Nee Naw - NHS Direct Question

NHS Direct Question

Here’s a question for any NHS Direct bods who might be reading this. The other day I had to arrange a out of hours GP for a patient who had decided not to travel to hospital with the crew. (Why people ring for ambulances and refuse to go to hospital I will never know. People are strange.) NHS Direct were handling the GP out of hours calls. I had the following conversation:

NHSD: Okay, I just need to run through a few questions. Is the patient conscious and breathing?
Me: *confused noise* Er, yes, he is.
NHSD: Sorry, we have to ask everyone that…
Me: No, it’s not that — you just threw me because that’s what we ask everyone too!
NHSD: Okay then. Is he blue around the lips? Non blanching rash? Chest pain? Overdose?

I recognised these last questions as NHS Direct’s “trigger” questions that they have to get an ambulance for. But we already had an ambulance on scene. So my question is, what would have happened if I’d answered yes to any of the questions? Would they have insisted on sending another ambulance? Would they have put me through to one of the call takers downstairs? And if not, what was the point of going through the questions?

Fortunately the answer to all of them was ‘no’ and the patient got his GP without any trouble. I’m just curious!

Published Mar 28, 2007 -

Comments on “NHS Direct Question”

ecparamedic Says:
March 28th, 2007 at 6:37 pm

My money is one them sending another Ambulance, but I’d better wait for Sick Sad Minion to confirm or deny.

SD
Petrolhead Says:
March 28th, 2007 at 9:22 pm

It would be pretty stupid to send another ambulance though, wouldn’t it? But yeah, chances are that’s what they’d do to cover their own backs.
speccy Says:
March 28th, 2007 at 10:19 pm

100% they’d have been sent another ambulance!
Craig D Says:
March 28th, 2007 at 10:49 pm

Haha, you’d get stuck in a loop!

Eventually it’d be noticed that 27 ambulances were sitting in one street for a patient with a cold
Dave M Says:
March 29th, 2007 at 12:03 am

i called NHS (re)direct for a problem with one of the kids. it puts the calltaker off when you say ” he does not have breathing or circualions problems, funny rashes, or anything that needs a ambo”

after a calm logical convo with the doc, who guessed i was a SJA member. (and admitted her brother was one too) we got a visit by a local GP.
Dory Says:
March 29th, 2007 at 12:24 am

I am thinking that in that situation (if a 999 dispo was returned), the health advisor would have had the priority downgraded by the clinical team leader, so that you could speak immediately with a nurse (a P1) - probably could be streamed straight to a GP too (not too sure on that as you would have been a ‘third party caller’). However, answering ‘yes’ to the last questions would have run into another series of questions to pinpoint type of rash (and other symptoms present)/chest pain and would not have necessarily led straight to 999. I would hope if 999 dispo was reached in that situation, the health advisor/nurse/clinical team leader would employ some common sense. Stranger things have happened.

I’m sure Sick Sad Minion will add anything/put me right.
dullahan_999 Says:
March 29th, 2007 at 6:59 am

I worked for NHSD (NCLon) before Amb Control and the basic questions are about the same, possibly a little more paranoid. The problem is that you can upgrade a call, but you can’t downgrade. SO if someone is gasping for breath, but complaining of a sore toe, you can upgrade. But if they say they are personally choking to death, while explaining it in very lengthy sentances, you have to pass it to a nurse or supervisor.
Chances are, the call taker has never had ambulance control pass a call to them, and so has had to work through those same questions to get to the end result.
Probably end up with a “see a doctor within the hour” response, which ends up with an ambulance but you can’t win them all.
I’ve covered out of hours doctors and NHSD at the same time in the same room and had to put on another accent to cover the fact I was the person they spoke to a couple of minutes ago.
Emma Says:
March 29th, 2007 at 9:31 am

