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This is the NHS: live from the UK's biggest maternity centre in Liverpool This is the NHS: live from the UK's biggest maternity centre in Liverpool
(35 minutes later)
11.57am GMT
11:57
Sarah McGrath, maternity ward manager
Jessica Elgot
Sarah McGrath, the ward manager in the maternity unit, is checking over her schedule for the day. “There’s not much you can plan for in this job, it would be nice if babies were spaced out each hour but that doesn’t happen,” she laughs.
One old wives’ tale seems to ring true more often than not for the midwives on the ward here – that more babies are born at the full moon. “There’s research into it which found that isn’t true, but sometimes if we get really busy, we say to each other, is it a full moon? And it usually is.”
The high risk unit for antenatal and postnatal women, who might have had a caesarian section or more blood loss than expected, is currently caring for 45 women. Ten beds empty, which McGrath says is an excellent position to be in.
One woman has had an emergency c-section this morning, but McGrath said she is now recovering well. Three women are due to be induced. In the low risk area, where women have a natural birth assisted only by midwives, unless complications occur, there are two women currently in labour – but that could triple by the end of the day, or the ward could have none at all .
Another 13 women are with their newborns in the Jeffcoate ward, a place where new mums can stay overnight for observation if doctors want to keep an eye on them. “It is totally unpredictable this job, but today is looking fine for now. If we get busier, we have to adapt.”
11.45am GMT
11:45
Dr Mark Turner, consultant neonatalogogist
Jessica Elgot
It’s mid-morning and consultant neonatologist Dr Mark Turner is doing the daily ward round to check on Liverpool’s tiniest babies in the intensive care wards.
The first baby he checks on has been on a ventilator, and Turner is debating how long to keep him on the breathing apparatus, and whether to put him on steroids to help him breathe on his own.
It’s a balancing act, we don’t want to put him on steroids for too long or too early because of the risk of brain injury, but we also don’t want to leave him on the ventilator too long either.
He leaves instructions to keep the baby on the ventilator a little while longer but hopes to take him off it very soon.
The second baby Turner looks at was born at 26 weeks, but is growing well and is breathing on his own. The babies are in covered incubators, to make sure they have as little disturbance from noise and light as possible.
Being a premature baby is a bit like having a hangover: if you have a headache, it distracts you. We want babies to have as little distraction as possible so they can concentrate on growing.
One of the biggest babies Turner examines is 5.2kg – ten times larger than the department’s smallest baby – but still needs extra care to help with his breathing. “In adults, the difference in size is only really people who are twice the size. We have to have equipment, like tubes, to deal with babies who might be ten times smaller than another baby.”
Several others on the ward have improved and moved from intesive care onto high dependency wards. But two had infections – one a common cold and another septicaemia – so are now back in intensive care. Both are improving, but Turner stresses how rigorous the ward had to be about infection. All hair must be tied up, rings removed and no handbags allowed in the ward, with hand disinfected after touching anything.
“There are things about biology we can’t control, but we can control infection – that’s our beginning and end here.”
One thing which can make a huge difference is skin-to-skin contact with parents, and Turner’s staff are trained to make sure parents can cuddle their children and not disturb any of the tubes. “We have to look after babies’ psychosocial needs as well as medical needs. We also want to feed babies on their mother’s milk as much as possible,” he said. “We have donors too who give milk that is pasteurised if mum can’t express her own.”
Updated
at 11.56am GMT
11.35am GMT
11:35
'My baby was born in our bathroom'
We’ve just launched the latest in our ‘The day the NHS saved my life’ series, in which Caroline Howe tells the dramatic story of the birth of her second child. Here’s an excerpt:
The paramedics took one look at me and realised I was crowning in the bathroom. Usually they take you to hospital, but they knew there was no way they were going to be able to move me.
And so my youngest daughter was born on our bathroom floor. She was grey. There was nothing, no crying. Because she was late, she had swallowed meconium and wasn’t breathing. The paramedics had set up in the kitchen, where they immediately whisked her away to try to resuscitate her.
Related: The day the NHS saved my life: my baby was born in our bathroom
10.51am GMT10.51am GMT
10:5110:51
10.49am GMT10.49am GMT
10:4910:49
One of the Guardian’s data team, Pamela Duncan, has tweeted this graphic from our NHS data dashboard, which is updated in real time to show some astonishing maternity statistics.One of the Guardian’s data team, Pamela Duncan, has tweeted this graphic from our NHS data dashboard, which is updated in real time to show some astonishing maternity statistics.
We’re up to 43,345 births so far this year – which means about 3,000 babies have been born nationwide since this liveblog began this morning!We’re up to 43,345 births so far this year – which means about 3,000 babies have been born nationwide since this liveblog began this morning!
12,000+ pregnancies of twins, triplets etc in the UK in 2014, up 23% on 1994 #thisistheNHS https://t.co/XyWCwgCBkb pic.twitter.com/l2ZmTFjBLB12,000+ pregnancies of twins, triplets etc in the UK in 2014, up 23% on 1994 #thisistheNHS https://t.co/XyWCwgCBkb pic.twitter.com/l2ZmTFjBLB
10.26am GMT10.26am GMT
10:2610:26
Readers share their childbirth storiesReaders share their childbirth stories
Elena CresciElena Cresci
Zoe Williams’s article on navigating the myriad options presented when having a baby has inspired our commenters to share their own birth stories below the line.Zoe Williams’s article on navigating the myriad options presented when having a baby has inspired our commenters to share their own birth stories below the line.
Ajchm emphasises how you should listen to the professionals:Ajchm emphasises how you should listen to the professionals:
My twopenneth for what its worth... Medical school and midwifery school plus years of practice means yes they do know more than you! If they are saying that you are high risk, that you need a procedure or test listen - if you are concerned that your assigned person isn't going the direction you want, get a second opinion rather than overrule them - they want a safe birth, that's their priority.My twopenneth for what its worth... Medical school and midwifery school plus years of practice means yes they do know more than you! If they are saying that you are high risk, that you need a procedure or test listen - if you are concerned that your assigned person isn't going the direction you want, get a second opinion rather than overrule them - they want a safe birth, that's their priority.
That said my attitude was to stay at home for as long as I dare then take no drugs, nothing. Keeping upright speeds things up. I had a midwife and a trainee, nobody else but knowing there was a nicu down the hall and an ob around the bend meant I had plan b. Birthing balls are the best. I was in, given birth and home within 8 hours, far better than homebirth.That said my attitude was to stay at home for as long as I dare then take no drugs, nothing. Keeping upright speeds things up. I had a midwife and a trainee, nobody else but knowing there was a nicu down the hall and an ob around the bend meant I had plan b. Birthing balls are the best. I was in, given birth and home within 8 hours, far better than homebirth.
Blibbka told us about the difference between their partner’s two labours:Blibbka told us about the difference between their partner’s two labours:
My partner just recently had our second child.My partner just recently had our second child.
First labour was frankly hideous - she was in agony for about 5 hours, naked on all fours screaming in agony; scenes reminiscent of a werewolf metamorphosis! Gas and air provided minimal pain relief but caused vomiting. Midwife was apparently reluctant to arrange epidural but when it eventually arrived mad a great deal of difference. Birth plan? Ha! Was never mentioned.First labour was frankly hideous - she was in agony for about 5 hours, naked on all fours screaming in agony; scenes reminiscent of a werewolf metamorphosis! Gas and air provided minimal pain relief but caused vomiting. Midwife was apparently reluctant to arrange epidural but when it eventually arrived mad a great deal of difference. Birth plan? Ha! Was never mentioned.
