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As the Former COO of NHS Direct, and Director of 111, it breaks my heart to see the state that call handling in the NHS has disintegrated into. 

The impact this is having on the people on the front line, the managers trying their best to organise it, with it being turned into The Hunger Games of the NHS, having to decide who dies and who lives on an hourly basis.

The resulting impact on patients, those everyone signed up to serve and care for, is a service broken to its knees, with 24 hour waits for Ambulances not uncommon, if you’re lucky enough to be triaged for one at all, and a system that burst its banks in plain sight.

Patients are being left to fend for themselves, being told by Government ministers to take a taxi or a bus to hospital, in some sort of 3rd world version of Survivor.

So is it about Money? Well Yes and No. As ever, it is more complex than that, but it’s a root cause.

When I joined the NHS in 2011 I learned very quickly that Inflation in that system ran at 10-15%. This was due to demand. Whatever the causes, demand even back then was rising rapidly, as was the severity off illness. But there was spare capacity. The increased demand each year was funded however.

With a change of Government and the Health and Social Care Act in 2013, there was a fundamental shift in policy, and the ever increasing demand stopped being funded.

Whatever the politics of that, you can’t blame people for being ill or for getting old, and the 6th biggest economy in the world should not have its healthcare system crumbling or its staff relying on foodbanks.

Some say the public have a role to play in this, and certainly there has been a huge effort to manage expectations in recent years, even before the pandemic.

When I went to the Ambulance service, I was surprised that there was an expectation that ringing 999 would automatically bring an ambulance. I even saw one person on the news last week say “I ordered an Ambulance” like it was a pizza on Deliveroo.

Levels of conveyance are typically down to around 35% now. Single crew attendance is common and Make Ready Centres mean crews are always in a ready state.

111 is not NHS Direct, and never will be, and although that’s a debate for another time, the service has been running 10 years now, and yet barely any service provider has hit a front end service level over any reasonable period in all that time.

So yes, money is the answer, as unless you fund to meet the demand, you can’t staff to it. It’s pointless the Government saying here’s £200m go and fix it next month. We all know how long it takes to recruit and train in any call centre. But in 111 and 999? 5-9 weeks training. And that’s before they’ve built up a level of competence and confidence and been clinically supervised.

How much skill would you want your 999 or 111 call handler to have if it was your partner having chest pains or your child with a rash?

But as any good Ops Director knows, It’s a flow and a process, and if you block the back end, eventually the front end will eventually fill up. And there’s the rub. The crime of neglect in social care causes the backlog, because it’s not high profile, not politically sensitive, and everyone can get away with not talking about it, and not funding it.

And then the Government finally bring the Unions in to talk this week. But not about pay, they want to talk about productivity, and dismissals for going on strike.

From clapping to sacking. You make your own mind up. Who is it putting lives at risk?

Source: I worry we’re killing people – ambulance call centre worker – BBC News

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