When I got stung by a wasp when I was 15, I developed lumpy rashes all over my body, and after about 10 minutes my nose began to swell. My mum phoned NHSD, and when the call taker asked “Has the patient got any swelling around the mouth?” or words to that effect, my mum told her about my nose. Because of my SJA training I knew that it wasn’t going to be life-threatening, if I was going to go into anaphylactic shock, it’d have happened a hell of a lot quicker than that! But they still phoned 999 and it must have been a category-A because within 10 minutes, there were two (gorgeous) paramedics sitting in my lounge! Unfortunately, it was about 9am and I was still in my PJs, and the wasp had stung me on my bum (what should I expect? I did sit on the poor bugger!) which was pretty embarrassing. But the thing I was most embarrassed about was that they’d thought it neccessary to call an ambulance, when even the paramedic said all I needed was some Piriton! I do now have an EpiPen, but I’ve not used it yet though.

But my point is, just because my nose was swollen, that doesn’t mean my throat is going to close any second. That visit from the men in green was purely NHSD covering their own backs!!
Dory Says:
March 29th, 2007 at 10:51 am

Dullahan_999 - just a little response to your comment. Our NHSD site have always been able to downgrade obviously incorrect priorities like in the situation you described (but a 999 will never go lower than P1 - transfer straight to nurse with pt on the line = ‘warm transfer’). Shows how different NHSD sites have slightly different ways of operating.
Bingo Says:
March 29th, 2007 at 12:35 pm

I’ve called an ambulance, but refused hospital once before. I was having an asthma attack, and knew my condition well enough that I just needed some salbutamol and I’d be fine. Ambo arrived, gave me some sweet, sweet drugs for five min, and I refused admission as I’d only have taken up bed space pointlessly.
Mary Says:
March 29th, 2007 at 3:13 pm

Dave M - why did you want to put the calltaker off?

I cannot think of any reason why I would want to purposely confuse someone who I had called for help.
KJX Says:
March 29th, 2007 at 9:45 pm

This would be the NHS Direct who suffer a computer system that insists Chichester (the county town of West Sussex) is in fact in Hampshire and that therefore I must attend an emergency dentist in Alton rather than the one less than a mile away at our local hospital - that will only take appointments via a phone number that NHS Direct hold but will not give out if you live ‘out of the area’ - which apparently I did! Poor sods, they must have constant concussion from HAVING to use a computer system so poo.
Dory Says:
March 29th, 2007 at 11:13 pm

KJX - the computer database searches on postcodes and returns information on services closest to the callers address as the crow flies. However, each entry on the database has notes beside it detailing which areas are covered by said service. So this time it is not the computer system at fault, but the person giving you the number - i.e. they gave you one from the top of the list without reading the info on the service.

Sorry for hijacking your comments, Mark!!!!
Jim Says:
March 30th, 2007 at 2:11 am

Called a GP one night for a pt I was with that flatly refused to travel, and I couldn’t get past nurse triage.

Nurse: ‘Is the pt turning blue?’

Me: ‘Yes’

Nurse: ‘Oh, Ive got to send you an ambulance’

Me: ‘Don’t do that, we’re here. Besides, there aren’t any left’

Nurse: ‘I’ll get my supervisor’

Me: ‘Good idea’

Absolutely, frustratingly, ridiculous. Hard to beleieve its 2007 sometimes.
ecparamedic Says:
March 30th, 2007 at 7:11 pm

“Petrolhead said,

on March 28th, 2007 at 9:22 pm

It would be pretty stupid to send another ambulance though, wouldn’t it?”

