Editorial: Confidentiality waiver for 111 calls merited

During the trial period emergency call referrals to nurses freed up an extra 15 ambulances on the road 24 hours a day. Photo / File

For some time, the high standard that New Zealanders have come to expect from the St John Ambulance service has shown signs of fraying. A number of incidents in which people have waited too long for paramedics to arrive have underlined its struggle to meet response time targets.

Two factors are working against it. One is an ageing population; the other is the way the 111 system is clogged by callers with relatively minor ailments. In that context, there is good reason to welcome the stationing of nurses at emergency call centres to answer non-urgent calls.

This arrangement comes at the same time as a 10-year contract with the Ministry of Health for a new 24-hour integrated "telehealth" phone service that has gone to a company owned by doctors' groups ProCare and Pegasus.

At present, a 111 caller is asked by an operator if they need police, fire or an ambulance. If the caller chooses an ambulance, they are put through to another operator who deals with the call. Under the system, that operator would code the call and send all those deemed least urgent to the on-duty nurse. The nurse would decide whether to send an ambulance or make an appointment with the caller's GP.

It is easy to see the advantages of this. Critics have claimed that operators with no medical training were one reason for the dispatch of ambulances to people suffering no more than the likes of constipation, vomiting and gout. These operators had a rigid list of triage questions and were naturally inclined to err on the side of caution. The outcome was too many paramedics arriving at supposed emergencies with sirens blaring only to find people with minor complaints.

The presence of nurses should go a long way to preventing such occurrences. A trial started 11 months ago in Auckland has indicated as much. In that period, St John received 117,574 emergency calls, of which 22,150 were referred to nurses. According to a St John spokesman, this freed up an extra 1.5 ambulances on the road 24 hours a day, seven days a week in the city. These should enable a quicker response to calls requiring urgent attention.

Not all about the new system is plain sailing, however. Procare wants access to parts of patients' health records so that nurses answering calls in the middle of the night for its new telehealth service can understand the likely causes of callers' symptoms. That involves venturing into the arena of doctor-patient confidentiality. What people share with their doctor is supposedly protected information that cannot be shared with others. There will be instances, however, where it is necessary to balance the benefits of maintaining confidentiality against those of waiving it.

This is a case where, on balance, a waiver seems reasonable. The records would be shared with fellow medical professionals and used exclusively for the wellbeing of the patient. Further, it is difficult to see how the system would function effectively if nurses did not have access to such information. People, should, however, be made aware that their records could be shared in this manner, and have the right to insist it does not happen.