My name's Whitley Terms and I'm a health advisor, how can I help?

Caller (72yo F): *sniffling* My boyfriend stole my Lemsip last night, and I haven't stopped crying since.

Me : *biting through my headset cord* So what kind of help do you need from your GP tonight then?

Caller : I'm worried I might become dehydrated or damage my eyeballs if I don't stop crying. Are there any precautions I need to take?

Me : A nurse will call you back [click]

I only wish it had been a hoax, but I spoke to her again about three times, same problem each time.

I got the next call last August Bank Holiday. Calls were 40% above forecast, non-urgent and Health Information calls were running at 4-5 hours for a callback. We were getting absolutely hammered.

Me: Good evening Circus of Terrors, my name's Papa Lazarou, how can I help?

Caller 2 (45yo F) : Hi yeah, I wore some shoes that were too tight, my heels are blistered, I want advice

Me : I just need to inform you that callback times are running at five hours plus for non-urgent calls, do you want to proceed?

Caller 2 : Yes please, I can't be bothered to get my other shoes out of the cupboard

Me : [there is no emoticon for how I'm feeling] "OK"

I wonder what these people did before we were there? I know Google's hardly the most scholarly or unimpeachable source, but I'd rather try my chances than wait till 3am to be told how to break in a pair of new shoes!

I really do love this job. Even Agenda for Change and Transformation cannot scare me off, i'm here to stay.

You want what?

2006-09-20T00:28:00.000+01:00

Advice for some of my frequent callers:

No Sean, anal sex with your boyfriend won't get you pregnant. You've asked this very often, I'm worried, have a word with your mum or dad about the birds and bees.
Dorothy - I'm really not sure if cream crackers can be taken with tea or they're better with a cold drink, I checked the BNF but couldn't find any interactions.
Josephine - that flaky patch of skin on your nose happens to most of us in Winter. While I can't promise that it isn't cancer, the fact that you've been calling about it for two years gives me hope.
Dorothy again - I don't know about bread and tea either. Once again the BNF has let me down.
Tony - Remember how your CPN told you to stop buying meds from your friends, or swapping yours for cigarettes? It's sound advice, and you should take it. If you don't listen then you'll spend more and more of your time thinking you're a caterpillar. It's not productive. I desperately want you to become your inner butterfly!

*names have been changed to protect my sanity. If I see your real names again I will snap.

Reasons to be Cheerful

2006-09-19T08:40:00.000+01:00

The following are genuine call reasons that I've personally dealt with:

Abdo. pain + vaginal bleed - caller had had a coil fitted that morning
39wks pregnant, severe abdo cramps, pressure sensation in pelvis, watery pv discharge, nausea - caller said "But it's not due for two more days"
Child with red, sunburn like rash and high temp. - child had been sat in the garden all day during the July mini-heatwave
Vaginal bleed and cramping after taking the morning-after pill. How the hell do they think it works?
Oral pain following a dental extraction
13 year old girl with vaginal bleed and lower backache - any idea what that could be? Caller commented that "it happened last month too"

and finally:

11 year old girl with swelling under the nipples *ahem*

Introduction

2006-09-19T06:27:00.000+01:00

There are some people that seem solely devoted to blaming NHS Direct for all the World's ills. I'm here to redress the balance slightly, open up how my job is done, and hopefully shed some light on what we have to put up with on a daily basis.

I personally deal with basic triage, dental enquiries, dental assessment, interim care advice, NHS directory services etc. You'll see examples of most of these, but the recurring theme will (unfortunately) be dental in origin. That's because we're having a spot of bother in this country with regards to state-funded dentistry. I'll try to mix it up with other stories, so as not to bore you to death, after all you're not getting paid to deal with it, I am.

Without further ado, I present the first installment.

I have toothache, hear me roar!

: Good evening, Palace of Pain and Human Suffering. My name's Three Week Migraine and I'm a Health Advisor. Can I please take the telephone number that you're calling from?

Caller: You don't need that, we called.. we called 10 minutes ago. My husband needs a dentist NOW, I MEAN IT!

Me : I can't access his chart without any of his details *already has chart open due to the magic of caller ID*

Caller: HisnameisStupidoMcCandybardateofbirth6thofJune1966

Me: Well I just about got all of that, let me see.. you called five minutes ago about your husband's toothache, yes? What's the problem?

Caller: We were told it would take 15 minutes for someone to call back. If he doesn't get to speak to someone immediately then he's going to take a whole packet of his antidepressants with some vodka. He's very upset.

Me: .............

So I had to get a nurse immediately, because some guy who's had toothache for seven months decides to blackmail us. Great start to the shift eh?

Me: Good evening. Theatre of Death and Mortal Misery, we're currently taking calls on behalf of your GP service. How can I help?

