NHS 24 Attacked for ‘Refusal to Accept Damning Ruling’

The health service helpline NHS 24 was criticised yesterday for failing two patients who later died, after an inquiry concluded they both could have been saved if their life-threatening illnesses had been properly diagnosed. In a damning determination, Sheriff James Tierney ruled that the telephone triage system, used to assess patients, had led to crucial delays in a teenage schoolgirl and a 30-year-old joiner receiving lifesaving treatment. In each case the system failed to identify the fact that both patients,

Shomi Miah and Steven Wiseman, were suffering from life-threatening diseases – despite early indications they were both seriously ill. At least one of the nurse advisers had made “desperate attempts” to avoid a home visit by a doctor and three of the nurses had failed to err on the side of caution.

“In each case, had these signs and symptoms which were presenting been properly identified, or [had] the fact that they could not be properly understood been itself identified, there is a strong likelihood that each of the patients would have survived,” Sheriff Tierney said.

Miss Miah’s devastated family last night accused NHS 24 of “arrogance” and failing to learn the lessons of the double tragedy after senior management of the helpline service refused to admit that both deaths could have been prevented.

One of her three brothers, Jabir, 26, said: “They are refusing to accept what the sheriff is saying. My sister would still be alive if she had been seen by a doctor the first time we called.

“We have basically lost confidence in the service. If anyone in my family was ill again I would phone 999 myself. I wouldn’t even think about NHS 24.”

Her eldest brother, Khalis, 29, said: “It is now clear that reasonable precautions could and should have been taken which would have saved Shomi’s life, and that there were substantial and fundamental defects in the system that were in operation.

“The system is there to save lives – not take lives. But what they are trying to do with this system is to avoid calling out a doctor.”

Miss Miah, a sixth-year pupil at Aberdeen’s Harlaw Academy, died on 26 October, 2004, after contracting meningitis. Her family were forced to wait more than 12 hours before she received medical treatment, despite making repeated calls to NHS 24.

Mr Wiseman, a joiner, stayed in Laurencekirk, Aberdeenshire, with his partner, Kerry Robertson, and their two young children. He died from toxic shock syndrome on 21 December, 2004, the day after his girlfriend had been told by NHS advisers to give him mild painkillers and wait for the local surgery to open.

Miss Miah’s worried family made two calls to NHS 24 in the hours leading up to her death, after she complained of stiffness in her neck and aching arms and legs. And on both occasions her family were told by a nurse adviser that she was suffering from “flu-like symptoms”.

Mr Wiseman’s partner made three calls to the telephone helpline and was also told he probably had flu and should take painkillers. By the time a GP arrived at his home, Mr Wiseman was gravely ill.

Mr Tierney said the response by NHS nurse advisers in each of the five telephone calls was “in some way defective”.

He also criticised NHS management, commenting that while nurse advisers were encouraged to rely on their clinical judgment, they did not appear to have been given clear guidance in that regard.

There was also no ongoing formal assessment of the performance of each nurse adviser in discharging the difficult and demanding duties of the job and no formal structure in place to assist them in deciding when it would be appropriate to depart from algorithms, a series of formalised questions, aimed at helping them to diagnose a patient’s condition.

Listing a series of defects in the service’s system of work, the sheriff added: “Nurse advisers felt they were discouraged from involving doctors during out-of-hours periods.”

NHS 24, however, claimed: “There is no evidence to suggest that if either Shomi Miah and Steven Wiseman had been referred for face-to-face care earlier that the outcome would have been any different.”

Dr George Crooks, NHS 24’s clinical director, refused to say whether the service accepted the sheriff’s devastating findings.

He told a press conference in Aberdeen: “We note the inquiry highlights the challenge that particularly primary care clinicians face, and that is that some rare and potentially very serious conditions may mimic very minor and self-limiting illnesses and can therefore be quite difficult at times to identify.”

Dr Crooks added: “We recognise that it has been a difficult time for all involved, including our staff … Tragically two people have lost their lives.

“We have looked at the clinical performance, not only of the staff within NHS 24, but also the clinical staff within the Grampian out-of-hours service, and it is the considered judgment of senior clinicians within the NHS that there has not been significant underperformance on behalf of any single member of staff within the service. So no individual has been directly disciplined because of either of these cases.”

Dr Crooks said it was “impossible to say” if such a situation could happen again.

Shona Robison, the shadow health minister, called for a fundamental review of NHS 24 to deliver a better deal for patients.

She said: “It is a tragedy for the families that this has happened so it is vital that changes are made to improve the service.”

Andy Kerr, the health minister, said: “I have asked the chairman of NHS 24 to report to me by the end of September 2006 on what steps the organisation has taken or is planning to take in response to the recommendations made by the sheriff today.”