I'm an NHS 111 overnight call handler. AMA!

Most totally-emergency call but caller is too polite to call 999?

Old people having heart attacks and strokes, then they try to argue about the fact you are sending an ambulance because they don't want to make a fuss

That might be the most English thing I've ever heard.

Genuinely had a 38wk pregnant woman going into labour declining an ambulance. We can't send one if they refuse. So I had to get a clinical member of staff to call her back. It was hectic.

Most non-emergency are-you-serious-right-now call you've got?

Hiya, a man called last night saying he had left his medication at his friends house and wanted more. I said I can get a doctor to issue a repeat prescription and he said "no just pick it up from my friends house" I said no! Who are we gonna send out? I said "I'm not sending an ambulance to pick up your medication and bring it to your house." All my colleagues thought it was hilarious.

That's what the pizza guy is for!

If you ever need a ride somewhere call a pizza restaurant get them to deliver to where you are, and give the driver a fatty tip to drive you back to where he works.

All I see is you getting a one-way trip to the pizza restaurant.

No no no, once you're there you order pizza to your destination and get in the car again!!

What's your opinion on the new non-emergency number, 0118 111 881 111 119 725

3.

Also, are there operators really better looking?

As long as people don't ring 111 I'm happy 😂

Do you recognise and afirm that white Terry's chocolate oranges are indeed an abomination and should be purged from the land?

No. definitely not.

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I don't have to explain myself to someone as unhinged as you!! All chocolate oranges are created equal and you shall show respect!!

That's it, I'm never using 111 again.

Good because I would have to get the police involved with these radical extremist views of yours

How often do you have to tell someone that they should really be dialing 999?

111 can dispatch ambulances, they do it all the time. Maybe once or twice a week but only because they get angry that you ask them for details because it's an emergency

Ah! didn't know that, it makes sense when you think about it! thanks!

Once or twice a shift more like. We aren't allowed to tell them to call 999 unless they don't know where they are, because 999 can track them and we can't. We're equipped to deal with 999 and 111, but our systems are still non-emergency so it takes longer. So ring 999 if you need an ambulance!!

I'm in the US and we should really have a non-emergency line like you guys have. From reading the craziness I've read from our 911 emergency call line, I can only imagine what gets called in on the 111 number! I've had to look up the local police number for non-emergencies (like when my car was stolen) but idiots call the emergency line to report a lost dog.

It's difficult to know when to ring non-emergency or when to ring emergency. Sometimes people are just stupid though. There's a very famous case in the UK (or in my line of work anyway) where a woman rings 999 about a stolen snowman. You can hear it here. There's loads of good videos there, they make me shake my head in disbelief.

I work in the police in the UK, sometimes we have people sending us emails (to an address that is mostly to inform us of community events etc, it's checked during office hours only) when they should have really dialled the 9s.

I don't understand why in 2016 there's not official emergency email address. What if there's an intruder in the house and I don't want to speak? What if there's a fire?

'Subject: Fire. Dear Sir/Madam, I am writing to inform you of a fire that has broken out on the premises of 123 Cavendon Road...'

Haahahahaha is this the IT crowd scene

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I feel like maybe employees of care homes should have a different number to call.

Care homes are the worst staff to speak to. They are usually uninterested, inaccurate and unprepared. It genuinely leaves me scared for my mother if I ever have to put her in a care home. Some of the things that go on... we had three separate patients with unexplained bruising from the same care home in the same week. It doesn't bare thinking about.

What was the most disgusting/repulsive call you had?

It's a toss up. You get tired of all the diarrhoea and stuff like that, it just doesn't do anything for me any more. I had a man who had really bad constipation once and was having everything to relieve it and suddenly it just came in a torrent and he was describing it in detail "it's all in my chair it's going down my leg it smells so bad" and I unfortunately retched down the phone. The other one is a man I asked what colour his phlegm was and he went "hang on" and proceeded to make loads of revolting gargling throat-clearing coughing noises, before spitting something out and then going "green."

How fucking foul.

