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Patients who call 999 will be assessed over Skype

 

Patients who call 999 but are deemed to be non-emergency cases could face a Skype evaluation, an NHS whistleblower has said (file image)

Patients who call 999 but are deemed to be non-emergency cases could face a Skype evaluation, an NHS whistleblower has said (file image)

Patients who call 999 but are deemed to be non-emergency cases could face a Skype evaluation, an NHS whistleblower has said (file image)

Patients who dial 999 are being assessed over Skype instead of being sent an ambulance, it has emerged.

Trials are under way across England to see if video consultations on smartphone apps could replace ambulances for thousands of ‘lower priority’ calls.

They are being used on patients whose conditions aren’t deemed immediately life-threatening, such as back pain, abdominal pain, falls or heavy bleeding.

Details of the Skype and FaceTime trials were revealed by former South Central Ambulance Service emergency call handler Karen Frederick, who says patients are being failed because the service is so overwhelmed.

The whistleblower revealed a string of controversial practices being used to cope with rising numbers of 999 calls. They include:

  • A ‘no send’ policy whereby patients are refused ambulances if their lives aren’t thought to be in immediate danger;
  • Operators being allowed to take high-priority calls while drunk or high on drugs;
  • Call handlers being banned from giving out medical advice to heart attack patients because they don’t have time;
  • Taxis being used to ferry patients to hospital if ambulance crews are too busy;
  • Elderly patients who have fallen being made to wait nine hours for an ambulance as they are repeatedly bumped down the queue.

Just last week the NHS said heart attack and stroke victims will have to wait longer for an ambulance under controversial new targets. 

Paramedics will have 18 minutes to arrive – up from the current eight minutes – although in some cases, the target will be as high as 40 minutes.

Ambulance chiefs are also battling a recruitment crisis of paramedics and about one in 14 posts nationally are vacant. 

To add to the pressures, ambulance crews are increasingly having to queue up outside AEs to offload patients, meaning they are unable to respond to incoming calls.

The Skype consultations were initially trialled on patients in nursing homes, but they have been widened to include other patients whose conditions aren’t life-threatening and who would normally be dispatched an ambulance within 60 minutes.

Patients told to make own way to hospital 

Patients calling 999 are being refused ambulances and told to make their own way to AE.

During periods of high demand, call handlers are told not to dispatch any ambulances to ‘low priority’ emergencies.

They include patients with broken bones, heavy bleeding, severe abdominal pain or even those who have accidentally cut off their fingers.

The ‘no send’ policy is being regularly deployed by one of the best-performing ambulance trusts, South Central, to help cope with the soaring volume of calls. 

In addition, when the lines are very busy, call handlers are instructed not to give out vital medical instructions to patients suspected of having a heart attack.

Normally, they would issue what is known as ‘interim care advice’ to patients while they wait for an ambulance, but during the busy periods – sometimes up to twice a week – they are banned from giving out the advice so they can hang up ready for the next call.

Patients dial 999 as normal and if their condition is classified as not being an emergency, they get transferred to a hub of paramedics and nurses at the call centre.

One of them will call back using Skype, FaceTime or a similar app on their smartphone or computer.

In the case of elderly patients, carers or relatives who are more technically knowledgeable may take charge of the call and zoom the phone’s camera in on particular injuries.

But doctors’ leaders are concerned by the practice and say virtual consultations should never replace assessing a patient in the flesh.

South Central Ambulance Service is one of the better-performing trusts, having recently been rated ‘Good’ by the inspection watchdog.

But the fact it has to resort to such drastic measures to cope with the demand suggests the situation is far worse elsewhere.

Dr Richard Vautrey, interim chairman of the British Medical Association’s GP committee, said: ‘You can’t rely on it for making a physical examination. You always have to err on the side of caution. 

‘There’s also sometimes technical difficulties, the broadband might fail, the connection takes longer.

‘You need to be that bit more cautious as it’s only when seeing a patient face-to-face in the consulting room or at home that you can really do a proper physical examination.’

Miss Frederick, who was employed by South Central between October 2015 and May this year, said: ‘You can’t do blood pressure via Skype, you can’t do a heart rate via Skype. There are a lot of issues I can see happening.’

She said Skype consultations would not help diabetic patients with potentially fatal high blood sugar levels who have a distinct smell on their breath.

Miss Frederick left the ambulance service after suffering serious health complications she believes were triggered by stress.

She also told of how call handlers often turned up to work drunk or high on drugs and managers refused to dismiss them. ‘When you call 999, don’t assume the person on the other end is sober,’ she said.

Mis Frederick, who left the ambulance service due to stress-related illness, said other call handlers turned up to work drunk and high on drugs and managers refused to fire them (file)

Mis Frederick, who left the ambulance service due to stress-related illness, said other call handlers turned up to work drunk and high on drugs and managers refused to fire them (file)

Mis Frederick, who left the ambulance service due to stress-related illness, said other call handlers turned up to work drunk and high on drugs and managers refused to fire them (file)

It also emerged that people who dial 999 are increasingly being sent taxis to take them to hospital instead of ambulances. 

‘Managers say patients have been ‘overwhelmingly positive’ about the policy and the taxis had freed up ambulances for the most urgent calls.

But taxi drivers do not carry medical equipment and most have never been trained in first aid. If a patient suddenly deteriorates, there is little they could do to help.

Nonetheless ambulance services covering 20 million patients in London, Yorkshire, South Central England and Wales have all arrangements with local taxi firms.

