If It Ain’t Broke, Don’t Fix It – A Lesson From NHS Direct (Part 4/4)

Here’s the final part of my piece on NHS Direct. If you’ve read all the others as they were released, how very masochistic of you. If not, click here for part 1, part 2 and part 3.

What can we learn from NHS 111? Apart from recognising that knowing your arse from your elbow is probably important if you’re going to be health secretary (seriously, I could unload a minigun into a conference of midwives, nurses and paramedics and do less damage to the NHS than Jeremy Hunt and Andrew Lansley have).

Firstly, politicians need to recognise that just because something is slightly broken that replacing it completely is not the answer. NHS Direct did a reasonably good job. It was not perfect, like most parts of the NHS (and a few of its staff members), it was bloated, inefficient and sometimes did the wrong thing. What it realistically needed was someone to come in and say ‘why in God’s name do we have algorithms in Laotian, Cherokee and Luxembourgish?’ and address other such silliness and then see if any other cost-cutting measures could be done. What actually happened was the Coalition reacted as if NHS Direct was a Mid Staffs level crisis and burnt the whole house to the ground to kill a few mice in the wall. NHS 111 doesn’t send people to the correct service than NHS Direct did. It doesn’t employ more clinical staff than NHS Direct did. Most importantly, people seem to be dying unnecessarily under NHS 11 than under NHS Direct.

Secondly, we, as the general public, need to somehow force political parties to buck up their ideas when it comes to the NHS. I’ll write about this more in forthcoming articles but none of the major parties seem to have any comprehension of what pressures the NHS is actually under and what it will take to fix it. Instead they rearrange services to do essentially the same thing under a more confusing structure (with additional privatisation) and crow that that will fix the NHS and make people healthier. It won’t. What will is putting more money into the bits that work well, and trying to improve the bits that don’t work well. For example, perhaps not asking GPs (already the most efficient service in the NHS) to open 7 days a week with no extra funding.

Thirdly, we need to stop voting in humongous cretins to run our health system. Again, I’ll be doing more detailed posts on our current political ideologues, but here’s a short profile of the last five Health Secretaries:

  1. Jeremy Hunt – believes that homeopathy is anything more than an expensive placebo
  2. Andrew Lansley – cretin of the highest magnitude, roundly criticised by both the Royal College of Nursing (RCN) and the British Medical Association (BMA)
  3. Andy Burnham – only ran a public enquiry into Mid Staffs after multiple requests to do so, 2800 people died after the first alarm was raised
  4. Alan Johnson – seemingly quite good
  5. Patricia Hewitt – expanded private sector involvement in the NHS, and managed to get 12,000 doctors to march across  London in opposition to a computerised training cock-up

Not sure I need to say much, but we can hardly complain about how politicians are messing up the NHS if we keep electing people with seemingly less sense than a rabid orangutan.

We need sensible middle-of-the-road politicians who are willing to realise that NHS improvements probably need to happen over years-to-decades, rather than months-to-years. We need them to notice that rhetoric around a 7 day NHS isn’t going to suddenly spring into existence neither the doctors, nurses and support staff to run it nor the money to pay their wages. We need them to realise that mental and social health services can’t continue to be negelcted to the point that vulnerable patients (or clients or consumers or whatever corporate nonsense we’re supposed to call people nowadays) end up in A&E because the unsupported healthcare assistant has nowhere else to send them. 

Will we get this? I’d like to think so, but I’m not hopeful. What can we do? Given that I’ve already written a stupidly long piece, I think I’ll address that another time. 

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If It Ain’t Broke, Don’t Fix It – A Lesson From NHS Direct (Part 3/4)

This is part 3 of this article. It won’t make much sense unless you read Part 1 and Part 2.

This wouldn’t actually bother me too much if NHS 111 was better than NHS Direct used to be. Well guess what? It isn’t. Remember the criticisms that I mentioned about NHS Direct – one being that it was too cautious and just sent everyone to the GPs anyway? Bearing that in mind, here’s a quote from Dr Chaand Nagpauls, head of the British Medical Association’s GP committee, made on the 21st May 2015.