Proof

Not to rock the boat, but that's not proof on its own as it's just your smart card.

I have one of these and I'm in IT.

http://imgur.com/3FvbDBN - proof

Plus that's a pretty old card. The new ones look quite different.

Yeah, they're a bit more coloured and modern looking. Most RA's won't replace the old ones for a new one unless they are broken or lost/stolen.

Some clinical staff can eat through them from the usage so end up with the new ones, where as admin staff will mostly need to put it in the card reader once or twice a day. I use mine once a month at most.

I've only had this one for about a year...

I can't provide any other proof! What should I do?

Well I would suggest your staff ID with your department details or your payslip, but with our shared hatred of Adastra I feel confident you're legit.

I don't have a staff ID yet, there is a big backlog. As I write this I feel it sounds like a made up excuse but it genuinely is the truth!!

How easy is it to get someone sectioned?

As in under the mental health act? I can't speak for the whole country but in my area there are several ways to access mental health services, the usual bieng; 1. The police can detain you under section 136 of the mental health act if you are in a public place and they are concerned that you may be suffering from mental health issues. 2. The police under section 135 where they are concerned about a person in their home, however they need a warrant for this. 3. Present at your local A&E department where a mental health worker will assess you and possibly refer you for admission to a mental health unit. 4. Your GP can refer you for assessment by mental health services. 5. If you are already involved with mental health services your worker may refer you for a mental health assessment or admission to hospital.

Ideally these admissions would be informal admissions where the patient has capacity and consents to admission. Where someone does not have capacity/insight into their condition or are unwilling to stay in hospital then it may be considered appropriate to exercise a section of the mental health act.

This is not a comprehensive list and the process differs with forensic mental health facilities but these are the most common paths of admission in the setting I work in.

iirc Section 5 (i.e. a danger to self or others) is what most people view as being 'Sectioned' - but you describe the real world more accurately. I have had family members go missing then re-appear days later at a police station calmly explaining about the fact they are hearing voices and they are getting scared now. Sometimes it takes losing your grip to realise you are falling.

One of my most touching calls was a woman who had schizophrenia and she said she knew that she needed to take her medication and it would help her get better but the voices won't let her. She kept saying I know they aren't really there, I know it's in my mind but it's so loud. She said she has tried so hard to take her medication and she even managed to swallow it but they made her be sick to get it out again. It surprised me because she had a very clear understanding of what was going on but just couldn't do it. She was in tears not knowing what to do.

It makes you think, does she just have mental health problems, or are we all oblivious to these voices that are really there that control our lives, and a very small number of people actually hear them? Sounds like a good premise for a novel.

Really hard!!! We've had repeat callers who plague our service 20-50+ times a day and it's taken two years to get one of them sectioned.

Most obvious problem that the patient was unable to self-diagnose?

Believe it or not, heart attacks. The first two questions asking about chest pain is

Have you had previous heart attack? If they say yes then it says

Is this pain the same as previous heart attack? If they say yes it sends an emergency ambulance and makes you think about Darwin and survival of the fittest if 111 wasn't there.

Last time when I called 111 I asked for the number to poison center, but they didn't know what I was asking for. Most of the essential oils have the warning on the label that in case of the ingestion, call the poison center. Does such thing even exist in the UK? If not, who you should contact to for any advice in the middle of the night (whether the thing what you've just ingested it's poisonous or not in the given amount)?

We (i work in nhs24 in Scotland) have access to a poisons database.

Ingestion of any essential oil is a direct referral to A&E unless your symptoms are life threatening or require immediate ambulance assessment.

Yeah essential oils are killer. Someone drank olbas oil once and had chest pain and we sent an emergency ambulance for it.