Yep, but it’s never stopped them before………………………
Dave the Ambo Says:
April 3rd, 2007 at 4:16 am

A very similar system has been started in Australia called Nurse On Call (NOC), or as most ambos like to call it, Nuisance On Call. We are constantly turning up to see people who don’t need an ambulance and say that’s what they told NOC, all they wanted was some advice. It has been suggested there’s been an 100-200 job increase for emergency ambulances because of NOC. I understand its not the calltaker’s fault, because they have to follow the computer program to the letter, but the program over triages by a long shot.
GET OFF MY PHONE Says:
April 9th, 2007 at 1:37 pm

I work for NHS24 (Scottish equivalent to NHSD). Personally, if I’d taken that call, I’d have just put you straight through to the on-call GP. If there’s already an ambulance in attendance and you’re asking for a GP there’s not anything more I could do so what’s the point in getting involved. It would just be a waste of everyone’s time. I am slightly surprised that ambulance control doesn’t have a direct number for the on-call GPs exactly for this reason. Maybe it’s different down there, I don’t know.
Mark Myers Says:
April 9th, 2007 at 1:52 pm

There’s about twenty different out of hours GP services in London, so the easiest way of getting through to the right one is ringing the normal GP number and then ringing the OOH number on their answerphone. In this case it went straight through to NHSD, as NHSD were handling the out of hours doctors for that area.
EmmaC Says:
April 10th, 2007 at 1:35 am

NHS direct is (imo!!) next to useless !! If I call them about my daughter they ALWAYS insist that she MUST go to hospital and if I decline they threaten to send an ambulance, all because she has a heart defect !! Now we ring the OOH straight away, or failing that A and E .

I rang them one night for myself, I had stood on a very thin, but long sliver of glass. My foot bled like the proverbial stuck pig. Despite all efforts it still bled. So I rang NHSD for advise as to how to stop the bleeding. Excplained the problem, and that despite attempting various methods, as per first aid training, my foot was still dripping blood everywhere. Told them I had been trying by then for an hour. Their answer ??????

‘We will ring you back…’
‘ ok when ?’
Oh well its currently about four hours… ‘
‘ok well by then I will possibly have bled to death.!’
‘Yes madam’

Cue another call to the OOH !!

Fortunatly OOH popped out and gave me some stuff to stop the bleeding.
Went to bed, six hours after my original call to NHSD they rang me back !

Bah !

I hate calling ambulances out , our service here ( Swindon, wilts) are fantastic, very very helpful, horrendously understaffed and underpaid, and overworked like nobodys business.. but with NHSD as useless as they are , many people round here feel they have no option
Sal Says:
April 11th, 2007 at 4:52 pm

I have consulted NHS direct online recently for a couple of things. Bad idea, I can only assume the people running the site want to induce some kind of heart attack/seizure as each time I’ve been on and gone though my symptoms I’ve been told to ring 999 as I’m in imminent danger of death/my head falling off etc. I’m still here……
flateric Says:
April 12th, 2007 at 4:21 pm

Well i am a nurse adviser at NHSD and i can say that if an ambulance had been sent for this the call handler would have been bollocked severely!

Where NHSD handle calls for gp OOH there is always an option to transfer direct too OOH if the call warrants this. hopefully in similar situations this is what would happen.

I should also say in our defence, the ambulance despatchers get i wrong too..

Ambie control

Hello, ambulance service whats happening there.

NHSD Hi, have an elderly patient conscoius breathing and fine buit has gone over on anklle, cant walk but is safe and well, needs xray but no other way of getting her there.

Ambie control Is she conscious and breathing,

NHSD Er yes we have assessed her just needs an ambulance as she cant walk, doesnt need to be a cat A she is perfectly ok.

Ambie control, well it will be on lights and sirens as it came through as 999.

NHSD we have to call 999 we dont have any other numbers can you downgrade it? it doesnt need a blue light response.

Ambie control, no cant downgrade it, will be on lights and sirens.