Second time around, much better in part due to us being wiser. As soon as we arrived at the delivery ward we made our birth plan really clear to the midwife: we want an epidural. Midwife was obliged to explain risks and that's fine, but happily complied and this meant that my partner had effective pain relief from an early stage.Second time around, much better in part due to us being wiser. As soon as we arrived at the delivery ward we made our birth plan really clear to the midwife: we want an epidural. Midwife was obliged to explain risks and that's fine, but happily complied and this meant that my partner had effective pain relief from an early stage.
The comparison was as night and day; labour was still undoubtedly difficult but far more positive experience.The comparison was as night and day; labour was still undoubtedly difficult but far more positive experience.
So my key advice would be to make sure the midwife is very clear about your birth plan at the earliest moment. For first time Mum's - do not underestimate the amount of pain involved (sorry), I'd urge you to remain open minded to all pain relief options.So my key advice would be to make sure the midwife is very clear about your birth plan at the earliest moment. For first time Mum's - do not underestimate the amount of pain involved (sorry), I'd urge you to remain open minded to all pain relief options.
And RedMove makes the point that sometimes it doesn’t matter how prepared you are – sometimes all your plans go right out the window!And RedMove makes the point that sometimes it doesn’t matter how prepared you are – sometimes all your plans go right out the window!
And sometimes the plan just goes out of the window. Baby no 1 was a bit of a disaster, so was determined both 2 would be better. So there I am, well into labour, high as a kite on gas and air, with my relaxation music doing its job, and my water break. Two minutes later there's utter panic as they can't find a heartbeat & 10 minutes later I'm in theatre for an emergency section, with no pain relief until they put me under. Luckily all turned out well, but you can't plan for everything.And sometimes the plan just goes out of the window. Baby no 1 was a bit of a disaster, so was determined both 2 would be better. So there I am, well into labour, high as a kite on gas and air, with my relaxation music doing its job, and my water break. Two minutes later there's utter panic as they can't find a heartbeat & 10 minutes later I'm in theatre for an emergency section, with no pain relief until they put me under. Luckily all turned out well, but you can't plan for everything.
UpdatedUpdated
at 10.27am GMTat 10.27am GMT
9.29am GMT9.29am GMT
09:2909:29
Dianne Brown, director of nursing and midwiferyDianne Brown, director of nursing and midwifery
Jessica ElgotJessica Elgot
There is approximately one baby born every hour (not quite every minute) at Liverpool Women’s hospital. So at least one newborn has arrived since the Guardian live blog launched this morning.There is approximately one baby born every hour (not quite every minute) at Liverpool Women’s hospital. So at least one newborn has arrived since the Guardian live blog launched this morning.
Dianne Brown, director of nursing and midwifery, has seen generations of women pass through the hospital, often spotting grandmas, mums and babies in the waiting rooms together.Dianne Brown, director of nursing and midwifery, has seen generations of women pass through the hospital, often spotting grandmas, mums and babies in the waiting rooms together.
It is a very different role than working in a department of a hospital where people are coming in regularly just to get something fixed. Everyone here has an extreme emotional attachment to what is happening: having a baby, having a sick baby taken care of, trying to get pregnant, getting treatment for a problem like endometriosis which might prevent pregnancy, or getting genetic counselling.It is a very different role than working in a department of a hospital where people are coming in regularly just to get something fixed. Everyone here has an extreme emotional attachment to what is happening: having a baby, having a sick baby taken care of, trying to get pregnant, getting treatment for a problem like endometriosis which might prevent pregnancy, or getting genetic counselling.
Brown has a background as a nurse, rather than a midwife, and is passionate about an all-rounded approach to women’s health, rather than just caring for babies. Women travel to the hospital from across the north of England and Wales for specialist gynaecological treatment, including cancer.Brown has a background as a nurse, rather than a midwife, and is passionate about an all-rounded approach to women’s health, rather than just caring for babies. Women travel to the hospital from across the north of England and Wales for specialist gynaecological treatment, including cancer.
Not only are babies born here, but the hospital has end-of-life suites for women with terminal cancer. “Unfortunately, they are always occupied,” says Brown. “In the 30 years I’ve been here, we’ve see a real increase in early diagnosis and prevention of cervical cancer but we see women presenting at our A&E with late stage cancer of the vulva, with ovarian cancer. We should never want to see that.”Not only are babies born here, but the hospital has end-of-life suites for women with terminal cancer. “Unfortunately, they are always occupied,” says Brown. “In the 30 years I’ve been here, we’ve see a real increase in early diagnosis and prevention of cervical cancer but we see women presenting at our A&E with late stage cancer of the vulva, with ovarian cancer. We should never want to see that.”
The hospital has the only women’s-only A&E in the country, dealing most frequently with miscarriage. “Women having a miscarriage are obviously going to be extremely distressed, coming here means they don’t have the added stress of waiting in a general A&E.”The hospital has the only women’s-only A&E in the country, dealing most frequently with miscarriage. “Women having a miscarriage are obviously going to be extremely distressed, coming here means they don’t have the added stress of waiting in a general A&E.”
The hospital deals with around 1,000 baby deaths every year, from early stage pregnancy to neonatal death. “We do a remembrance service every year and this year 400 women came. But there was one elderly lady I remember who told me she lost her baby when she was in her early twenties. In those days you couldn’t hold the baby – couldn’t even see it – and she has struggled with it all her life.”The hospital deals with around 1,000 baby deaths every year, from early stage pregnancy to neonatal death. “We do a remembrance service every year and this year 400 women came. But there was one elderly lady I remember who told me she lost her baby when she was in her early twenties. In those days you couldn’t hold the baby – couldn’t even see it – and she has struggled with it all her life.”
UpdatedUpdated
at 9.39am GMTat 9.39am GMT
8.32am GMT8.32am GMT
08:3208:32
7.59am GMT7.59am GMT
07:5907:59
Thursday's morning briefingThursday's morning briefing
Mark SmithMark Smith
Hello and welcome to Thursday’s #ThisIsTheNHS live blog, the fourth day of the Guardian’s series seeking to get under the skin of the health service.Hello and welcome to Thursday’s #ThisIsTheNHS live blog, the fourth day of the Guardian’s series seeking to get under the skin of the health service.
The big pictureThe big picture
The NHS deals with more than a million patients every 36 hours. Since its founding in 1948, the health service budget of £437m (equivalent to about £15bn today) has snowballed to £136.7bn – or £260,084 a minute – in England alone. The statistical story is staggering: last year NHS England reported almost 10m operations, 22m visits to A&E, 16m hospital admissions, 82m outpatient visits and almost 2 million people getting help from specialist mental health services.The NHS deals with more than a million patients every 36 hours. Since its founding in 1948, the health service budget of £437m (equivalent to about £15bn today) has snowballed to £136.7bn – or £260,084 a minute – in England alone. The statistical story is staggering: last year NHS England reported almost 10m operations, 22m visits to A&E, 16m hospital admissions, 82m outpatient visits and almost 2 million people getting help from specialist mental health services.
