NHS 24 is safe territory for fourth chief executive

Perhaps, therefore, the first question for the new head John Turner should be: why on earth has he chosen to take the post?

Yet as he talks through his CV what becomes surprisingly clear is that, despite the troubled history of NHS 24, this is relatively safe territory for Mr Turner.

When he arrived at the phoneline last September he came fresh from NHS Western Isles, where he had spent 12 months tackling debts and the hangover left by allegations of bullying and financial mismanagement.

Before then he worked for the Scottish Government, where he oversaw the introduction of the very GP contract that allowed doctors to stop providing cover outside surgery hours and saw NHS 24 overwhelmed with callers.

So even though the helpline suffered that crisis, when patients had to wait hours for nurses to call them back, and was criticised by sheriffs following fatal accident inquiries into three patient deaths, it is actually relatively solid ground for this 43-year-old father.

Today the service is not without its issues or its critics, but it appears to have survived another Christmas without the kind of backlogs that ruined its reputation in the winter of 2004-05.

The latest available statistics show that in November 98.2% of calls were answered in 30 seconds, all people with serious and urgent health problems were put through to a nurse straight away and when people with less pressing conditions did have to wait for a response, 99.9% of those given top priority were phoned within an hour.

Mr Turner said: "I think you would look at that overall performance and think that was pretty strong and effective service delivery."

However, there were still occasions in November when the number of calls were higher than predicted and it took four or five minutes for a call-handler to answer.

Furthermore, the proportion of people who had to wait to be called back has crept up year on year. At weekends in November 33% of patients who rang had to wait for a nurse to return their call, compared to 29% in the same month the year before.

The inquiry team that investigated the problems at NHS 24 back in 2005 - and included Mr Turner - were very critical of the way call-back had become a feature of the service. They said it glossed over the shortage of staff at peak times, and demanded action to reduce its use.

Nearly four years since that finding, Mr Turner said of call-back: "It is part of the service and we are continuing to look to reduce it.

"The way in which the service has developed over the past few years means that it is being managed in a safe and effective way for patient care."

He goes on to describe the prioritisation system that determines whether people must be spoken to immediately or can wait up to one, two or three hours.

The introduction of this and other safety nets is reassuring, but the question remains: is call-back still a sticking plaster covering recruitment problems?

Papers submitted to the NHS 24 board in December talk about "the shortfall in the nurse service target numbers" and suggest the number of frontline staff was projected to be 159 behind goal for the month.

However, when asked for more information on nurse numbers, NHS 24 responds by adding together different types of nurses, such as dental nurses, and some call handlers who have been given extra training, and comes up with a figure that suggests in November, at least, there were more than enough.

How to know if this is gloss?

Mr Turner said that on staffing, the story is one of progress: "I think our recruitment and retention issues have improved a lot over the past couple of years.

"We still need to work away at it, but the most obvious example (of improvement) is the way staff sickness absence rates have come down."

This is true. In 2006-07, the average NHS 24 employee was off one day in 10. By November last year the rate had dropped to 5.22%.

That said, the whole of NHS Scotland has missed the sickness absence target - something else Mr Turner was in charge of during his time with the Scottish Government health department.

He really isn't one for comfort zone jobs.

While there are new initiatives in the pipeline for NHS 24, such as an exploration of how text and e-mail could be used to support patients, Mr Turner is clear that continuing to improve the medical advice line is his first priority.

"We are staying vigilant," he says.

It will be interesting to see how long he stays, full stop.

Phoneline's troubled past August 2001 Launches in Grampian. November 2002 Launches in Glasgow. October 2004 Shomi Miah, 17, dies of meningitis after her family call NHS 24. November 2004 Rolls out across Scotland. December 2004 Steven Wiseman, 30, dies of septic shock after consulting NHS 24; NHS 24 takes over calls to GPs outside surgery hours across Scotland. February 2005 John McGuigan appointed chief executive; concerns about patient waiting times; independent review ordered. April 2005 Doctors warn there is "serious risk of patient harm" amid delays at NHS 24. May 2005 Chairwoman Christine Lenihan resigns; it emerges a joint Fatal Accident Inquiry (FAI) has been ordered into the deaths of Ms Miah and Mr Wiseman. June 2005 Interim report levels damning criticism at helpline. April 2006 Toddler Kyle Brown dies after his mother rings NHS 24. July 2006 Sheriff in joint Miah and Wiseman FAI says their lives could have been saved if the seriousness of their conditions had been spotted earlier. January 2007 John McGuigan announces resignation. February 2007 Sandy Forrest appointed chief executive. October 2007 Sheriff in the Kyle Brown FAI says the toddler's death from meningitis might have been avoided if NHS 24 staff had called an ambulance; Sandy Forrest resigns.

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