Caller 2 : Well the wife's done her back in, she's in fucking agony, she cannot move, she needs a doctor now. She taks fits man, we've got four babbies to look after [my good lady has an epileptiform disorder and stress causes her to have seizures. Who will help me care for our four children if she becomes incapacitated?]

Me: Could I possibly speak to her?

Caller 2 : Nah she's in too much pain to talk, I keep telling yer.

Me : [explains service, requests that the caller mind his language, and takes patient details, asks ABC questions] How did she hurt her back?

Caller 2 : We were out on the drink the other night. She had a few too many and fell.

[sound of patient in background talking perfectly, telling him not to say that - I try to ignore it]

Me : So.. how many days ago exactly, and has she had any treatment for it?

Caller 2 : About four days ago . She didn't want to go anywhere, she was hungover, and she felt bad because she hadn't taken any [very important anti-seizure meds] so she could drink.

Me : *dies inside* [takes a few more questions, confirms details, gives a call back time of half an hour which I've actually asked permission to shorten from one hour as I'm concerned]

Caller 2 : WHAT?? No fucking WAY!! She's got hold of two of the babbies now, what if she taks a fit and drops them?

*cue assorted moans in the background*

Me: Someone will be in touch very soon. I suggest you put the children somewhere safe, get her to rest until she can get some advice from the nurse, and call back IMMEDIATELY if her condition worsens.

Caller 2 : *grumble, whinge, moan, fucking NHS etc*

I checked later to see what had happened. A nurse had called them within 13 minutes. The original caller claimed the woman had had twenty-seven seizures in that time.

Head - meet carpark three floors down.

Me : Good evening, Sixth Circle of Hades. My names Beelzebub's Minion and I'm a Health Advisor, can I take your telephone number please?

Caller 3 : ROOOAAARRRRR WAAAAAAARGHHHHH MMMNNNGGGGGGFFFFFFFF

Me : Ow. OK. Your TE-LE-PHONE number please?

Caller 3 : WAAAAAAH I've called five times today, I need a dentist NOW!

Me : I still need your telephone number, I can use the one on my caller ID if you don't know it.

Caller 3 : [gives number] This fucking pain is fucking killing me

Me : Hang on while I look at your chart...

Caller 3 : {butts in] I've been calling since 7am and no-one's fucking helping, and it's not toothache it's PAIN!

Me : OK. So you called at 7am and were given an emergency appointment for 8am tomorrow, is that right?

Caller 3 : I can't FUCKING wait that long

Me : Calm down or I'll terminate the call. Now it's a Sunday. There are a very small number of weekend emergency appointments available in your area but they're gone now. If they were gone at 7am today then there won't be anymore until tomorrow. I understand that you're in pain, but honestly, unless it's a situation where you have massive facial trauma or bleeding then you won't be seeing anyone today. You've actually been very lucky to get an appointment for tomorrow

Caller 3 : It's not GOOD ENOUGH. I'm in pain, don't you understand? I've phoned five times today

Me : I know, I have your chart here. However, if you were told at 7am- there were no appointments, 9am - there were no appointments, the same at noon, again at 2pm and once more at 4pm and were told very clearly that there were NO. MORE. APPOINTMENTS. LEFT. THIS. WEEKEND., then why did you think there would be any now? It's nearly midnight!

[the 'five times' bit and the 'no appointments' reply were repeated about seven times, by which point I was almost in tears of frustration]

Caller 3 : *howls of rage, profanity* But my MAN has to look after our children because of this!

Me : [Oh my, how awful for him] If you're not registered with a dentist then there's nothing I can do. You only have just over eight hours left to wait. All I can do is get a nurse to call you with some pain-relief advice

Caller 3 : But they already did that, it didn't work!

Me : Did you follow their advice?

Caller 3 : Well no, I have no paracetamol or anything in the house.

Me : So.. wait.. have you taken anything?

Caller 3 : NO I JUST TOLD YOU!

Me : Nothing, all day? Because if not, that's why it's not WORKING!

She then told me she intended to go to her local A&E, I told her not to bother as this was neither an accident nor an emergency situation, the clue's in the name, see? At that point I started to lose all hope in humanity, and advised the caller that she'd be better off waiting, and gave her the details of several dentists she could register with after her EDS appointment. When I was searching for her chart I found a duplicate chart with slightly different identifying details, where she'd posed as someone else at 3pm and 5pm to try and get an appointment. She certainly gets an award for her persistence. The prize? I'll take suggestions!

I'm happy to answer any genuine questions as to how the service works, what we do and what we're for. So I'm extending this to the public and to other health professionals. Want to know why the callback times are so high? What the stupid questions are for? Why we don't have 60 million GPs and dentists available so that no-one ever goes without? Leave a question in the comments and I'll address it as best I can.

Sick, Sad Minion