How much they drank? I drank olbas oil by mistake, but it was like 10 drops with a glass of water and I was fine later on by drinking more water. Unfortunately 111 or 999 couldn't tell me how much toxic it is, they just told me to go to the nearest A&E asap (no matter how many drops I would say). But my point of the call was to get some meaningful information about the toxicity of it, which I didn't get at all. So it sounded like they didn't have any access to any poisons database and have no clue, no matter how many drops I tell them I took, they'll just tell me to go to A&E (which I can go without calling anyone, without any pressure). So my conclusion was that there is no point calling 111/999 if you ingested small amounts of essential oils, it's better to wait and see what would happens, because you won't get any information over the phone. If you would die, you would die anyway, at the time you arrive to A&E. So I only hope poison centers in the US works in a better way, as it seems UK has lack of them.

It's hard because we can't diagnose over the phone, obviously, but them saying A&E is their way of saying you've had too much. If you had had one extra ibuprofen then they wouldn't be sending you probably. Of course every case is different. We're always taught that essential oils is immediate A&E so if we don't reach that outcome in our assessment, a clinician will need to. Any amount of essential oil is too much.

111 really. I don't know about poison centres but the clinicians have a system where they can look up any chemical - literally anything - and tell you what happens if you ingest it and what to do. You would be in safe hands with that.

Do you have any repeat offenders? Such as a person calling a lot for the slightest thing?

Ooooooh yes we do. We have repeat callers who ring all the time from making up life threatening symptoms muncheausens style, to people who phone to make sure they can eat cheese before bed.

Here in the US, you can be fined for calling 911 for a non emergency. Do you just have to deal with these callers over and over?

Well technically we can fine them but they usually come down to mental health disorders and disabilities so it gets a bit tricky. If someone believes they are right in calling, even if they aren't, it's unfair to prosecute people. If people just take the piss as a laugh with mates then we would, but thinking about it I've only had a single prank call in 18 months on the job. And they obviously give fake details so it's very hard to find someone to prosecute. The threat is there but realistically it's very difficult to follow through with.

Do you ever get an influx of calls about a particular issue after it's been featured on TV?

Yes!! Someone phoned up because their child banged their head and had no symptoms. They said they usually wouldn't have called but "cos of that kid on eastenders, with the seizures..." I never saw the episode but I can only imagine...

Do you have a Minor Injuries Unit in your local area, and has it helped keep the A&E free of people who aren't actually dying but can't wait for their GP's next free appointment slot?

Yes and no, but often the out of hours gp are in the walk in centre so they get really busy and the unhelpful receptionists start turning people away and sending them to A&E so it defeats the objective.

What's the deal with calls about dying animals? What's the procedure on that?

Never had one, but I would sympathise and be supportive but say there isn't anything we can do. Even if we send an ambulance the crew aren't veterinary trained of course, so they can't treat the animals at all.

What is the procedure for prank calls?

Good question. We get surprisingly few prank calls actually. We do get time wasters but no one ringing up with silly stuff like exploding head syndrome or something else stupid. We have a Pathway on the systems devoted specifically to frequent callers who call all the time telling lies or just wasting time. If someone was pranking us we would give them three warnings and then terminate the call.

How many calls do you get from people that are too stoned/tripping and believe that they are "going to die" etc?

I've never had a call like that! I've had drunk people slurring and being stupid and drunk like people are, but I've never had anyone high. Although people have admitted to doing cocaine before. And you wonder why you have chest pain...

What's the quickest way to get you guys to come over if there's people loitering and being loud at 2AM?

Wrong service mate!

What service do I call?

Edit: shit is it 101?

Yes, 101 is police,111 is NHS.

This whole conversation is a snapshot of my daily life.

Is adastra still terrible?

Haahahahaahah!

Can we call 111 when the Samaritans aren't picking up fast enough during bouts of sudden panic or depression? Do you offer similar "talk down" services to them?

The short answer is no. We aren't there to talk to about it and counsel people. The trouble is people do phone doing this, especially when samaritans was an 0845 number. It sounds harsh to say no but we are very busy dealing with a very wide range of issues, not just mental health, and we don't have the resources to spend an hour on the phone talking someone down. the likelihood is that if they've called us, they've called for medical help so are usually talking themselves down anyway. It's very very very rare that someone would call specifically to commit suicide.