Yesterday, we focused the lens of our journalism on paramedics and ambulance services. Jessica Elgot liveblogged from the North East ambulance service offices in Newcastle, which houses both 999 and 111 call centres. Her reports and interviews – with photographs from Alicia Canter – provided a fascinating insight into the day to day lives of people who can genuinely claim to be on one of the frontlines of the NHS: the staff responsible for taking initial calls from emergency patients.Yesterday, we focused the lens of our journalism on paramedics and ambulance services. Jessica Elgot liveblogged from the North East ambulance service offices in Newcastle, which houses both 999 and 111 call centres. Her reports and interviews – with photographs from Alicia Canter – provided a fascinating insight into the day to day lives of people who can genuinely claim to be on one of the frontlines of the NHS: the staff responsible for taking initial calls from emergency patients.
Jessica even got to play the role of someone with a sore throat (in an acting performance of a lifetime) in order to test the 111 call operator’s question script. She was grateful to be offered an appointment to see a doctor within three hours.Jessica even got to play the role of someone with a sore throat (in an acting performance of a lifetime) in order to test the 111 call operator’s question script. She was grateful to be offered an appointment to see a doctor within three hours.
Steven Morris spent a day with Steve Hulks, one of a new breed of paramedics charged with keeping people out of hospital. Hulks says he is still there to save lives, but his job now is much more about helping an ageing population stay out of hospital and remain independent, advising and reassuring troubled young people, and thinking about patients’ mental wellbeing.Steven Morris spent a day with Steve Hulks, one of a new breed of paramedics charged with keeping people out of hospital. Hulks says he is still there to save lives, but his job now is much more about helping an ageing population stay out of hospital and remain independent, advising and reassuring troubled young people, and thinking about patients’ mental wellbeing.
Caroline Davies reported on how a trailblazing scheme in the Isle of Wight to bring key staff, from 999 operators to social workers, under one roof has attracted international attention.Caroline Davies reported on how a trailblazing scheme in the Isle of Wight to bring key staff, from 999 operators to social workers, under one roof has attracted international attention.
And Denis Campbell broke the story that NHS funding is falling behind that of its European neighbours’ average. A King’s Fund study ranks UK 13th out of 15 original EU members and casts doubt on ministers’ claims they are giving the NHS generous cash settlements.And Denis Campbell broke the story that NHS funding is falling behind that of its European neighbours’ average. A King’s Fund study ranks UK 13th out of 15 original EU members and casts doubt on ministers’ claims they are giving the NHS generous cash settlements.
Today’s focusToday’s focus
Today we go back to the start. Childbirth is most people’s first experience of the NHS – albeit one they are unlikely to remember. So far this year there have been more than 43,000 babies born in the UK (you can see live data on this – and other fascinating real-time statistics – in our NHS data dashboard).Today we go back to the start. Childbirth is most people’s first experience of the NHS – albeit one they are unlikely to remember. So far this year there have been more than 43,000 babies born in the UK (you can see live data on this – and other fascinating real-time statistics – in our NHS data dashboard).
In today’s coverage, Zoe Williams seeks to navigate the key issues faced by expectant mothers: home birth or hospital? Birthing pool or bed? Drugs or no drugs? Our readers have shared their own birthing stories, from the vital statistics to the quality of care, and we have a secret diary from a sexual health officer.In today’s coverage, Zoe Williams seeks to navigate the key issues faced by expectant mothers: home birth or hospital? Birthing pool or bed? Drugs or no drugs? Our readers have shared their own birthing stories, from the vital statistics to the quality of care, and we have a secret diary from a sexual health officer.
Related: 'I'm insisting that things be done my way': readers share their birth storiesRelated: 'I'm insisting that things be done my way': readers share their birth stories
Jessica Elgot is at Liverpool Women’s hospital, the largest maternity centre in the UK. Around 8,000 newborns kick and scream their way into the world here every year – an average of 20 a day. It carries out at least 30 gynaecological operations daily, and offers reproductive services as well as a specialised genetics team.Jessica Elgot is at Liverpool Women’s hospital, the largest maternity centre in the UK. Around 8,000 newborns kick and scream their way into the world here every year – an average of 20 a day. It carries out at least 30 gynaecological operations daily, and offers reproductive services as well as a specialised genetics team.
We’ll be spending time with pregnant women and new mums on the neonatal unit, and will be speaking to IVF consultants, midwives and miscarriage experts.We’ll be spending time with pregnant women and new mums on the neonatal unit, and will be speaking to IVF consultants, midwives and miscarriage experts.
You can comment below the line, tweet us (@marksmith174 or @jessicaelgot) and help shape the conversation on Twitter using the hashtag #ThisIsTheNHS. We hope you’ll stick with us throughout the day.You can comment below the line, tweet us (@marksmith174 or @jessicaelgot) and help shape the conversation on Twitter using the hashtag #ThisIsTheNHS. We hope you’ll stick with us throughout the day.
Guardian Live: This is the NHSGuardian Live: This is the NHS
Tonight also sees the first Guardian Membership event devoted to our NHS series. At Kings Place on Thursday there will an evening of debate and discussion on the challenges of working in our most vital public service, featuring: Dr Salyeha Ahsan, A&E doctor and broadcaster; Robert Freeman, consultant paediatric orthopaedic surgeon, the Robert Jones & Agnes Hunt NHS foundation trust; Dr Faye Kirkland, GP; Dame Donna Kinnair, RCN’s director of nursing, policy and practice. The event will be chaired by Guardian writer and columnist Polly Toynbee. Tickets are sold out.Tonight also sees the first Guardian Membership event devoted to our NHS series. At Kings Place on Thursday there will an evening of debate and discussion on the challenges of working in our most vital public service, featuring: Dr Salyeha Ahsan, A&E doctor and broadcaster; Robert Freeman, consultant paediatric orthopaedic surgeon, the Robert Jones & Agnes Hunt NHS foundation trust; Dr Faye Kirkland, GP; Dame Donna Kinnair, RCN’s director of nursing, policy and practice. The event will be chaired by Guardian writer and columnist Polly Toynbee. Tickets are sold out.
What you’re saying about our NHS seriesWhat you’re saying about our NHS series
A must read! How @MyLifeAFullLife #futureNHS vanguard is improving care on the Isle of Wight https://t.co/uz1FC4vFTF #ThisIsTheNHS #FYFVA must read! How @MyLifeAFullLife #futureNHS vanguard is improving care on the Isle of Wight https://t.co/uz1FC4vFTF #ThisIsTheNHS #FYFV
Another great article as part of the @guardian's #ThisIsTheNHS series. This time looking at Paramedics: https://t.co/ARp5fscIcKAnother great article as part of the @guardian's #ThisIsTheNHS series. This time looking at Paramedics: https://t.co/ARp5fscIcK
'The Secret Hospital Manager's Diary' @NHSGradScheme candidates this is worth a read to gain insight #ThisIsTheNHS https://t.co/252pUhplE8'The Secret Hospital Manager's Diary' @NHSGradScheme candidates this is worth a read to gain insight #ThisIsTheNHS https://t.co/252pUhplE8
Wednesday’s most readWednesday’s most read
UpdatedUpdated
at 8.25am GMTat 8.25am GMT
4.08pm GMT4.08pm GMT
16:0816:08
Wednesday's liveblogging endsWednesday's liveblogging ends
That’s it for another day on the NHS’s frontline. Thanks for getting involved with your tweets and comments. And thanks to the staff at the North East ambulance service HQ in Newcastle for giving us such valuable access and sharing their working day with our readers.That’s it for another day on the NHS’s frontline. Thanks for getting involved with your tweets and comments. And thanks to the staff at the North East ambulance service HQ in Newcastle for giving us such valuable access and sharing their working day with our readers.
