Mother of baby who died of sepsis calls for NHS 111 to be staffed by clinicians

A mother whose baby son died of sepsis following missed opportunities across the NHS has called for the 111 hotline service to be staffed by clinicians, and for nurses to be aware of guidance on the condition.

An NHS England investigation report into the death of one-year-old William Mead from Cornwall, who died in 2014, revealed there were missed opportunities where, had a different course of action been taken, the boy would probably have survived.

It looked into care and treatment provided by the family's GP practice, the 111 service run by South West Ambulance Service Foundation Trust (SWASFT) and the out-of-hours service run by Serco in the four months prior to his death.

The report said he died of blood poisoning, which occurred as part of sepsis, and other health complications.

His mother Melissa called 111 the day before he died after he had been vomiting.

The report found the call handler, who was not a trained clinician, missed opportunities to find out more about William’s condition, including further questions about his breathing and his body being limp.

Ms Mead, who has spoken of the devastation caused to the family by William’s death, told Nursing Standard: 'I believe that any call to NHS 111 that is for a child should be dealt with by someone who is from a nursing background or a trained paramedic.

'Adults can speak up for themselves, but really everyone needs to speak with a clinician and I would call on NHS England to make this a key priority.'

The report said that had a clinician taken the call, they might have picked up on William crying in the background throughout the call and recognised this as a child in distress, given rise to further investigation or escalation.

The call handler ran through a NHS algorithm and did not identify the boy as being seriously ill.

The investigation found there were not serious failings in the call handler’s decisions but there were missed opportunities and learning points for SWASFT.

The report highlighted that 111 call advisers need to be trained to appreciate when there is a 'need to probe further, how to recognise a complex call and when to call in clinical advice earlier'.

NHS 111 was launched as a 24-hour non-emergency helpline in 2013 as a replacement for NHS Direct, which was run by nurses.

Acting RCN England director Patricia Marquis said last October that the service ‘desperately needs more nursing staff to make up for the experience and knowledge that was lost when NHS Direct was disbanded’.

Ms Mead called on nurses and other health professionals to take note of information provided by charity the UK Sepsis Trust and their own organisations.

She said: 'Any important information out there about sepsis should not be ignored.'

RCN general secretary Janet Davies said there are tragic consequences when skills and expertise are lost through cost-cutting exercises and said the NHS 111 service was 'simply not fit for purpose'.

The investigation report found missed opportunities in primary care to consider William’s history and recurrent attendances prior to the 111 call.

During a House of Commons debate on the report, health secretary Jeremy Hunt said the government would look at whether more clinicians were needed at NHS 111 and said that the service needed to be improved.

He said the NHS will learn from the serious failings and apologised to William’s parents.