Mail on Line 29 September 2015
By KATHERINE FAULKNER and ANDY DOLAN and JOSH WHITE and PAUL BENTLEY FOR THE DAILY MAIL INVESTIGATIONS UNIT
- 21-year-old mother of one left after four months due to pressure of the job
- She has spoken out because she is so concerned about operation of 111
- She said: ‘I was suddenly being asked to make life-or-death decisions’
Irsah Tahir, 21, worked for NHS 111 as a call handler earlier this year. But after four months, she decided she could no longer cope.
The mother of one from Derby was so concerned about what she saw that she has waived her anonymity to speak out.
Irsah Tahir, 21, worked for NHS 111 as a call handler in Derby, Derbyshire, earlier this year but quit after four months because she could no longer cope
When my friends or family members ask me about 111, my advice to them is simple: don’t call it. After four months working there, I saw enough to know that the service is simply not safe.
The people who take your calls at 111 have no medical training.
The NHS says we always have access to a clinically-trained person we can ask for help – but in my experience that is just not the case. Frequently we had no nurse at all to help us with the life or death decisions we had to make.
We’d come in, and the managers would just casually say: ‘We’ve got no nurses today, so just deal with things as best you can.’
At other times you’d log in to your computer, and a little instant message would pop up on your screen to say: ‘No nurse today, so please do your best to resolve calls yourself.’
It was awful to see that. When I started the job at 111, I had no idea it was going to be like it was.
I thought it was more of an administrative job – someone’s hurt their leg, we’re directing them to a walk-in centre.
Instead, I was suddenly being asked to make life-or-death decisions over the phone – with sometimes no one to turn to for help.
I worked the night shift – starting at 10pm, and finishing work at six in the morning.
The night-time shift is the shift that nobody wants to do. And as a result it is usually short-staffed.
And the pressure is absolutely non-stop.
In other jobs I’ve had, you know who your manager is, people say hello, you are briefed on what you will be doing.
But at 111, that rarely happens because everyone is too busy.
You are expected to get in, sit down – any seat will do – get your headset on and get on with answering the calls that are piling up. No one even says hello – there isn’t time. The chatter in the call centre can get incredibly loud at busy times.
It’s difficult to hear yourself think. You can see people with their fingers in one ear, trying to block out the noise.
It’s an incredibly isolated job. And because we are so stretched, there is very little support when things get difficult.
The pressure on the call advisers is just massive. Sometimes, you sit in your chair and don’t leave it for an entire eight-hour period. It just gets too much, particularly with the noise.
You look up at the screens that tell us how busy we are, and you can see they have turned back, because we are not answering people’s calls.
Where the numbers are against a red background, you know there are patients piling up, waiting to speak to a nurse.
It just gives you a sick feeling in your stomach.
At night, the people calling in are mostly worried parents with sick babies, elderly people who have had a fall – and people with serious mental health problems.
I once had a patient who believed he was possessed by the devil – I could hear that he was smashing his head against a wall.
On other occasions I had patients who said they were going to commit suicide. I had a man once who told me he was about to kill himself with his young son in the house.
Ms Tahir worked at this NHS 111 call centre in Derby, Derbyshire, but said she could never have prepared herself for the role, claiming on some days she was asked to make life-or-death decisions, often without help
We had had a workshop of about 20 minutes on suicide – and that was it. And yet we were supposed to be advising these people.
Sometimes, they would scream and shout at you down the phone, incredibly distressed. You just feel powerless. I felt physically ill all the time I was working for 111. It wasn’t just the hours, I felt stressed constantly: You’re just so under pressure all the time.
Anything with babies terrified me because it’s just impossible to tell anything over the phone.
The parents don’t know, and the baby can’t talk, so what chance do you have of making the right call?
There’s been at least one death of a baby associated with the 111 service in my area.
I was suddenly being asked to make life-or-death decisions over the phone – with sometimes no one to turn to for help
Former NHS 111 worker Irsah Tahir
Call handlers at the 111 service have no medical knowledge beyond what we have learned on a basic two-week course.
This is despite the fact that – as our training documents state – we are responsible for an ‘incredibly complex process’ during which ‘a poor decision can cause a patient’s death’.
Because we are not medically qualified, we have to use a computer system called ‘pathways’ developed by the NHS to work out whether we think patients are in need of urgent treatment or not.
We are supposed to be able to consult a nurse – or transfer the patient to speak to a nurse directly – if we are not sure. But this was often impossible.