Tomorrow Jessica Elgot will be reporting from maternity wards as our #ThisIsTheNHS series moves on to most people’s first experience with the health service, albeit one they are unlikely to remember: childbirth.Tomorrow Jessica Elgot will be reporting from maternity wards as our #ThisIsTheNHS series moves on to most people’s first experience with the health service, albeit one they are unlikely to remember: childbirth.
3.56pm GMT3.56pm GMT
15:5615:56
Jessica ElgotJessica Elgot
The last call I listen in to with nurse Mary Mallorca is a woman concerned about her young son who had tonsillitis but is having difficulty swallowing his medication.The last call I listen in to with nurse Mary Mallorca is a woman concerned about her young son who had tonsillitis but is having difficulty swallowing his medication.
The first call handler has suggested sending him to an urgent care centre doctor, but Mallorca is concerned by some of the symptoms. “He can’t swallow any of the medication, that could mean he needs to go to hospital because the glands are so swollen.”The first call handler has suggested sending him to an urgent care centre doctor, but Mallorca is concerned by some of the symptoms. “He can’t swallow any of the medication, that could mean he needs to go to hospital because the glands are so swollen.”
She begins to arrange transport to get the boy to A&E, when the woman says her son has changed his mind and no longer wants to go to hospital, and will try again to swallow his medication.She begins to arrange transport to get the boy to A&E, when the woman says her son has changed his mind and no longer wants to go to hospital, and will try again to swallow his medication.
Mallorca switches to a different script, arranging an appointment for an hour’s time at an urgent care clinic. It’s a scenario several members of the team say happens quite often – patients change their minds about the seriousness of symptoms; call handlers and nurses then have the onus to ask the right questions, to get a more accurate picture.Mallorca switches to a different script, arranging an appointment for an hour’s time at an urgent care clinic. It’s a scenario several members of the team say happens quite often – patients change their minds about the seriousness of symptoms; call handlers and nurses then have the onus to ask the right questions, to get a more accurate picture.
UpdatedUpdated
at 4.01pm GMTat 4.01pm GMT
3.16pm GMT3.16pm GMT
15:1615:16
Mary Mallorca, 111 call centre nurseMary Mallorca, 111 call centre nurse
Jessica ElgotJessica Elgot
Not seeing a patient’s face was a tricky thing for nurse Mary Mallorca to adapt to. She has worked in A&E and care homes, but helping patients over the phone is a very different proposition.Not seeing a patient’s face was a tricky thing for nurse Mary Mallorca to adapt to. She has worked in A&E and care homes, but helping patients over the phone is a very different proposition.
It is very, very hard that you can’t see them; you have to find other ways to judge their responses – you can’t take anything for granted over the phone.It is very, very hard that you can’t see them; you have to find other ways to judge their responses – you can’t take anything for granted over the phone.
Mallorca has had to deal with many patients who have said they are suicidal. “Even if you can’t see them, I believe they can feel when you care, when you talk to them, you have to have a positive approach, even though it can be very difficult for you as well.”Mallorca has had to deal with many patients who have said they are suicidal. “Even if you can’t see them, I believe they can feel when you care, when you talk to them, you have to have a positive approach, even though it can be very difficult for you as well.”
Although she has nothing but praise for call handlers, Mallorca said it would be better if everyone answering calls was a qualified nurse. “But we have to be able to cope with demand,” she said. “For a minor case, they can handle it themselves.”Although she has nothing but praise for call handlers, Mallorca said it would be better if everyone answering calls was a qualified nurse. “But we have to be able to cope with demand,” she said. “For a minor case, they can handle it themselves.”
3.14pm GMT3.14pm GMT
15:1415:14
We want to hear your wishlist for NHS mental health servicesWe want to hear your wishlist for NHS mental health services
in a perfect world, what would you like to see from the NHS' mental health services? #ThisIsTheNHS https://t.co/yXdV0PncdLin a perfect world, what would you like to see from the NHS' mental health services? #ThisIsTheNHS https://t.co/yXdV0PncdL
Get involved with the mental health element of our #ThisIsTheNHS series and help shape our future coverage.Get involved with the mental health element of our #ThisIsTheNHS series and help shape our future coverage.
3.05pm GMT3.05pm GMT
15:0515:05
Video: we role-play a 111 callVideo: we role-play a 111 call
Jessica Elgot poses as a sufferer of pharyngitis (that’s a sore throat to you and me) in order to be given an insight into the kind of questions patients are asked when calling 111. Call handler Karl Walker makes sure Jessica isn’t bleeding or sensitive to light before booking her an appointment with a GP within three hours.Jessica Elgot poses as a sufferer of pharyngitis (that’s a sore throat to you and me) in order to be given an insight into the kind of questions patients are asked when calling 111. Call handler Karl Walker makes sure Jessica isn’t bleeding or sensitive to light before booking her an appointment with a GP within three hours.
Walker has taken 999 calls for 5 years, and trained to do 111 when the service first started:Walker has taken 999 calls for 5 years, and trained to do 111 when the service first started:
They can really overlap: you might get an elderly person call 111 because they don’t want to bother an ambulance, but their are signs indicating a heart attack. On 999, you’d be surprised how many times we get people with toothache. It might be painful, but there’s nothing an ambulance can do about toothache.They can really overlap: you might get an elderly person call 111 because they don’t want to bother an ambulance, but their are signs indicating a heart attack. On 999, you’d be surprised how many times we get people with toothache. It might be painful, but there’s nothing an ambulance can do about toothache.
UpdatedUpdated
at 3.31pm GMTat 3.31pm GMT
2.44pm GMT2.44pm GMT
14:4414:44
Lynsey Redpath, team leaderLynsey Redpath, team leader
Jessica ElgotJessica Elgot
“If a 111 call handler was sending more than 5% of their calls to A&E, we want to know why,” team leader Lynsey Redpath said. “It’s not true that we send everyone there.”“If a 111 call handler was sending more than 5% of their calls to A&E, we want to know why,” team leader Lynsey Redpath said. “It’s not true that we send everyone there.”
Around a quarter of calls get transferred to a nurse either straight away, or for a call back. But mostly call handlers are trusted to make the right decision on how to advise a patient.Around a quarter of calls get transferred to a nurse either straight away, or for a call back. But mostly call handlers are trusted to make the right decision on how to advise a patient.
“It’s not just A&E or a GP; we can send people to pharmacists, midwives, opticians, dentists, district nurses, mental health services,” she said. “The pathways system we use is a spider’s web, not a linear process.”“It’s not just A&E or a GP; we can send people to pharmacists, midwives, opticians, dentists, district nurses, mental health services,” she said. “The pathways system we use is a spider’s web, not a linear process.”
1.50pm GMT1.50pm GMT
13:5013:50
Richard Abdy, planning managerRichard Abdy, planning manager
Jessica ElgotJessica Elgot
New Year’s Eve is Richard Abdy’s biggest night of the year – closely followed by whenever Newcastle play Sunderland. His job as planning manager is to try to predict the busiest times for 111 or 999 calls in order to keep staff costs down.New Year’s Eve is Richard Abdy’s biggest night of the year – closely followed by whenever Newcastle play Sunderland. His job as planning manager is to try to predict the busiest times for 111 or 999 calls in order to keep staff costs down.