‘NHS111, which last year referred 5m more patients to general practice, clogging up our appointments, and with only 15% of patient managed with self-care compared to a 48% previously. This comes as no surprise with a system relying on computer algorithms – not clinicians – to give advice.’

If 15% GP referrals was too cautious, what in the name of David Cameron’s incredibly shiny forehead is 48%? That makes Neville Chamberlain look at Atilla the Hun. Here’s another quote made last year by Dr Nagpauls:

NHS 111 continues to provide a variable and often inadequate call handling and triage system, and will impact on the ability for GP out-of-hours services to provide optimal care.’

Fancy some examples to back that up? Well here’s an article detailing how pensioners were asked ‘are you conscious?’ by call handlers, and another detailing how a lady who couldn’t get through to NHS 111 ended up going to A&E anyway. The kicker about that last one? The GP involved with the case was Dr Laurence Buckman, the previous chair of the BMA GP Committee. When two successive chairman of the committee dedicated to the countries biggest primary care specialty are critical of you, it may be time to start doing things a little differently. 

OK, so many more patients go to GPs unnecessarily, but at least they’re not ending up in A&E, right? Err…no, in fact here’s an example from Staffordshire where more patients are going to their local A&E due to advice from NHS 111. My favourite quote from the story ‘It’s quite obvious to me that the people who are being trained to answer the phones do not have sufficient clinical knowledge to take those calls.’ For anyone concerned, I’ve cherry picked an isolated case, here’s the President of the College of Emergency Medicine saying NHS 111 may be contributing to winter pressure on A&E. Hopefully, his talkinge knows what 


OK, so maybe GPs are getting more visits. And yes, A&E are getting more visits than they should. But at least people aren’t dying unnecessarily? Well here’s four headlines I found in less than 30 seconds of searching 

Distressingly, the fourth headline isn’t just about those three deaths. The main story also discusses 19 ‘untoward incidents’ since the service was rolled out nationally the month before. Twenty two serious incidents is hardly the best of starts. And why might people be dying unnecessarily? Perhaps because the minimum you need in some areas to work as a 111 call handler is a Maths and English GCSE. I might apply. I could do with some cash and I’m vastly overqualified if that’s the minimum standard. 

Here’s the fourth and final part of this article.

If It Ain’t Broke, Don’t Fix It – A Lesson From NHS Direct (Part 2/4)

Here’s part 2 of my NHS 111 extravaganza – check out part 1 here.

So why was it abolished? Primarily, a Department of Health report said that there was confusion around which NHS service to use and that one three digit number for triaging non-emergencies might help solve this. This I can completely understand. An ideal world would be I ring up 111 and I’m told exactly what I should do with this cough I’ve been having. That service should know what services are available in my area, have a good knowledge of clinical problems to send me to the correct service and, most of all, not result in me dying due to poor advice. Frankly, that doesn’t sound too hard, or even too dissimilar to what NHS Direct was. For those Labour fans out there, they even mentioned it in their 2010 manifesto.

Realistically, what the report recommended could have been implemented by changing 08454647 (NHS Direct’s old number) to 111. In fact, that is what the Conservatives said they would do. Until they stopped saying that and changed their minds. Now I’m not an expert, but how many times do you have to ‘change your mind’ before it becomes apparent that your minds haven’t changed and what you said originally was just a big pile of horse dung? 

Instead of simply phoning up Vodafone and asking for their SIM card to have its number changed, Andrew (I’ve Tried Nothing and I’m All Out of Ideas) Lansley, and his successor, Jeremy (I’m A) Hunt completely overhauled the way telephone triage services were done in the NHS, essentially phasing out NHS Direct, and letting private companies pick up the slack. These include Harmoni, a company previously criticised for being unsafe at running GP out-of-hour practises. You’ll glad to know they run 8 NHS 111 services across clinical commissioning groups (CCGs), including most of London. Interestingly, I’m pretty sure that Westminster is in one of the few bits of London covered by a not-for-profit scheme, though I’ll have to look into that.