This said, of course, if someone did need talking down then we would have to and if it takes an hour then it takes an hour. The patient comes first always. But I don't want to encourage people to use 111 as a replacement samaritans because that really is not what the service is for.

Sorry I thought you were talking about suicide specifically, I've re read now. If someone has depression or panicking and need help then that is just as important as any other physical or mental illness or injury. It needs to be dealt with soon. People ringing for a chat is not acceptable but if you have symptoms like these that need assessing and to provide help, we would do it straight away.

What are the most common outcomes from most of the calls? E.g. send ambulance, police, fire brigade, refer to A&E, 999, psychiatrist (?), do nothing, did I missed anything major?

We can't refer to a psychiatrist, but I would say the most common is probably speak to a gp or speak to an in-house clinician. You get different timeframes to follow the advice too, like 6 hours, 12 hours etc. The least urgent outcome is contact own GP for a non-urgent appointment and that's basically the same as telling them to do nothing.

What was the best question on reddit that you chose not to answer?

I think I answered all of them!

Have you ever had to talk with automated assistant/voice and thinking wtf?

Yes!!! We get text to speech concerters for deaf people and I had a woman being sarcastic I think. But I don't know!! A monotonous tone saying "this has taken far too long. Are you wanting me to die. I don't know why I bother." It was so funny and so awful at the same time

Has anyone tried to order a pizza, claiming it was a party emergency or they were starving, or something like that?

No, thank GOD. I would not take it!! Although speaking of starving, I spoke to a woman who wanted to commit suicide. I had to ask if she had a means and a plan, and she said yes. She was going to starve herself to death. I had to put Yes to the question because technically she did have the means and a plan, and the system suggested ambulance. I remember thinking, "yeah, in a months time. I'll pencil you in for may"

How much training do you have to go through? And what qualifications are needed?

No qualifications. It's a seven week course which involves a full anatomy and body systems training, system training (you may have heard of NHS Pathways) and then trial and love assisted calls, before were released on our own.

Just how awful is the IT system you use?

It's a good system! Pathways is very helpful and clever. It knows more than I do sometimes.

They guy who designed it disagrees with you.

Really? Where?

You get many prank calls? If so how quickly can you usually tell it's someone wasting your time?

Not very often. I think I've only had one or possibly two. But I can remember it was almost immediate. The people want to tell you what's wrong straight away because that's the "funny" bit. But we have to take all their telephone numbers, address, names etc and match all their details to an NHS medical record first, which of course they don't want to do. So they often just blurt it out and you can hear people laughing and sniggering. I wish they would be a bit cleverer about it, at least put me through my paces! It's just boring when they're so obvious and blatant about it. I think the call in question the girl had allegedly done such a big shit that it had ripped her vaginal/anal wall open and now she had a vaganus. Really tedious lowbrow shit.

You guys are awesome. My nan gets bladder infections fairly often and gets confused/grumpy/slightly racist lol. Whenever I call and you have to ask her the usual questions, you take it like champs.. So thanks, and my question would be has anyone ever really got under your skin?

Aww that's really good to hear!! We get far too little positive feedback here. And yes, all the time. People that refuse to wake their children. People that are certain they've got crushing chest pain and you just know they haven't!!

... I can call 111 overnight??

You could, but the staff are on reddit.

Haahahahah

What's been the best experience you've had?

Leaving my shift at the end of the day! I enjoy my job but it is exhausting. You don't really get rewarding calls. I suppose if someone stopped breathing and I had to give CPR advice and they came back to life to someone with them, that would be so amazing. Like I had literally saved a life. But that's not happened yet.

If I call my dr's office or a nurse on call type thing in the US when I'm sitting on the fence about an issue, they always say "come in" which I assume is about liability concerns or them not getting revenue. Is that true with 111 too? Do you have liability concerns? How many times to you refer a person to be seen in person vs. not?