You hear all the time that frontline services aren’t affected by the cuts. They are. Staffing is, like most places, 60-70% of our budget. When you have got nowhere else to cut, you have to look at how you can use staff effectively.You hear all the time that frontline services aren’t affected by the cuts. They are. Staffing is, like most places, 60-70% of our budget. When you have got nowhere else to cut, you have to look at how you can use staff effectively.
Abdy’s background is in the private sector. “It’s very different to selling insurance or PPI, saving people’s lives, but we also have to be sustainable.”Abdy’s background is in the private sector. “It’s very different to selling insurance or PPI, saving people’s lives, but we also have to be sustainable.”
Patterns that affect staffing are constantly changing. “The weather affects us in all sorts of different ways,” Abdy says. “If there’s snow, we can predict demand won’t be as high as you might think because people stay indoors. If there’s ice, it’s worse because people don’t see the danger, they go out, they fall.”Patterns that affect staffing are constantly changing. “The weather affects us in all sorts of different ways,” Abdy says. “If there’s snow, we can predict demand won’t be as high as you might think because people stay indoors. If there’s ice, it’s worse because people don’t see the danger, they go out, they fall.”
New Year’s Eve is now a totally different beast to when Abdy first started. “The pattern is later and later. Peak times used to be 1am; now it’s constant until 4am or 5am for 999 – and then it spikes again in the morning for 111. We only have a certain number of staff trained and they aren’t robots, they have to go home and sleep so that is a real challenge.”New Year’s Eve is now a totally different beast to when Abdy first started. “The pattern is later and later. Peak times used to be 1am; now it’s constant until 4am or 5am for 999 – and then it spikes again in the morning for 111. We only have a certain number of staff trained and they aren’t robots, they have to go home and sleep so that is a real challenge.”
One of the ways the service has tried to tackle the pressure is to train staff to take both 111 and 999 calls, so they can immediately switch to a different system if a 111 call seems more serious, or if a 999 caller really only needs a GP appointment. “It makes us more resilient, it means staff can deal with the unknowns, and we have a contingency who can always switch between roles.”One of the ways the service has tried to tackle the pressure is to train staff to take both 111 and 999 calls, so they can immediately switch to a different system if a 111 call seems more serious, or if a 999 caller really only needs a GP appointment. “It makes us more resilient, it means staff can deal with the unknowns, and we have a contingency who can always switch between roles.”
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at 1.55pm GMTat 1.55pm GMT
1.44pm GMT1.44pm GMT
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'The problem is most people don't need to be in hospital''The problem is most people don't need to be in hospital'
We’ve just launched a special report by Steven Morris, who spent some time with Steve Hulks, a new breed of ambulance paramedic charged with keeping people out of hospital, rather than simply ferrying them to and from A&E.We’ve just launched a special report by Steven Morris, who spent some time with Steve Hulks, a new breed of ambulance paramedic charged with keeping people out of hospital, rather than simply ferrying them to and from A&E.
When [Hulks] first signed up a quarter of a century ago the job entailed going to the scene of an emergency and rushing the patient to hospital. “It was about doing some first aid, putting the patient in the back of an ambulance and taking them to A&E. The problem is most people didn’t need to be in hospital – it was no good for them and no good for the hospital.”When [Hulks] first signed up a quarter of a century ago the job entailed going to the scene of an emergency and rushing the patient to hospital. “It was about doing some first aid, putting the patient in the back of an ambulance and taking them to A&E. The problem is most people didn’t need to be in hospital – it was no good for them and no good for the hospital.”
… The idea is to embed teams of highly trained paramedic practitioners into the heart of communities. They have the decision-making skills – plus the local knowledge of regular patients – to know when someone needs to be taken to hospital and when they are better off staying where they are.… The idea is to embed teams of highly trained paramedic practitioners into the heart of communities. They have the decision-making skills – plus the local knowledge of regular patients – to know when someone needs to be taken to hospital and when they are better off staying where they are.
Related: The new breed of paramedics charged with keeping people out of hospitalRelated: The new breed of paramedics charged with keeping people out of hospital
UpdatedUpdated
at 3.01pm GMTat 3.01pm GMT
1.26pm GMT1.26pm GMT
13:2613:26
Cold snap putting more pressure on A&E departmentsCold snap putting more pressure on A&E departments
Guardian reporters Aisha Gani and Nadia Khomami have been calling A&E departments across the country to get a sense of the pressures they are under at this time of year – and during the coldest spell of weather of the winter so far.Guardian reporters Aisha Gani and Nadia Khomami have been calling A&E departments across the country to get a sense of the pressures they are under at this time of year – and during the coldest spell of weather of the winter so far.
The cold snap has particularly affected elderly patients suffering with “comorbidities” – one or more additional disorders – a spokesperson from the Cambridge University hospitals NHS foundation trust said. He added the A&E unit at Addenbrooke’s hospital had been busier – although not unusually so for the time of year.The cold snap has particularly affected elderly patients suffering with “comorbidities” – one or more additional disorders – a spokesperson from the Cambridge University hospitals NHS foundation trust said. He added the A&E unit at Addenbrooke’s hospital had been busier – although not unusually so for the time of year.
A spokeswoman for St George’s University hospitals in south London (the subject of this liveblog on Monday) said the trust was busier than in the same period 12 months ago.A spokeswoman for St George’s University hospitals in south London (the subject of this liveblog on Monday) said the trust was busier than in the same period 12 months ago.
She added that though the hospital had not met its four-hour A&E waiting target on any day in the past fortnight, the performance had been better than a year ago. “St George’s has struggled to meet the target all year and are just above average compared with similar sized London trusts,” she said.She added that though the hospital had not met its four-hour A&E waiting target on any day in the past fortnight, the performance had been better than a year ago. “St George’s has struggled to meet the target all year and are just above average compared with similar sized London trusts,” she said.
There have also been a high number of acutely unwell patients at arriving at Southend hospital in Essex and requiring admission. A spokewoman said: “In common with other hospitals in the region we have been seeing – and continue to see ‐ high numbers of acutely unwell patients arriving at the hospital and requiring admission.”There have also been a high number of acutely unwell patients at arriving at Southend hospital in Essex and requiring admission. A spokewoman said: “In common with other hospitals in the region we have been seeing – and continue to see ‐ high numbers of acutely unwell patients arriving at the hospital and requiring admission.”
Dr Jimmy Stuart, divisional medical director for medicine at the Pennine acute trust, reported similar levels of increased pressure, which has been compounded by inpatient bed pressures on wards andhigh numbers of patients occupying beds both due to clinical care and delayed discharges.Dr Jimmy Stuart, divisional medical director for medicine at the Pennine acute trust, reported similar levels of increased pressure, which has been compounded by inpatient bed pressures on wards andhigh numbers of patients occupying beds both due to clinical care and delayed discharges.
“The majority of patients requiring urgent treatment for what we call major conditions have included head injuries, falls, respiratory problems, abdominal pain and mental health issues,” he said.“The majority of patients requiring urgent treatment for what we call major conditions have included head injuries, falls, respiratory problems, abdominal pain and mental health issues,” he said.