Even when we did have nurses on duty, it was usually just one, and they would quickly be overwhelmed. On the screens on the walls of the call centre, you could see how many people were waiting to speak to the nurse.
If there were three or four already waiting – as there usually was – it was pointless even trying to get through.
I once had to wait ages in the queue with a patient on the line who I believed was having a stroke.
Former NHS 111 worker and whistleblower Irsah Tahir, 21, (pictured), who has waived her anonymity to raise her grave concerns, said sometimes only nine call centre workers were available to take calls from a health region covering 2.3million people across Derbyshire, Leicestershire, Nottinghamshire and Northamptonshire
But the computer said they didn’t need an ambulance – and without speaking to the nurse, I can’t override the decision. So I had to wait in the queue. With strokes, after a certain amount of time, nothing can be done to stop the damage.
I just remember thinking: I’m wasting time waiting for a nurse and this person could be losing the use of their arms or legs.
It is horrendous. Even though we were paid only £7.10 an hour, we were so busy that people had to be brought in to bring us drinks at our seats.
TICKBOXES THAT DECIDE YOUR FATE
The 111 number is intended for those who urgently need medical advice.
In clearly life threatening situations, patients should always call 999.
But the 111 number is meant to be used when someone has concerns about their health or another person’s, but is unsure whether it is serious or what they should do.
The number was rolled out nationwide in 2013, and is run by different bodies in each of the different regions of England. It replaced NHS direct, which was a nurse-led advice line for patients.
Unlike NHS direct, which was staffed mainly by clinically trained staff such as nurses and paramedics, 111 relies on advisers who have no clinical training.
As a result it has been highly controversial, and some doctors claim it is unsafe for patients. The call advisers use a computer to input the symptoms described by the patient. They are then guided through a flow-chart of tick boxes which asks a series of questions.
Based on the answers given, the computer system will – in theory – provide the best course of action of the patient. On some occasions, for example, it might state that the patient requires an ambulance immediately.
At other times it will recommend the patient attends a walk-in centre within four hours, or that the patient should simply try to see their GP within seven days. The Government claims that those answering the phones at 111 are ‘highly trained advisers’. Crucially, they are supposed to be constantly ‘supported by healthcare professionals’, such as ‘experienced nurses and paramedics’.
Evidence seen by the Mail shows that this is often not the case.
These people would come around with mugs full of instant coffee to keep up going. It was ridiculous.
But I literally could not get up to go and get a cup of tea because there were just too many calls and too few staff.
People used to eat at their desk too – even though it wasn’t allowed.
They’d get fruit and sweets and pass them around to keep us all going. I never had a proper lunch break.
One of the biggest problems with 111 is that it relies on a computer system.
Sometimes, there are questions you want to ask, but you have to stick to the script on your screen.
If you feel the computer is taking you off in the wrong direction, there is nothing you can do. There have been numerous occasions when I think the computer has got the decision wrong.
In those cases, you have to call the nurse for advice – but often you can’t get hold of them.
I remember once, I had a patient – someone with a baby – I thought needed an ambulance straight away, but the computer said they didn’t.
I went to my manager but she didn’t have any medical training either. There was no nurse to ask and so you’re just stuck.
In the end, she agreed the patient did need an ambulance, and we sent one but by then we had wasted valuable time.
Most people who work at 111 find it utterly demoralizing.
Many of them panic and send too many ambulances out because like me, they don’t know what to do and have no one to ask. The managers check on everyone’s statistics, though, and you can get in trouble if you seek advice from nurses too much, or send out too many ambulances. I was once told off for trying four times in a row to get through to a nurse for advice on what do about a sick baby.
I was told I should stick to procedure – which was that we only try twice, then leave the patient in a queue.
But I didn’t want to leave them, I felt they urgently needed help. Another colleague of mine was hauled in by the bosses over sending too many ambulances.
He told them he’d rather be safe than sorry, and that if he had a nurse he could ask advice from he wouldn’t have to.
But the bosses were having none of it. They told him that East Midlands ambulances were stretched and we were putting too much pressure on them.
When he came out, he said well, until we’ve got someone to ask, what am I supposed to do?
After all, despite all the problems, it’s made very clear to us that if something goes wrong with a patient, we will carry the can.
If someone dies, we will be sent out to coroners’ court to explain why we didn’t send out an ambulance.
SHARMILA CHOWDHURY 