We always err on the side of caution and go with worst case scenario. The call handlers don't have full medical training like the nurses or paramedics do, but the system we use has been designed for us by expert medical staff, so we have to be very careful not to 'step outside' of our role and stick to the systems. If we do, we put ourselves at risk. It seems silly but if we so much as tell you to take paracetamol (Americans call it acetaminophen I think) when the advice isn't presented on the system, and then you have an allergic reaction and die, we would get the flak.

Also to answer your question about getting seen, you may know the NHS is publicly funded so we don't have any money or profits to worry about. the system triaged patients depending on the severity of their symptoms and the likely cause of that, and generates a timeframe of when you need to be seen. So at 18:30 if you get a time frame of "6 hours" you'll get to see the out of hours doctor that evening, but if you got "6 hours" at 4am then we would send you to your own gp instead.

If I'm visiting England and don't know wtf I'm doing and dial 911; does it go anywhere?

I don't know. It's like Schrödinger's cat. I don't want to open that box in case it does work!! To confuse things further there is also a 112 number. I'm still not clear on what that's for.

You guys are awesome! NHS 111 service has really helped us out at some awkward middle-of-the-night times; my partner has a chronic condition (migraines) and there's times when we know we need to get her to the nearby clinic to get a painkilling injection.

Most of the time, the 111 call handlers figure out pretty quickly that we know what's going on with her symptoms and we just need to be referred to the clinic. Occasionally, we'll get someone who insists on going through the whole symptom matrix and suggesting stuff like 'have you tried a warm flannel to the back of the neck' and talking to my partner when she's in no fit state to answer questions.

I totally get why they want to do all that stuff, but is there an effective (and obviously polite/respectful) way to say 'hey, we know what's going on, could you just skip this bit'? I don't want to sound like an arse and like I'm telling someone how to do their job or anything, so if there's a way to communicate what we know effectively, that would be really cool!

Hiya, good question. There's been a recent update come round. Previously if someone had symptoms, whatever the case, we must always assess them. But now if someone has an ongoing medical condition and knows what they need to treat it (migraines is a great example) then we can put that you have a particular course of action to follow. We just have to verify that the patient is still conscious and breathing and not bleeding, and we can pass it straight through for a priority call from the GP. So just say it's an ongoing condition, he knows what he needs and he just needs the medication and you should be fine :)

What medical training have you received or is required for this job? How much does it pay? Any benefits?

We don't need any fully licensed medical training. We are all fully first aid trained and taught BLS (basic life support) including using AEDs in public. We also get a rigorous crash course in anatomy and physiology during our 7 week training. Pay varies depending on what time of day you work. If you work 9-5 the pay is quite poor but I do evenings and overnights and out of six call centre jobs this one pays the best by a good margin. The benefits, as NHS employees we get loads of discounts as standard by presenting the pictured smart card. Nando's, Cineworld, body shop, superdry, loads of places. Also if we need medical attention while we're on shift, we can have a call added on for us and it might get prioritised just a little...

Hey, thank you for doing this AMA. I used to be a 111 call handler back in 2013 when it first launched in my county.

I guess my question would be, how has the role of the Clinical Advisor changed since you first started, if at all?

I'm hoping they have been allowed more input into the patient dispositions should the 111 handler not feel comfortable with what the Pathways system has provided.

Good luck and take care.

Hi, thanks for the question :) the role hasn't changed much since I started but clinicians do have a lot of input on dispositions (call outcomes, for those uninitiated). If you reach an inappropriate dispo you can query it and state your concerns and the clinicians usually agree with you and take the call and change it. . Of course you try to remain impartial when speaking to a clinician but you can use a subtle tone of voice change or certain words to win them round to your way of thinking. They are medically trained but I'm talking to the patient and I can hear the pain and call handlers and clinicians respect these things. I'm sad to hear it didn't use to be like that.

How do you mentally deal with your job?