“We have also seen a large proportion of patients coming to us with less serious conditions and minor complaints such as alcohol intoxication, back pain, migraines and headaches, ear problems, and sore throats. Many of these could be treated through local pharmacies, primary care and GP practices.”“We have also seen a large proportion of patients coming to us with less serious conditions and minor complaints such as alcohol intoxication, back pain, migraines and headaches, ear problems, and sore throats. Many of these could be treated through local pharmacies, primary care and GP practices.”
Recent NHS stats reveal that in the week leading up to 8 January 2016, there were 41 instances of A&E diversions across England. In the same period 2,998 beds were closed in hospitals due to outbreaks of norovirus-like symptoms, according to the latest available winter situation report.Recent NHS stats reveal that in the week leading up to 8 January 2016, there were 41 instances of A&E diversions across England. In the same period 2,998 beds were closed in hospitals due to outbreaks of norovirus-like symptoms, according to the latest available winter situation report.
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at 2.01pm GMTat 2.01pm GMT
12.41pm GMT12.41pm GMT
12:4112:41
Gerardine Hope, assistant managerGerardine Hope, assistant manager
Jessica ElgotJessica Elgot
Before working at the North East ambulance service (NEAS) contact centre, Gerardine Hope used to run a call centre for T-Mobile. But customers’ mobile phone problems are a world away from what her call handlers deal with now, which can be matters of life and death.Before working at the North East ambulance service (NEAS) contact centre, Gerardine Hope used to run a call centre for T-Mobile. But customers’ mobile phone problems are a world away from what her call handlers deal with now, which can be matters of life and death.
Her 111 and 999 call handlers arrange up to 4,000 ambulance journeys a day across the north-east of England – though many of those are scheduled transports. She is adamant that her staff are well-trained enough to handle even the most complex scenario, and rejects the criticism that call centre staff are not suitable to deal with the problems callers present.Her 111 and 999 call handlers arrange up to 4,000 ambulance journeys a day across the north-east of England – though many of those are scheduled transports. She is adamant that her staff are well-trained enough to handle even the most complex scenario, and rejects the criticism that call centre staff are not suitable to deal with the problems callers present.
“There are a lot of misconceptions about 111,” she said. “It is a competitive job, there is eight weeks’ training with assessments all the way through and staff can fail those and have contracts terminated. We are not just pulling people in off the streets.”“There are a lot of misconceptions about 111,” she said. “It is a competitive job, there is eight weeks’ training with assessments all the way through and staff can fail those and have contracts terminated. We are not just pulling people in off the streets.”
NEAS does not employ agency staff, she said, because there is always a steady stream of applicants.NEAS does not employ agency staff, she said, because there is always a steady stream of applicants.
It is a tough job. I don’t think people always realise that, to be quite honest. We play them a call on the first day of training which is a woman calling when her partner slashed his wrists. We want them to realise what they are responsible for. It takes a special kind of person.It is a tough job. I don’t think people always realise that, to be quite honest. We play them a call on the first day of training which is a woman calling when her partner slashed his wrists. We want them to realise what they are responsible for. It takes a special kind of person.
The main complaint from patients is generally the frustration at how many questions call handlers ask, which may seem completely unrelated, like a person suffering a urine infection who is asked about chest pain. “It’s because we are not diagnosing, we are checking for signs of an emergency, we want to get the right care at the right time,” says Hope.The main complaint from patients is generally the frustration at how many questions call handlers ask, which may seem completely unrelated, like a person suffering a urine infection who is asked about chest pain. “It’s because we are not diagnosing, we are checking for signs of an emergency, we want to get the right care at the right time,” says Hope.
She admits that demand for 111 help is related to the shortage of GPs and the difficulties patients can often have getting an appointment at a surgery, but rejects the widespread criticism that the service sends patients to A&E too readily.She admits that demand for 111 help is related to the shortage of GPs and the difficulties patients can often have getting an appointment at a surgery, but rejects the widespread criticism that the service sends patients to A&E too readily.
We are a natural evolution of the healthcare system. Traditionally a GP was your only option, now there are many alternatives and we can signpost people to a minor injuries unit, or an out-of-hours walk-in centre which they may not know about.We are a natural evolution of the healthcare system. Traditionally a GP was your only option, now there are many alternatives and we can signpost people to a minor injuries unit, or an out-of-hours walk-in centre which they may not know about.
We asked the CCGs [clinical commissioning groups] to assess whether we were sending too many patients to A&E and their research into the patients and our advice on calls showed no one was sent unnecessarily – though some patients said they had been sent by 111, even if they hadn’t.We asked the CCGs [clinical commissioning groups] to assess whether we were sending too many patients to A&E and their research into the patients and our advice on calls showed no one was sent unnecessarily – though some patients said they had been sent by 111, even if they hadn’t.
Hope said she wished the handlers got more plaudits of their own. “Mistakes happen, everyone is human. But GPs can also get things wrong. The praise is often for the ambulance crews, but actually it can be the call handler too who helped save a life.”Hope said she wished the handlers got more plaudits of their own. “Mistakes happen, everyone is human. But GPs can also get things wrong. The praise is often for the ambulance crews, but actually it can be the call handler too who helped save a life.”
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at 2.00pm GMTat 2.00pm GMT
12.15pm GMT12.15pm GMT
12:1512:15
12.05pm GMT12.05pm GMT
12:0512:05
Scotland's chief medical officer launches annual reportScotland's chief medical officer launches annual report
Libby BrooksLibby Brooks
Scotland’s chief medical officer has called for doctors to practise “realistic medicine”, moving away from a culture of over-treatment and involving patients more fully in decisions about their own care.Scotland’s chief medical officer has called for doctors to practise “realistic medicine”, moving away from a culture of over-treatment and involving patients more fully in decisions about their own care.
Starting a conversation with #doctors today on #Realistic Medicine in my first CMO report Views from all welcome https://t.co/YE0P1LlBH7Starting a conversation with #doctors today on #Realistic Medicine in my first CMO report Views from all welcome https://t.co/YE0P1LlBH7
Launching her first annual report in Edinburgh this morning, Dr Catherine Calderwood said:Launching her first annual report in Edinburgh this morning, Dr Catherine Calderwood said:
In striving to provide relief from discomfort, illness and death, modern medicine can sometimes over-reach itself and provide treatment that is of little long-term benefit to the patient.”In striving to provide relief from discomfort, illness and death, modern medicine can sometimes over-reach itself and provide treatment that is of little long-term benefit to the patient.”
It’s an interesting fact that doctors tend to choose fewer treatments for themselves than they offer to their patients. As doctors we should be asking why that is, and whether patients – if better informed – might also choose less intensive and less medicated treatment regimes. A person may achieve a greater quality of their life if less is done - fewer treatments, more targeted medication.It’s an interesting fact that doctors tend to choose fewer treatments for themselves than they offer to their patients. As doctors we should be asking why that is, and whether patients – if better informed – might also choose less intensive and less medicated treatment regimes. A person may achieve a greater quality of their life if less is done - fewer treatments, more targeted medication.
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at 2.02pm GMTat 2.02pm GMT
12.00pm GMT12.00pm GMT
12:0012:00
Your comments so far on today's NHS coverageYour comments so far on today's NHS coverage
Elena CresciElena Cresci
Today’s secret paramedic’s diary has inspired many of you to share your own dramatic stories of ambulance rescue in our comment threads.Today’s secret paramedic’s diary has inspired many of you to share your own dramatic stories of ambulance rescue in our comment threads.