NB: I used Vodafone as an example due to the fact that they diverted some of the tax-dodging gains through to me. I also rode a flying pig to work at the magic bean factory. No, I actually used them as they run part of the 111 telephone network and suffered a huge technical fault last November. To their credit, they seemed to respond OK-ish and it hasn’t happened since

Click here for Part 3.

If It Ain’t Broke, Don’t Fix It – A Lesson From NHS Direct (Part 1/4)

(This was originally meant to all be in one big article but I got rather carried away and now I have 2000 words. I’ll now be publishing it in a few parts to squeeze every last measly drop of content I can out of it. See I’m learning good journalistic practises already)

After our recent general election, I saw a lot of people posting on social media about how the NHS is doomed, rest in peace NHS, and that the Tories would essentially sell of their grandmas in order to make money out of her private healthcare scheme. It all struck me as a bit late to be upset about how the NHS has been treated. If you’re not supposed to lock the stable door after the horse has bolted, this was like locking the door after the horse had run into next door’s field and knocked up their world-class filly.

The NHS has been in trouble for years, mostly due to political mishandling and naivety. I could talk about how Labour facilitated private finance initiative (PFIs), which were originally a Tory idea. I could mention the promise not to reorganise the NHS made by David Cameron, which was rather spectacularly broken by the Coalition government.

In fairness to Mr Shiny Forehead, Matthew D’Ancona’s book ‘In It Together’ puts the blame squarely on Andrew Lansley. Given Lansley’s history of taking money from private healthcare whilst a minister, fiddling his expenses, and letting massive multinational corporations get involved with drafting health legislation, I can absolutely believe it was entirely his moronic idea. You won’t be surprised to know that Lansley has stepped down as an MP, and I’ll be following with interest to see whether he joins any of his chums in private healthcare or fast food.

Instead of those two undoubtedly meaty topics, I’ll talk about the demise of NHS Direct, and it’s successor, NHS 111.

NHS Direct officially passed away on March 31st 2014, and became NHS 111. Now on the surface, they should be pretty similar. Both exist to take calls from worried members of the public about medical problems, and to direct them to the right area of the NHS. In essence, it is designed to send those with sore throats to the chemist and away from A&E and to tell stubborn Yorkshireman that walking off there sudden right-sided paralysis probably isn’t the best idea.

I have personally seen the first one happening – as I was being asked about the massive bandage I had covering one eye, a man came in with a rather messy injury which I can only describe as ‘industrial staple may have burst an eyeball’. Understandably, the man was sent through immediately to see someone. Less understandably, someone complained they hadn’t been seen about their sore throat for an hour, and it was unfair they’d been waiting so long.

I’ve not seen a Yorkshireman try to walk off sudden paralysis, though a consultant reliably informed me that he has.

Anyway, NHS Direct was a service that ran for 16 years and was described as the best service of its kind in the world. In the interest of balance, it was accused of being expensive and wasteful. As those accusation centered around questions such as ‘why is it as expensive to call NHS Direct as visit the GP?’, ‘NHS Direct is too cautious and send too many people to GPs’ ‘why are we translating our service into Cherokee?’, I’d say those criticisms may have been valid. But what NHS Direct was never accused of was being a bad service. It primarily did what it was supposed to do and, most importantly, it was safe. 

(For Part 2, click here)

Sheffield Central – The Aftermath

Let’s get the elephant out of the room straight away – last nights election result was an absolute blindside. Not one poll suggested close to a majority one the eve and fair play to the Tory party for managing to completely turn that on it’s head. To say that this is a dream scenario for them is understating it – they have the control of the Commons, lost no seats to UKIP, saw their coalition partner utterly crushed and their three main opposition parties are all facing the prospect of internal struggles over leadership. The one blip on the landscape is the surge of SNP support. Realistically, the Tories could do nothing about this, relying on the other unionist parties to stem the tide. Even in this worst case of scenarios in Scotland, they have a potential ace up their sleeve. They’ve been proposing one of the few solutions that might fly both in Holyrood and Westminster – a more federalised United Kingdom – for a while now. Overall, this is a wildly successful night nationally for the Tories.
But what about locally? Who is going to be celebrating their performance? And who will be drowning their sorrows? First up, the Communists (6th) and the Workers Revolutionary (10th). None of them were forecast to be popular and none of them were. Frankly, I don’t think they care. As I said in my previous posts, the Far Left have consistently ran in Sheffield Central, achieved next to nothing and continued doing so anyway.