I smoke. I compartmentalise. I remember being new and I had a suicidal woman and she hung up and when I tried to call back it just kept ringing. I broke down and cried loudly. It stays with you. But time goes on and you get more calls like that and you (I hate this phrase) put your work hat on and you learn to do what needs to be done. I find these days I get more panicky when I'm being abused than when I'm dealing with a heart attack. I just get on with it now. You do get really horrid calls occasionally that strike a nerve and the management know that and are happy to accommodate extra cigarette time or down time and a debrief etc. You're very well cushioned.

Do you find the pathways accurate? I work for the Out of hours district nursing service and I can't remember the last time I received a referral from you chaps that was appropriate for our service. So frustrating.

Is this a question or a criticism? ;) Most of the time the Pathway is fine, it's the patient that isn't. As Dr House says, everybody lies. No-one wants to say the pain isn't severe because they think they aren't going to get any help. I prefer assessing 12 year olds because they are too young to understand the implications of telling the truth. They just tell you exactly the correct answer to the question. But adults think if it doesn't sound bad we won't help. It isn't true, of course. But that doesn't stop them from screwing up my assessments by lying and exaggerating.

My hypochondriac friend called the NHS24 hotline in a panic after experiencing pain into his groin/lower abdomen.

After much googling he discovered the term 'blue balls' without understanding the correct context and called using that term to describe his problem. "Hello, can I speak with a nurse I believe I have verticulitis or blue balls".

What's the weirdest call you've had from an obvious hypochondriac?

Hahaahah!! Bet that went down well!! Someone rang up after doing three solid poos in three days, and was scared they had IBS. what? Also a man with rectal bleeding was beside himself sobbing and wailing because he was certain it was bowel cancer. He genuinely thought he was going to die, totally inconsolable.

Follow up question from my previous one about if 111 helps people with urgent mental health issues. What sort of support do they give you, especially if you've had a traumatic 111 phone call?

We get debriefing, free counselling, paid time off in extreme cases. Usually if I get a bad call I ask if I can go for a cigarette and they always say yes.

Hello there, fellow NHS drone! As an interested party, what do you think of your IT Department?

I only spoke to them once and they were helpful, why? Are you IT?

Are homeless people treated the same way?

Yeah we do our best to help but the trouble is, generally speaking, they tend to be abusive and unhelpful and unstable to speak to so it does end up being a different call to someone with a fixed abode, but because of their behaviour not because of their circumstances.

What's the procedure for calls from people not speaking in English?

We have a language line where we can call an interpreter and they join the call with us.

When person is calling and mumbling something, and you suspect something is wrong going on, are you able to track that person down (like mobile numbers, or private calls)? Any real scenario examples?

I had a woman who didn't want to give any details as her partner had taken loads of illegal drugs, and she didn't have children. All I had was the number she called from. The partner, he was grey and clammy and unresponsive. She eventually hung up without giving any details as I said I couldn't help if she wouldn't tell me. I called her back and got her voicemail where amazingly she said "hi you're through l john smiths voicemail" real name redacted, obviously. And I called the police and they had an address attached to the mobile number for previous calls to 999 regarding concern for child welfare and familial arguments and abuse, so I gave the name for security and they gave me the full address so we dispatched police and ambulance. I don't know what happened but if they were at home then he would've got some help and possibly that child might have been taken away from them and given to a better family which is always a positive.

How 111 calls are redirected to endpoint centers, is it location based, or based on the load?

It's location based. There are various different call centres that cover diffferent parts of the country. Depending on where you are you come through to different services. So if you're ringing about someone else, and they're a county over, we're going to have a problem!

What was the funniest prank you received from the caller?

I don't think pranks are funny in this line of work.

I'm the funniest person I know, I'm fucking hilarious imo, and the moment I get on the phone I am like no. Nothing is funny. We are 111 we aren't selling double glazing. Not to diss any other professions but we sometimes deal with literal life and death, and prank calls are not funny at all.

That said there is a certain person who pretends they have loads of life-threatening symptoms all day every day and if you call them out on it they call you a twit and I snorted down the phone last time it was so funny. This person gets really abusive if you don't send an ambulance it's quite funny. But to them they are serious, they aren't taking the piss as a joke, they really feel they need the care so it feels different.