One example is this moving comment from RachaelLondon:One example is this moving comment from RachaelLondon:
To add my voice to the praise: thank you for saving my brother in law when he had a massive head injury. Thank you for scooping up my husband and his broken collarbone when he came off his bike. Thank you for coming out to my elderly neighbour. Thank you for really trying when my dad had a (what turned out to be) fatal heart attack. I wasn't there but from what we were told after it was pretty clear he was dead before he hit the kitchen floor, but you tried for long after it must have looked hopeless.To add my voice to the praise: thank you for saving my brother in law when he had a massive head injury. Thank you for scooping up my husband and his broken collarbone when he came off his bike. Thank you for coming out to my elderly neighbour. Thank you for really trying when my dad had a (what turned out to be) fatal heart attack. I wasn't there but from what we were told after it was pretty clear he was dead before he hit the kitchen floor, but you tried for long after it must have looked hopeless.
Or this from edana23, which describes the time a paramedic made a helpful but non-medical decision they’re still grateful for:Or this from edana23, which describes the time a paramedic made a helpful but non-medical decision they’re still grateful for:
I'm so grateful to the paramedic who, on arriving with his team at my house, had the presence of mind to take up the kitchen rug and throw towels down where I'd been sick - otherwise the rug would have been ruined and I'd have needed to move 2 large appliances to clean the floor a week later, after abdominal surgery! Although it was a non-medical decision, he made such a difference to my recovery - I was very impressed by his thoughtfulness, and by the competence of the team in general - first time I've needed an ambulance in over 50 years, and I'd be dead without them!I'm so grateful to the paramedic who, on arriving with his team at my house, had the presence of mind to take up the kitchen rug and throw towels down where I'd been sick - otherwise the rug would have been ruined and I'd have needed to move 2 large appliances to clean the floor a week later, after abdominal surgery! Although it was a non-medical decision, he made such a difference to my recovery - I was very impressed by his thoughtfulness, and by the competence of the team in general - first time I've needed an ambulance in over 50 years, and I'd be dead without them!
Related: The secret paramedic's diary: 'The worst part is knowing it's likely they will die'Related: The secret paramedic's diary: 'The worst part is knowing it's likely they will die'
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at 12.02pm GMTat 12.02pm GMT
11.51am GMT11.51am GMT
11:5111:51
Welsh government launches 'self-care' campaign to reduce A&E pressureWelsh government launches 'self-care' campaign to reduce A&E pressure
Steven MorrisSteven Morris
A campaign urging people to think very carefully before heading for accident and emergency departments or ringing 999 if they do not have a life-threatening condition has been launched in Wales.A campaign urging people to think very carefully before heading for accident and emergency departments or ringing 999 if they do not have a life-threatening condition has been launched in Wales.
Though the population of Wales is only 3 million, around 1m visits are made to A&E every year and more than 100,000 non-urgent 999 calls received, wasting the time of call handlers and putting lives of those in real need at risk.Though the population of Wales is only 3 million, around 1m visits are made to A&E every year and more than 100,000 non-urgent 999 calls received, wasting the time of call handlers and putting lives of those in real need at risk.
The Choose Well Campaign includes digital adverts, a Facebook and Twitter campaign, traditional bus adverts and posters and leaflets in GP surgeries, pharmacies, opticians and universities.The Choose Well Campaign includes digital adverts, a Facebook and Twitter campaign, traditional bus adverts and posters and leaflets in GP surgeries, pharmacies, opticians and universities.
The campaign comes after yesterday’s warning that A&E departments in Wales are “on the edge”, with some patients reportedly waiting more than 24 hours in casualty before being seen. Dr Robin Roop, head of the Royal College of Emergency Medicine in Wales, also said no A&E department in Wales had enough consultants to meet minimum RCEM staffing levels.The campaign comes after yesterday’s warning that A&E departments in Wales are “on the edge”, with some patients reportedly waiting more than 24 hours in casualty before being seen. Dr Robin Roop, head of the Royal College of Emergency Medicine in Wales, also said no A&E department in Wales had enough consultants to meet minimum RCEM staffing levels.
Vaughan Gething, the deputy minister for health in the Labour-led government, said compared with England, Wales had an older, sicker, poorer population, meaning it was all the more important that people chose the right service. He said: “It’s about reminding people of the options. A more commonsense approach is needed.”Vaughan Gething, the deputy minister for health in the Labour-led government, said compared with England, Wales had an older, sicker, poorer population, meaning it was all the more important that people chose the right service. He said: “It’s about reminding people of the options. A more commonsense approach is needed.”
Gething described some of the figures around use of services in Wales as “astonishing”. According to the Welsh government:Gething described some of the figures around use of services in Wales as “astonishing”. According to the Welsh government:
Dr Andrew Goodall, chief executive of NHS Wales, said: “Our accident and emergency departments alone see 1 million people a year. However, self care is the best option for treating the minor illnesses and injuries which account for a very large proportion of what health workers deal with. Many illnesses can be treated in your home with over the counter medicine and plenty of rest.Dr Andrew Goodall, chief executive of NHS Wales, said: “Our accident and emergency departments alone see 1 million people a year. However, self care is the best option for treating the minor illnesses and injuries which account for a very large proportion of what health workers deal with. Many illnesses can be treated in your home with over the counter medicine and plenty of rest.
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at 12.02pm GMTat 12.02pm GMT
11.33am GMT11.33am GMT
11:3311:33
'You can't let a stereotype guide you''You can't let a stereotype guide you'
Jessica ElgotJessica Elgot
A key part of a 111 call operator’s training is the “wellness bias”. Foster said he is trained not to assume that a young adult patient is likely to be fine, compared to a child or elderly person:A key part of a 111 call operator’s training is the “wellness bias”. Foster said he is trained not to assume that a young adult patient is likely to be fine, compared to a child or elderly person:
A 14-year-old can have a stroke, a 25-year-old can have a heart attack. You can’t let a stereotype guide you. We have had an incident in a different service where the signs weren’t picked up because of that kind of bias. You have to judge a call on its merits.A 14-year-old can have a stroke, a 25-year-old can have a heart attack. You can’t let a stereotype guide you. We have had an incident in a different service where the signs weren’t picked up because of that kind of bias. You have to judge a call on its merits.
Another thing that can happen often is that callers do not realise how bad their relative actually is. “They might think that the person they look after is always unwell; they can’t quite recognise they are deteriorating until we take them through the symptoms and it starts to dawn on them.”Another thing that can happen often is that callers do not realise how bad their relative actually is. “They might think that the person they look after is always unwell; they can’t quite recognise they are deteriorating until we take them through the symptoms and it starts to dawn on them.”