NHSD (sounds of nurses head banginginto table in dispair)

Some of us do try, honest……………
Mark Myers Says:
April 12th, 2007 at 5:08 pm

flateric: I don’t agree with it either, but it’s not the call takers’ fault: you need a doctor’s authorisation to book a ‘non blue light’ ambulance, and the doctors ring a special number to get them, not 999, as it could block another 999 call getting through. It does seem a bit silly that you’d have to ring a doctor who would then call us, but if you need a non emergency ambulance that is what you are supposed to do!
flateric Says:
April 12th, 2007 at 6:04 pm

Wish we had the direct number sometimes it would make things more efficient. during office hours i can usually get throught to the control room on a normal line if i need too, which has been helpful a few times for ECP or similar.

I hope i dont call to many ambulances out though, i like to think i dont. you may be vaguely interested to know that only 2-3% of calls to NHSD nurses get a 999 response. if we hit 5% or above questions start to be asked.

Unless it is blindingly obvious from the sorting questions the call handlers will transfer calls to us to decide if ambulance is needed.
Maz Says:
April 13th, 2007 at 9:42 pm

Hi everyone, so thrilled I have found this site - I am desperate to join the amb service and have done for the last 3 years but unfortunately (or fortunately!) I have 2 small cherubs that are preventing me from living my dream - for the time being anyway!!

Anyhow, I thought that I must comment on this particular thread as I am a call handler for an OOH GP Service in Kent, and we like NHSD have a protocol to run with which includes all the usual questions. Until recently I was always led to believe that I HAD to ask the protocol questions with the only exception being a DN call that needed to be passed on. This always had me cringing when I would have a paramedic on the end of the line trying to organise a GP for some poor elderly person with a bit of a chesty cough, who had to listen to me rattle on asking questions eg are they breathing normally?! I have at numerous times had the reply ‘if pt was not breathing properly then I assure you we would be treating them’! Anyway, at last we have finally had confirmation from ‘the powers that be’ that we do not need to go through any protocol questions if the call is coming directly from another health professional.

Incidentally, to the nurse that works for NHSD, I am really surprised that you do not have tel no’s for ambulance control for non-urgent calls. We are obviously very fortuanate that we are able to do this as I would hate to take up a 999 line when something is clearly a call for a PTS crew etc.
Al Says:
April 14th, 2007 at 8:06 pm

I just thought I’d drop something in here.

I used to work in central appointments for my local hospital and still have family working elsewhere in the hospital. We have an internal code we can dial for the ambulance liaison desk, which everyone knows, for any non-emergency ambulance transport required today. We can also book patient transport in the future (although this is a different kettle of fish and now goes through the PCT’s choose and book people for some unknown reason). Even clerical staff (although usually only if instructed) can book an ambulance for today.

I suspect this is because we are a hospital and having to track down the relevant doctor for every ambulance booking for today would be rather impractical. Do you know if requests from hospitals are processed differently?

(Working in the hospital also allowed me to get hold of direct dial numbers for useful services like the OOH and even an NHSD one for CaB stuff; very handy indeed).
Cobber Doyle Says:
April 16th, 2007 at 8:56 pm

When you phoned NHSD you first get a call handler (Health advisor is their new name)- who, on pain of dismissal, has to ask all the routine questions. (some don’t,) but in order to log a call they have to ask these (sometimes) seemingly daft questions, but it is a rather blunt tool, for every purpose. Anyway the call handler (to date) hasn’t been able to just pass the call on to the OOH GP- so a Nurse Advisor then has to pick it up- and she too, has HAD to call the crew back (NHSD rules) and say she will pass the call on to the OOH GP. Ofcourse she/he doesn’t call another ambulance for the patient- that would be even more silly - but until they introduced streaming which meant that calls could just go straight over to the OOH service- the NHSD rules had to be obeyed unless we wanted to incur managerial wrath. And there was no shortage of this for some. Not every site was using all the streaming systems so it depended on which site you came through to. If it sounds a bit tied up in tape - it is. But I ask you - If a nurse at NHSD has assessed a patient then why are LAS- and every other ambulance service asking the same questions- and sometimes very unreflectively - ( the 80 year old who had chest pain was asked if she was changing colour- well, really how could she possibly know!) - you too, are making a set of notes, getting some skeletonic history and ruling out emergences ..
Bertus Says:
May 30th, 2007 at 5:07 am

