111: The NHS number on life-support

The cost of privatising out-of-hours doctors will be paid in lives. Axel Peanberg King was the first, writes Features Editor Oliver Duggan

Stethoscope LOWIf you have a heart attack, call 999. For everything else, try your luck with 111, the new out-of-hours dial-a-doctor introduced by the NHS.

Linda Peanberg King, mother to seven-month-old Axel, did just that. She called Harmoni, the private company that has won the vast majority of NHS contracts for the service, in November.

Her son had developed a cold that continued to worsen over the weekend. On the third day she rang again and the operator – a faceless voice with six weeks’ training on a computerised script that auto-diagnoses patients – downgraded his condition from urgent to routine. He died within four hours aged 54 weeks.

Harmoni strenuously denies culpability for the tragedy but Axel’s grieving mother savaged the firm at St Pancras Coroner’s Court last week. The coroner described her one minute consultation with Harmoni as “wholly inadequate”, and Ms Peanberg King said “there are still many questions to answer about the safety of the service provided”.

In response, Dr David Lee, medical director for Harmoni, expressed his sympathy for the Peanberg King family and said the company would be considering the coroner’s findings. “The death of such a young child is always a particularly traumatic experience for all concerned,” he said. “In response to this we have undertaken an exceptionally detailed review of the circumstances.”

In a later statement, a spokesman for the company said: “The coroner’s comments relating to the tragic death of Axel Peanberg King confirmed that there was no evidence to suggest that Harmoni staffing levels were unsafe.” Case closed.

And yet, according to Harmoni’s official overnight review that was quoted in The Guardian, in the month pneumonia killed Axel, staff shortages meant just one senior nurse was exclusively designated to assessing the seriousness of every call from patients for the whole of London on at least one occasion, and the Whittington clinic was routinely closed for hours on end without warning.

If you had an accident in north London in November and tried your luck with 111, chances dictate you would have got an answer phone message, and then a locked door. Harmoni did not dispute the allegations when they were made in The Guardian, reiterating the tired party line that ‘safety’ had not been compromised. The company was unavailable for comment on this.

Dr Fred Kavalier, a GP in North London who joined Harmoni in 2010, has joined the chorus of dissenters since the Whittington scandal. Revealing that he resigned from the private contractor after just six weeks of employment, he said:

“I had been an NHS GP for many years and it was my first experience of working for the private sector. I resigned because I felt their service was unsafe and potentially dangerous. I fear it is only a matter of time before this low level of service leads to a serious clinical incident. I hope urgent action will be taken.”

When he quit in December 2010 he wrote a letter to the company’s then directors explaining their inadequacies. The four founding GPs say they “responded fully” to Dr Kavalier’s concerns. But the scandals roll on as misguided call centre robots who remotely connect patients and Volvo-bound GPs flirt with the difference between teething problems and criminal negligence.

Bizarrely, in spite of countless instances of failure, the Harmoni directors have enjoyed a massive pay-out. The four founding fathers became millionaires in the weeks before Axel died when they sold the company to Care UK in for £48 million, having won more than a quarter of national 111 contracts.

The Harmoni defence, that failures are unavoidable in the transition to the new service, could be convincing if their service was a reformed tax code or revolutionary carbon emissions monitor. But casualties are a little hard to stomach, and the hurdles new care providers must clear before being granted lucrative contracts should be higher.

Like a Harmoni consultation, there is no adequate statement of responsibility that can be made. In every one of the above cases, they are a phone call away from the action, sat somewhere hundreds of miles from the babies with a cold, the girls with a cough, the cancer patients in pain. As they continue to accrue contracts, so too will they accrue fatalities. It is an inevitability of private, telephonic care.