Families whose relatives died from Covid-19 in the early period of the pandemic are calling for an inquiry into the NHS 111 service, arguing that many critically ill people were given inadequate advice and told to stay at home.
The Covid-19 Bereaved Families for Justice group says approximately a fifth of its 1,800 members – more than 350 people – believe the 111 service failed to recognise how seriously ill their relatives were and direct them to appropriate care.
“We believe that in some cases it is likely these issues directly contributed to loved ones dying, due to causing a delay in receiving treatment, or a total lack of treatment leading to them passing away at home,” said the group’s co-founder Jo Goodman, whose father, Stuart Goodman, died on 2 April aged 72.
Many families have said they had trouble even getting through to the 111 phone line, the designated first step, alongside 111 online, for people concerned they may have Covid-19.
The service recorded a huge rise in calls to almost 3m in March, and official NHS figures show that 38.7% were abandoned after callers waited longer than 30 seconds for a response. Some families who did get through have said the call handlers worked through fixed scripts and asked for yes or no answers, which led to their relatives being told they were not in need of medical care.
“Despite having very severe symptoms including skin discolouration, fainting, total lack of energy, inability to eat and breathlessness, as well as other family members explaining the level of distress they were in, this was not considered sufficient to be admitted to hospital or have an ambulance sent out,” Goodman said.
Some families also say their relatives’ health risk factors, such as having diabetes, were not taken into account, and that not all the 111 questions were appropriate for black, Asian and minority ethnic people, including a question to check for breathlessness that asked if their lips had turned blue.
Vincenzo Manta, 62, the owner of Enzo’s pizza takeaway, a fixture in Burnley for 36 years, died in Royal Blackburn hospital on 1 April having previously called 111 twice and been told to stay at home and take paracetamol.
His wife, Maria Manta, told the Guardian that Vincenzo, who had diabetes, first lost his sense of taste and smell and was in pain when going to the toilet, but was told on his first call to 111 on 20 March that he might have food poisoning.
His condition worsened, he developed a fever, lost his appetite and had no energy but was not breathless, and when they called 111 he was again told to stay at home, Manta said.
By 26 March his face had turned grey – “That frightened me,” Manta recalled – and they called an ambulance, which took him to hospital. He was placed on a ventilator in the intensive care unit and he died alone on 1 April.
“My husband was diabetic and they should have seen that as a red flag,” Manta said. “He was fit, working, he used to go to the gym. Five weeks earlier our first grandchild was born. I feel an anger that will stay with me for ever. For five days he was at home and we were giving him paracetamol. I don’t believe the government equipped the 111 service with what to do, and that’s one of the big things that let us down.”
‘Patrick gave his life to the NHS’
Lena Vincent, whose partner, Patrick McManus, 60, an NHS staff member for 40 years, died on 19 April, has pursued a complaint about the advice he was given in three 111 calls. She has been told that the calls, handled by two private companies contracted by the NHS to provide the service, were not recorded, so her complaint cannot be investigated further.
She believes McManus, who had multiple sclerosis, contracted the virus at the County hospital in Stafford, where he worked. He tested positive for Covid-19 on 3 April and isolated at home but his condition deteriorated, Vincent said, with his temperature “hitting the roof”. He called 111 twice on 7 April and was told to stay at home, then called back on 10 April.
“That is the call I’m really complaining about,” she said. “They told him that as he’d had the virus for seven days, he could go out again. His MS did not seem to be recognised as an underlying health issue. They never said it was serious and he needed to go to hospital.”
The following day McManus was shaking, had a high temperature and could barely manage the stairs. This time he called a nursing colleague and described his symptoms, and she told him to call an ambulance immediately. He was taken to the Royal Stoke University hospital where he was put on a ventilator. He died on 19 April.
“Patrick and I gelled the moment we met,” Vincent said. “He was a fantastic nurse who gave his life to the NHS. He was given the freedom of the city of Derry and Strabane, where he was from, as a distinguished Northern Irish health worker who died from the virus. I’m traumatised now, and I owe it to Patrick to get some answers and accountability for what happened to him.”