Hmm. I work for the service. The call handler (health advisor, strange as we can’t advise on much) should have used a protocal called ‘Policy Direct Transfer’. This sends the details straight to GP without triage, just contact details and a GP are needed. A person refusing hospital treatment doesn’t need any more triage or assesment, the situation is stupidly clear. More burocratic fuckwittery of waffling shit scared call handlers trying to cover their backs using the computer as an excuse for the lack of common sense.
Millerxg Says:
June 14th, 2007 at 4:59 pm

One of our Ambulance Technicians called NHS24(Scottish Equiv) from the ambulance station as he was coughing up green phlegm. Call taker kept asking him if he had chest pain, he said his chest was a little tight but all he wanted was to go to the OOH and get a presciption for antibiotics. What was the outcome?

‘Stay where you are , I have arranged an emergency ambulance to take you to hospital’

Taxpayers money at work?!?!

Shut it down, it has increased our workload by 50% especially at weekends and nights. Get back to doctors getting off there backsides and earn their money by going out and treating people at home. Hospitals are becoming blocked by these idiots sending everyone in for minor stuff which can be treated in the home.
stu Says:
June 21st, 2007 at 6:37 pm

I have experience of being a crew on scene and requesting an out of hours dentist for a patient with wisdom tooth pain via NHSD and them seeking to send another ambulance. the calltaker did not seem to understand that I was an ambulance crew member and that I had ruled out a cardiac diagnosis due to the lack of chest pain, ECG and presentation of the patient … they said their protocol was to send an ambulance - yes we’re already here! it drives me mad!
clare Says:
July 9th, 2007 at 10:55 pm

I am a nurse advisor for NHSD. We receive a lot of CAT C calls from our local ambulance service. Many of the calls are then passed back to the ambulance service following assesment. We do have a direct number for this. Often it is when elderly people have had injuries and are unable to be transported safely to hospital by their family or neighbours.

I think some of the comments are harsh towards health advisers who are not medically trained when ambulance personell ask many of the same questions then pass the call to us. Why can the ambulance service not make a decision that a person who cannot be moved although is responsive and breathing needs a non urgent or AS2 ambulance? All that this achieves is the caller becoming more frustrated and by the time they reach the nurses they are fuming and angry about everything in the NHS.

It is a thankless job sometimes and NHSD gets slated a lot but we have to believe what the caller says! We do not rely on the computer otherwise everyone would be 999 or A and E but if the caller is adament that they for example have chest pain and breathing difficulties even though they are speaking in sentances I usually reduce the diosposition but really emphasise the worsening instructions. At the end of the day it is my registration on the line if the person is genuine!

NHSD is blamed for a lot of things. It has to be recognised that reduction in services i.e Out of hours dental provision!! Reduction in GP services will lead to these problems increasing. Most people call and have expectations about their needs and are unhappy when you give home care advice, service provision and waiting times. People just want a quick fix and because unfortunately I cannot wave a magic wand and make their 2 hours of vomiting dissappear or chicken pox last less than a day they blame the service.

People need to start taking some responsibility for themselves like the parents who have children with injuries and don’t want to wait in A and E (it might be busy). Or the people who have had tooth ache for a week and think Saturday morning is the time to want to see a dentist.