A spokesman for South Central Ambulance Service – which covers Oxfordshire, Hampshire, Buckinghamshire and Berkshire – said other trusts were testing the use of video consultations but did not name them.

‘South Central Ambulance Service is currently trialling the use of technology to provide face-to-face consultations over the telephone.

‘This enables both the patient and the trained clinician … to see each other. 

‘This gives the clinician more information when they are assessing the patient as they can see the patient and view the injury severity, symptoms, etc.’ 

We left elderly patients lying on the floor for nine hours

Karen Frederick said she used to work as a medic in the US before taking her 'dream job' as a call handler, only for it to unravel

Karen Frederick said she used to work as a medic in the US before taking her 'dream job' as a call handler, only for it to unravel

Karen Frederick said she used to work as a medic in the US before taking her ‘dream job’ as a call handler, only for it to unravel

The job of my dreams slowly became a soul-destroying daily torture. I went to work every day desperate to help people, and instead I was forced to leave them in limbo, waiting hours for emergency aid that was endlessly delayed.

As a 999 call handler for South Central Ambulance Service, serving more than four million people from Oxfordshire to the South Coast, I was often the first voice that patients would hear when they dialled.

I’d reassure them and go through a menu of questions to discover what their emergency was and how urgently they needed help. Often I would talk them through vital first aid. 

But the good I was doing seemed to be undone all too frequently by the chaotic conditions that are reducing the NHS emergency service to helpless inefficiency.

I saw elderly patients left without aid for up to nine hours, unable to move after a fall. We were reassuring them that help was on the way – but what we weren’t telling them was that it might still be hours away.

I saw patients repeatedly being bounced to the back of the queue, as new calls with a higher priority came in. And I watched in helpless frustration as more than a dozen ambulances were backed up in a hospital car park, because there were no beds to accommodate the patients.

In the end, the job I once loved drove me to stress-related illness and depression. And I was not alone: at least one colleague with another ambulance service committed suicide.

As a fully qualified Emergency Medical Technician, working from the back of ambulances, I’d spent 20 years living in America before I returned to my home town of Bicester, near Oxford, in 2013. 

When I took a job in the 999 call centre, I thought I’d found my ideal employment – I was born to work for the NHS but, in my mid 40s, I no longer wanted to be the ‘first attender’ at accident scenes.

Here was a way to use my skills. But increasingly, I felt I was being asked to do my job with my hands tied. 

The sense of disillusionment came from management policies which prevented me from dispatching an ambulance swiftly to people who clearly needed one. Other callers who knew the right responses were able to play the system, and had to be seen right away. 

That made me angry: there is a management rulebook, which dictates certain symptoms requiring a face-to-face assessment must be given priority.

All my experience was useless in those cases, because I had to follow rigid protocol. Common sense went out of the window. But the shift officers had the final say. 

Miss Frederick recalled getting one call from an elderly patient who had been waiting for an hour for an ambulance for her elderly husband, before it became apparent he wasn't breathing

Miss Frederick recalled getting one call from an elderly patient who had been waiting for an hour for an ambulance for her elderly husband, before it became apparent he wasn't breathing

Miss Frederick recalled getting one call from an elderly patient who had been waiting for an hour for an ambulance for her elderly husband, before it became apparent he wasn’t breathing

As long as cases didn’t seem urgent, they could be put on hold. In practice, that often meant the elderly patients, who had suffered a fall and were lying on the floor all alone.

My own mother is 82. I hate the thought that if she falls, she might wait anything up to nine hours for help after making an ‘emergency’ call. But that’s the reality, and it’s only getting worse.

Inevitably, when people are left for such a long time, their condition can deteriorate. When that happens, the ambulance service could be held liable – and the shift officers are quick to hush it up, moving to stop junior staff from discussing the case among themselves.

I took one call from a woman whose elderly husband had fallen in the bathroom.

She had rung 999 almost an hour earlier, and was distressed that help hadn’t arrived. The injury had not seemed serious, but as I listened to her complaints I realised her husband did not appear to be breathing. I told the woman what steps she had to take to stand any chance of saving him, and handed the call over to a senior manager.

Later, I saw the case had been locked down on our computer screens, so that we could not access the details. It wasn’t a cover-up, but the information was suddenly available on a strictly need-to-know basis, and I never learned whether the man had survived.

Every day, managers were telling us that we would not have any ambulances for non-urgent cases for five or six hours, though of course we couldn’t say this explicitly to callers. And even for serious emergencies, the resources were simply not available. 

The highest level of priority is the Red Response, for patients whose lives are in immediate peril. Our target was to get an ambulance there within eight minutes. In reality, too often, it could take up to an hour. That’s a shocking delay. And it is only one aspect of the crisis.

One day in December last year we had 19 ambulances queuing to unload at Queen Alexandra Hospital in Portsmouth, and no one there available to cope with the intake. That’s a double bottleneck, because 19 patients were not being treated, and 19 more were waiting for ambulances.

Sometimes the solutions were farcical, with managers ordering a taxi to collect someone and take them to AE.

In the 18 months I worked for the ambulance service, I cannot remember a day when we met all our targets.

With so many impossible demands call centres could become thoroughly unpleasant environments. Bullying was systematic, with managers venting their stress on staff.

The bullying, frustration and sense of helplessness took their toll and I was diagnosed with bleeding stomach ulcers brought on by stress. The job was killing me.

I can see the problems within the ambulance service, but I don’t know how to fix them. Sometimes it seems to me like riding a bicycle with your clothes on fire… but the wheels are on fire too, and even the road is burning. What part of the crisis do we tackle first?

 

 

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