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at 12.36pm GMTat 12.36pm GMT
11.24am GMT11.24am GMT
11:2411:24
'Sometimes you just get a feeling after a call that it's not quite right''Sometimes you just get a feeling after a call that it's not quite right'
Jessica ElgotJessica Elgot
The second call Craig Foster takes is from a mother concerned about her three-year-old’s chickenpox. She describes particularly bad swelling and a great deal of pain. Something about the description of the child, who is listless and unwilling to play, rings alarm bells for Foster, despite the commonness of chickenpox. He passes the call on to a qualified nurse. “Sometimes you just get a feeling after a call that it’s not quite right, so that’s why we get advice. That’s the training,” he said.The second call Craig Foster takes is from a mother concerned about her three-year-old’s chickenpox. She describes particularly bad swelling and a great deal of pain. Something about the description of the child, who is listless and unwilling to play, rings alarm bells for Foster, despite the commonness of chickenpox. He passes the call on to a qualified nurse. “Sometimes you just get a feeling after a call that it’s not quite right, so that’s why we get advice. That’s the training,” he said.
Next, Foster speaks to a woman worried about her mother, who is in her 90s and has fallen and hit her head in the night. The GP surgery has advised her to go to hospital, but the woman is worried about taking her to A&E herself and calls for advice about whether she should ring an ambulance. It takes a while for Foster to be able to ask his questions, as the woman talks him through her mother’s recent medical history. “Sometimes you have to be quite firm, we have to ask those emergency questions straight away,” Foster says.Next, Foster speaks to a woman worried about her mother, who is in her 90s and has fallen and hit her head in the night. The GP surgery has advised her to go to hospital, but the woman is worried about taking her to A&E herself and calls for advice about whether she should ring an ambulance. It takes a while for Foster to be able to ask his questions, as the woman talks him through her mother’s recent medical history. “Sometimes you have to be quite firm, we have to ask those emergency questions straight away,” Foster says.
You can’t let a person talk and talk. I once had a man who was in a different room to his wife, and he wanted to talk me through everything that has happened in the past few weeks, and I had to keep trying to convince to go in the same room as his wife. When I finally managed to ask the question, I found out his wife was unconscious.You can’t let a person talk and talk. I once had a man who was in a different room to his wife, and he wanted to talk me through everything that has happened in the past few weeks, and I had to keep trying to convince to go in the same room as his wife. When I finally managed to ask the question, I found out his wife was unconscious.
Often people might not actually be listening to you; they have their bit they want to say, and it’s our job to get them to listen, to get them to snap out of it. You can’t be rude, but you have to sometimes be quite blunt, because it could be an emergency.Often people might not actually be listening to you; they have their bit they want to say, and it’s our job to get them to listen, to get them to snap out of it. You can’t be rude, but you have to sometimes be quite blunt, because it could be an emergency.
After the woman describes her mother’s bump, Foster uses a special script for head injuries, asking about medication, recent surgery, bruising and whether there is crackling under the skin. Looking at the symptoms, Foster wants a nurse’s advice, and arranges for one to call her back. “She was advised to go to A&E by the doctor and I think the nurse will probably tell her the same thing.”After the woman describes her mother’s bump, Foster uses a special script for head injuries, asking about medication, recent surgery, bruising and whether there is crackling under the skin. Looking at the symptoms, Foster wants a nurse’s advice, and arranges for one to call her back. “She was advised to go to A&E by the doctor and I think the nurse will probably tell her the same thing.”
There is one call that stands out for Foster in his three years at 111 – an out-of-hours call that came through from Nottingham, when a premature baby had stopped breathing.There is one call that stands out for Foster in his three years at 111 – an out-of-hours call that came through from Nottingham, when a premature baby had stopped breathing.
The mother described the child as limp and floppy. I was shaking but you just have to go into autopilot. I put the phone on mute and screamed across to colleagues in 999 to get in touch with Nottingham ambulance service; we sometime get calls from outside the area but we don’t then have a direct line to contact them.The mother described the child as limp and floppy. I was shaking but you just have to go into autopilot. I put the phone on mute and screamed across to colleagues in 999 to get in touch with Nottingham ambulance service; we sometime get calls from outside the area but we don’t then have a direct line to contact them.
I talked the woman through how to perform CPR on the phone, as we waited for the ambulance to arrive. I got a message back at about 2 or 3 in the morning that the baby was in hospital and had survived. It was really scary stuff though – you train for it but it could have been disastrous. But when something like that happens, everyone piles in: the whole team came to help.I talked the woman through how to perform CPR on the phone, as we waited for the ambulance to arrive. I got a message back at about 2 or 3 in the morning that the baby was in hospital and had survived. It was really scary stuff though – you train for it but it could have been disastrous. But when something like that happens, everyone piles in: the whole team came to help.
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at 12.02pm GMTat 12.02pm GMT
10.52am GMT10.52am GMT
10:5210:52
10.37am GMT10.37am GMT
10:3710:37
Craig Foster, 111 call handlerCraig Foster, 111 call handler
Jessica ElgotJessica Elgot
Craig Foster has been taking 111 calls since the service began three years ago; he was one of the call handlers who worked on the pilot in Durham and Darlington. “At the beginning it was very quiet,” he says. “No one knew about us; there were just a few posters in GP surgeries, but now it’s completely different.”Craig Foster has been taking 111 calls since the service began three years ago; he was one of the call handlers who worked on the pilot in Durham and Darlington. “At the beginning it was very quiet,” he says. “No one knew about us; there were just a few posters in GP surgeries, but now it’s completely different.”
Flashing boards above the call handlers show the room is currently in the “green”, meaning that the service is meeting national targets of answering 98% of calls in 60 seconds, though Wednesday mornings are not exactly the busiest time for handlers here.Flashing boards above the call handlers show the room is currently in the “green”, meaning that the service is meeting national targets of answering 98% of calls in 60 seconds, though Wednesday mornings are not exactly the busiest time for handlers here.
Foster’s next call is a carer worried for her client who has slipped and fallen. She’s not injured, but her size means she needs assistance to get up from the floor. “Is she awake and alert?” Foster asks, reading from his script to check for other warning symptoms, such as whether her face has frozen, or whether she feels a crushing on her chest.Foster’s next call is a carer worried for her client who has slipped and fallen. She’s not injured, but her size means she needs assistance to get up from the floor. “Is she awake and alert?” Foster asks, reading from his script to check for other warning symptoms, such as whether her face has frozen, or whether she feels a crushing on her chest.
The questions may seem obvious, but he also asks if the woman is on a carpeted or cold wooden floor, to make sure she is comfortable. He decides to book an ambulance to assist her, though he decides she is unlikely to need to go to hospital.The questions may seem obvious, but he also asks if the woman is on a carpeted or cold wooden floor, to make sure she is comfortable. He decides to book an ambulance to assist her, though he decides she is unlikely to need to go to hospital.
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at 10.43am GMTat 10.43am GMT
9.35am GMT9.35am GMT
09:3509:35
Jessica ElgotJessica Elgot
Today, Alicia and I are at North East ambulance service’s 111 centre in Newcastle, where we’ll be speaking to call handlers about how they deal with a huge range of different problems, and to medical advisers and management about the reputation of the service and the times of day, week or year it is under most strain.Today, Alicia and I are at North East ambulance service’s 111 centre in Newcastle, where we’ll be speaking to call handlers about how they deal with a huge range of different problems, and to medical advisers and management about the reputation of the service and the times of day, week or year it is under most strain.
I'm here at @NEAmbulance in Newcastle to live blog from their 111 centre #ThisIsTheNHS pic.twitter.com/fqMn5MhXm2I'm here at @NEAmbulance in Newcastle to live blog from their 111 centre #ThisIsTheNHS pic.twitter.com/fqMn5MhXm2
UpdatedUpdated
at 10.27am GMTat 10.27am GMT