The service is excellent for the people who use it as an advice line! These people are always happy with the information they receive.
Needless to say I am leaving the organisation moving on in my career to attend to people who really do need nursing care. Yes NHSD has its problems but think of how many more people would dial 999 for a splinter in their finger if it didn’t exist!!
J. Smith Says:
July 17th, 2007 at 9:03 pm

I am a Registered Nurse working at NHSD . The assessment tools that we use are completely erring on the side of caution and sue-ability. We are encouraged to ‘down-grade’ dispositions (e.g Gp Out of hours to Home care advice ). We get regular appraisals and are constantly being told that we do not down grade enough. Although I work for NHSD I think it is a totally pointless service and people constantly ring for assurance - with the nurse ‘nannying’ them because they cannot make their own decisions. I and many other middle aged people did’nt have this service when my kids where young - we relied on our Common Sense . It is another part of the ‘nanny state’ we have come to recognise.
Why do people actually ring up with a child with a fever and they have’nt given them calpol etc.. it beggars belief

It astounds me that there are people out there who do not know how to cope with a basic cold or d & v. The place where I work has become like a greedy business culture call centre - target related completely.

Also if we don’t use the call handlers don’t use the basic line of questions they get there hands severely slapped .

I fully understand the ambulance services frustrations of our service sometimes - I too get very frustrated with it also. They are trying to turn us into morons !

from a disgruntled , angry ‘factory farm hen’ Nurse.
Linda Says:
August 22nd, 2007 at 1:02 am

I have worked for NHSD in the past and it is indeed a very rigid place to work these days.It’s all about targets and numbers.As long as you keep your phone on ready and your calltimes short the management is happy.God help you if you have to spend more than 10 mins on a call sorting it out or passing it on to the OOH GP.
No wonder people are deserting it like rats jumping off a sinking ship.
I could not wait to get out of there.
The one thing that we all got really fed up with is all these calls about abdo pain or just pain anywhere.They are all in severe pain but haven’t taken anything for it.The answer is ususally that they don’t like taking tabletts or that they took one paracetamol yesterday and it didn’t help so they’re not taking naymore.What do you want us to do then?If you don’t want to help yourself then it’s not much anyone else can do over the phone.The other category that usually got to us is the parents calling about their kids.We could all understand if it’s a new parent or iif the child has a genuine illness or a previous disease that the parent is concered about but the parent who calls at 7am screamimg down the phone that their child is severly ill or even dying with a high fever.When you sk them A) how high the fever is and B) have they given the child something for it
The answer would more often than not be that the temeprature was around 37 or if the temperature was high that they don’t want to give their child medication.
I thought by working in A&E I had stopped being surprised and horrified by peoples ignorance and inability to treat the most simplest things at home but working for NHSD made me ealise that common sence just doesen’t seem to exist.People have no concept of basic selfcare or first aid.
helen Says:
September 13th, 2007 at 9:33 am

I know this debate has dragged on, but i just want to say I’ve worked for NHSd, when the ambulance option comes up, its because of what the patient has said not because the health adviser has decided it, the caller is usually advised that the answers they have given suggests an ambulance is required, they do get the option to decline, if its so inappropriate why don’t they?? We wouldn’t send one if people decline. If you want the GP out of hours number just say that when your asked what your calling about, if there is a direct line they’ll give it to you..or more sensibly just ring your GP surgery, the number will be on the answer phone.
NHSD nurse Says:
October 19th, 2007 at 9:07 pm

I too am an NHSD nurse advisor. Not really much I can add to the above but would reiterate:

it’s a target-driven, number crunching organisation that errs on the side of caution.

It’s our registration on the line if we get it wrong.

The callers often have the most unrealistic impression of the service offered, wanting a second opinion (can’t give one), a diagnosis (can’t do that either), a prescription (can’t do that either), a home visit (you guessed it) or for us to conjure up a dental/GP appointment where none is available.

Instead of publicising NHSD for health information, as has happened recently, WITHOUT the resources to back it up (lets not forget they made redundant a whole section of the staff last year), the management should concentrate on what we CAN do - advise and inform.

As an aside to previous postings, if ambulance crew rang for OOH GP when I was call handling, it would go through as a Policy Direct Transfer.