Finishing 9th was Thom Brown of Above and Beyond, with 0.1% of votes. Now I’m sure Thom would have liked to see his message of electoral reform being taken up more widely, but I’m sure he’ll feel vindicated in his position nonetheless. Turnout fell this election and the winner once again did not get over 50% of the total electorate, thought they did at least get over 50% of the votes cast. Nationally, Thom, and his Above and Beyond party, will have plenty of allies for electoral reform. The Greens, UKIP and even the Lib Dems have won vastly less seats than their national percentage suggests they should have. 22% of votes should not result in 10 combined seats.

Elizabeth Breed of the English Democrats finished 8th with 0.2% of the votes. Unsurprising. What is surprising is that there was once a point where the English Democrats had an elected mayor and some councillors. Strategically, they need to focus in on any areas they are remotely successful and try to regain any foothold they had. Not that I think they’ll do that – much more likely they stay as a walking punchline.

Andy Halsall is the final minor placer finishing just behind the Communists in 7th with 0.3% of votes cast. Whilst the low votes were expected, the fact remains the majority of the Pirates flagship areas were not talking points in the election. As even their leader admits they only run to raise awareness, the lack of discussion must be disappointing.

Having been as courteous as possible to all the minor candidates, who should all be applauded for standing and never really had a hope so there’s no point being mean, I can move onto the bigger guns. And possibly be more mean.
In 6th place, UKIP’s Dominic Cook with 7.5%, up nearly 6% from last time. Weirdly, UKIP’s brand of ‘blame the EU’ and ‘pine for the Empire’ didn’t go down that well in a constituency of mostly leftie students. Shocker.
In less of a shocker, the student could have sledgehammered the local Lib Dem office and done less damage. Minus 31% and a drop to behind the Tories?!? Might as well have campaigned in bondage gear, couldn’t have gone worse. Joe Otten is a first time candidate and will probably have learnt a lot but frankly the Lib Dems sealed his fate five years ago. Lesson one for the post mortem: do not piss off a large core group of your voters, it tends to end badly.

Stephanie Roe came 3rd with an amount of votes, and a gain that’s numerically small but reasonably important. I’ve heard nothing from the Tory campaign locally, not one sign or tweet, and their vote still went up! In a seat that is as loony left as the Tories could imagine. That in a nutshell is why Labour lost nationally: even when they did well, they didn’t hurt the Tories. Instead they joined in the puppy kicking that was the Lib Dems evening.

In second place, as I predicted in my preview post, Jilian Creasy of the Greens with a 12% gain to just under 16%. Not that it was that hard a prediction: students hate UKIP, the Tories haven’t topped 12% in years and the Lib Dems have been losing votes like the 70s have been losing likeable DJs – quite frankly someone had to come second. Not that it’s a poor achievement, a solid second is pretty much best case scenario. Along with a gained council seat, the Greens are now pretty obviously the main opposition to Labour in Sheffield Central. Whether they progress from this will be the story of the next five years.
And finally our winner, Labour’s Paul Blomfield with a clear win with over half the votes cast. In what must one of the weirder swings for Labour of the evening, Blomfield’s majority grew a thousandfold to 17,000. Put in perspective, his majority is more than the total votes for the next three candidates. Absolute baller. And vindicating my previous thoughts that Labour would probably romp to victory here.

Overall, a fairly predictable outcome. Sure, Lib Dems fell by more than expected, Tories made a surprising increase and pleasingly, UKIP’s overly nationalistic fearmongering was rejected. On the other hand, I basically called this ages ago with Wikipedia and gut feelings as my guide. More excitement next time please.