Clinical negligence: NHS Helpline failures contributed to patients' deaths

The NHS 24 helpline service has been criticised by a sheriff over the deaths of two people in Aberdeenshire. Sheriff James Tierney said the system had failed Shomi Miah and Steven Wiseman by not identifying their life-threatening conditions. He claimed that if NHS staff had "erred on the side of caution" during their diagnosis there was a strong likelihood both patients would have survived. NHS 24 said it has since made major improvements to the service.

Sheriff Tierney's findings followed a lengthy joint fatal accident inquiry, which heard from a range of witnesses including NHS call centre staff. He said the NHS 24 system, which involves making a diagnosis over the telephone, relied on the quality of the nurse advisors' (NAs) clinical judgement and "a strict adherence to the principle of erring on the side of caution".

His report said that while the system was "not inherently defective", it had failed both Ms Miah and Mr Wiseman: "It failed to identify the fact that they were each suffering from a life threatening condition or at least from a condition that the NA did not properly understand," it said. The report said that the questioning techniques of NAs, which were central to the safe operation of the system, were in most cases defective.

Seventeen-year-old Ms Miah, from Aberdeen, had been told by nurse advisers to take paracetamol for flu-like symptoms. She later died from meningitis.

The report said: "In Shomi's case had she been seen by a doctor at the time of the first call her life would almost certainly have been saved." It said a further two NAs failed to recognise the seriousness of the symptoms and incorrectly recorded answers.

The report said in Mr Wiseman's case his life could have been saved if an NA had recommended a 999 hospital admission. The 30-year-old father-of-two, from Aberdeenshire, died after complaining of flu-like symptoms. His fiancée called NHS 24 in the early hours of the morning and was told to administer painkillers and wait for the doctor's surgery to open.

The report said: "The first NA was too quick and wrong to diagnose flu in the face of non-standard symptoms, but did recommend contact with his own GP which was appropriate. The second NA continued the wrong diagnosis of flu and failed to identify the reason behind the call, namely the intense and disabling shoulder pain, which was not consistent with flu. The third NA correctly identified pain and fever and the new condition of jaundice, but failed to appreciate that the seriously non-standard conditions warranted an emergency hospital admission on the basis of erring on the side of caution."

The report suggested that training in NAs questioning techniques should be reviewed, and it recommended that a formal system should be put in place to make it clearer to NAs when they should exercise clinical judgement rather than follow protocol. It also said steps should be taken to ensure NAs did not feel constrained from involving doctors out of hours.

Dr George Crooks, clinical director of NHS 24, said it would carefully assess the sheriff's observations in conjunction with NHS Grampian. He said improvements made to the service over the past 18 months included advanced training to raise awareness of meningitis symptoms and changes to the method of dealing with repeat calls. "The most constructive outcome is that the NHS can learn from these events and continue to improve services for patients in the future," he said.

The families of Mr Wiseman and Ms Miah said the findings justified the complaints they made against NHS 24 from the beginning. A statement from Mr Wiseman's family said: "The sheriff has gone on to identify serious defects in the system operated by NHS 24 which contributed to Mr Wiseman's death. His family hope that the findings will go some way to ensuring that no other family has to go through what they have endured."

Shomi Miah's brother, Khalis, said: "From the start we were saying that there is a problem with the system and if she had been taken into hospital at 6pm rather than 6am she could have been saved, and that's exactly what the report says."

Scottish Health Minister Andy Kerr said he would monitor further improvements made to the service in response to the sheriff's recommendations: "NHS 24 is an integral part of the NHS. It performs a valuable service to thousands every month. But as with all organisations, it can improve. Health boards have already made changes, following on from last year's independent review, and in anticipation of some of the findings expected from the inquiry."

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