Finally, as well as being a Nurse Advisor, I am, on a daily basis, now a call handler and health information advisor. At many times 75% of the nurses available on shift are call handling. This isn’t publicised. We are told to stack the calls, then the queue reaches about 400 for call back (health info is always around 700 at present) …. call this a service? I don’t.
Brian Jones Says:
July 23rd, 2008 at 12:21 pm

I am the husband of a lady was assessed as having a brain tumour and was awaiting surgery. The neurosurgeon consultant said should there be any deterioration in her condition, get an ambulance and get her staright into his hospital. Do not even phone first.
Following a very rapid deterioration an ambulance was called. The staff ignored the consultants instructions and took her to the nearest hospital with an A&E unit where she waited six hours to be transferred to a neurosurgery facility during which time she almost died.
When the ambulance drivers were challenged they said they have a directive to take people to the nearest A&E facility. Didn’t matter what her condition was or the fact that she was required to get to the neurosurgeon with as little delay as possible.
Seems like it isn’t only NHSD staff who have a procedure to follow.
which according to ambulance staff is covering your own a***
Mark Myers Says:
July 23rd, 2008 at 12:33 pm

I’m so sorry to hear about your wife’s experience, Brian. All I can do is put the ambulance crew’s perspective across. The protocol isn’t to take to the nearest, but to the most appropriate hospital. A lot of patients ask to be taken to the hospital where they are receiving specialist treatment, but if the crew are worried the patient will go into cardiac arrest, they often decide it is most appropriate to take the patient to the nearest A+E so they have advanced resuscitation facilities around them. They can then be transferred on once they are stable. The last thing the crew want is for their patient to die in the ambulance because they drove past three A+Es to get them to a specialist hospital.

I’m thinking from what you said that the biggest problem here is that she waited six hours for a transfer to her specialist hospital. It should have been done as a blue light transfer.

Also: it is very insult to call paramedics or EMTs “ambulance drivers”, please don’t.
Brian Jones Says:
July 23rd, 2008 at 4:07 pm

Mark,
Thats an interesting reply. It seems that I have inadvertantly offended EMTs/Paramedics by not knowing that the person driving an Ambulance was not an Ambulance driver.
Please refer to your original post above - You consider it acceptable for you to refer to other healthcare professionals as Bods but feel offended when I refer to the driver of an ambulance as an ambulance driver. Come on you can’t have it both ways. Should I have used ‘Ambulance bod’ I think not!

In your original post you identify that you have information which may have caused NHSD to respond differently - ie Ambulance at the scene. This is no different to me providing information which should have resulted in my wife being taken to a neurosurgery facility and not an A&E unit.

The initial telephone call I made to the emergency services contained all details regarding the consultants directive about getting to the neurosurgery facility asap. This was reiterated to the driver of the ambulance. This information was ignored and the driver of the ambulance advised me that it was policy to go to the nearest A&E unit. The ‘crew’ as you refer to them, did not decide where to take my wife. That decison had been made before they arrived and before any assessment was carried out. Perhaps protocol differs from area to area but from what you say it appears that your area supports the case for people to be taken to the most appropriate hospital. The team transporting my wife had no choice

Both the hospital my wife was taken to and the neurosurgical facility she eventually arrived at were equidistant from our location. However, the neurosurgical facility is immediately adjacent to a motorway network and therefore would have been reached in a considerably shorter time due to the time of day. The neurosurgery facility had my wifes medical history, expertise and facilities on hand to enable immediate action to take place. However, at the A&E unit several hours were spent monitoring and assessing my wifes condition, all of which would have been completely unecessary had the ambulance crews been able to make an informed choice about where to take my wife.

My point is that NHSD staff have procedures to follow as it appeared this emergency team were forced to do. Despite the logic being flawed in my opinion. Had they had the opportunity to assess my wife condition before deciding where to take her then the outcome as to which facility to go to would have been fully supported. They assessed her on route to the nearest A&E unit and potentially compromised my wifes life.