The 111 service responded to her emailed complaint by telling her that Patrick’s calls had been dealt with by the South Central ambulance service (SCAS). On 29 July the SCAS wrote to her saying that one of the calls on 7 April had been taken by Vocare, a private healthcare company. The call of 10 Aprilwas taken by Teleperformance, the French call centre corporation that has a £25m contract to provide services for the NHS.
The SCAS told Vincent that neither company was recording calls “as this was not part of the contractual stipulation”, so it had been unable to investigate further. The letter said the SCAS understood that the situation “must be frustrating and deeply upsetting” and apologised, acknowledging “that the service Mr McManus received did not meet the standards that you, or he, expected”.
Vincent says she is planning to take her complaint to the parliamentary and health service ombudsman, and seeking an inquest into her partner’s death.
‘111 wasn’t equipped to deal with the crisis’
NHS England, when asked about the issues raised by bereaved families, including the involvement of the private companies, initially replied with a statement that did not address those questions.
“GPs, nurses, paramedics and other health service staff working in the 111 phone and online service have played a key role in helping millions of people get the right care and advice – whether for coronavirus or any other urgent medical needs,” it said.
Pressed for further information, a spokesman said a separate operation to the general 111 service was set up, called the Coronavirus Response Service (CRS), and it was “run on behalf of NHS 111 by private providers”.
The SCAS said it was asked to set up the CRS because it had already been commissioned by Public Health England to set up a national pandemic flu service if one were needed.
The NHS spokesman later told the Guardian that the CRS private providers were Teleperformance, Vocare and two other call centre corporations with substantial government contracts: Serco and Sitel. He said it was a contractual requirement that calls be recorded. “However, due to how quickly the CRS was stood up to provide care and advice during the pandemic, this wasn’t initially possible, but was introduced shortly after.”
In response to the questions about whether the advice provided was adequate, he said: “NHS 111 call handlers and the online coronavirus service use pathways that follow guidance prepared by Public Health England. The guidance is regularly updated in line with local and global developments of the virus.”
Adrian Boyle, a vice-president of the Royal College of Emergency Medicine and a hospital consultant, told the Guardian that NHS 111 was not equipped to cope at the start of the pandemic.
“We were dealing with a new virus, a poorly understood virus; not enough was known about the symptoms and vulnerabilities such as diabetes, obesity and the effect of ethnicity,” he said. “NHS 111 wasn’t equipped to deal with what they were being asked to deal with, mainly due to lack of knowledge of the disease, and the volume of calls.”
Jo Goodman said the families’ experiences of the 111 service highlighted the need for a public inquiry with a “rapid-review first phase” so that lessons could be learned now.
“It is clear to us that many people did not get the right care at the right time, and it seems highly likely this led to preventable deaths,” she said. “It is difficult to believe that any assessment of the failings that led to the loss of our group members’ loved ones has taken place. With case numbers rising again, the public deserves answers before this winter, when more lives will be lost unnecessarily if issues such as this are not urgently addressed.”
Dr Jim Heptinstall, medical director of Vocare, confirmed that the company had provided 111 and CRS services, and said while it could not comment on individual cases, it extended condolences to Patrick McManus’s family. Teleperformance and Sitel did not respond to questions from the Guardian.
A Serco spokesperson confirmed the company had provided about a sixth of the CRS call handlers. “Our people were involved in answering initial phone calls and providing standard information, all from scripts provided by NHS England,” he said. “Wherever individuals required medical advice, the scripts clearly directed these calls to clinical personnel for specialist medical support.”
Boyle said doctors had a “duty of candour” and that the royal college had been calling for a rapid review of the response to the virus so medics could be better prepared for the expected rise in cases this winter.
“When things go wrong, [doctors have an obligation] to acknowledge it and be honest, and say: ‘We didn’t get everything right,’” he said. “And it will be ridiculous to think that every decision that was made back in March, on incomplete information, at times of enormous demand, will be correct.”