I am happy to say my wife has made a full recovery and is now back at work as a practising health care professional. best regards
Mark Myers Says:
July 23rd, 2008 at 4:31 pm

Well, “bods” is a colloquial term and I probably *would* say “ambulance bods” myself if I were being colloquial! The thing with “ambulance driver” is that it makes it sound like they just drive the vehicle and aren’t medical professionals, which is why they hate it. (Just like control staff hate being called “The Operator”!)

I am 99% certain that the “most appropriate hospital” rule is one laid down by the department of health, not the ambulance service. There is a strong emphasis on taking patients to the nearest but not a rule, though sometimes crews just explain this as “Sorry, we’re taking you to the nearest cos we have to” because they don’t want to get into an argument. I will ask when I am back at work. It does seem a very odd and inappropriate choice to make, given that the neuro hospital wasn’t much further, and I can only guess at the reasons the crew had for making it. Can I ask if you had a letter from the neuro consultant stating that she had to go there? I’m wondering if the ambulance crew didn’t believe you, because I am sorry to say a lot of people insist on going to certain hospitals for spurious reasons and crews sometimes do have to put their feet down otherwise they’d end up taking people all over the place…

I understand everyone has their procedures to follow, not all of which make sense (you should see some of the ones we have to follow in the control room!) and am not criticising NHS Direct at all, I was just wondering where this particular procedure would lead to!

Glad to hear your wife recovered. That’s the main thing.
Brian Jones Says:
July 24th, 2008 at 7:55 am

Appreciate your time spent responding. only glad I don’t deal with the public! keep up your good works. best regards
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Caoimhe Says:
February 22nd, 2009 at 4:34 am

Living with a chronic condition that likes to throw all sorts of new symptoms at me from time to time, i have lots of experience with NHS direct. Most of the time they’re jolly good, and do exactly what I need of them (assess whether I’m okay continuing to home treat or if I should be paying more attention to the new symptom and seeking help. If you’re in constant pain with a myriad of symptoms that most people would dial 999 over, it can be a little tricky to figure out when you actually _do_ have a problem.

What I have noticed, is they sure don’t like you refusing the ambulance their system is flagging up for you. I was certain my chest pain and difficulty breathing was not an emergency, as it had been going on (albeit steadily worsening) for four days, I just wanted a little advice on additional home care as it was particularly bad and I had maxed out on prescription painkillers… saying “no, I don’t think I’ll have an ambulance, my partner can take me up to A&E when he finishes work in a few hours, if I stay this bad” frustrated the poor NHSd nurse a lot.

I did feel sorry for her, but it turned out I was right, and all it was just a particularly severe immflamation of my rib cartilige. On the odd occasion, the patient does have some idea about whether they need an ambulance or not!

I was thoroughly put off NHSd-called ambulances the one time I did get one, though, which might have contributed to my decision. I had a UTI, was on medication for it, and just as the symptoms started to wane, had come over hot, dizzy, short of breath and with a pin-prick purple rash that didn’t blanch. I agreed to the ambulance on a ‘I’m sure it’s not meningitus but it doesn’t sound good all the same’ basis (the nurse was not overly happy with me insisting that a migrane, sore neck and strong adversion to light are everyday things in my case). So the ambo came, was my first time in one(!), and it was all very nice, very professional. However, somewhat embarassing to be taken all the way through A&E and into OOHs, who promptly treating me like scum for coming in an ambo for a bad reaction to the antibiotics. *sigh* (OOHs I avoid like the plague, as with a chronic pain condition I get treated like a junky looking for a fix, as well as a hypochrondiac attention seeker )

NHSd do seem a pretty caring bunch, and they do a good job. It’s definitely a service I’m glad to have on hand. I heard ages ago it was under threat, and that sadened me. I hope it’s not the case, as they’re great at what they do!

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Nee Naw

Nee Naw is a blog about life in the London Ambulance Service control room. It is written by Suzi Brent.

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