NHS Direct Wales 'turned off' for 999 calls, Unison claims
The NHS Direct Wales helpline is turned off occasionally as its nurses deal with 999 calls instead, a health union claims.
Unison says the service is being "compromised" as staff prioritise non-life threatening calls that are transferred from the ambulance service.
It fears delays in getting through to the 24-hour phone line mean people may go straight to A&E or ignore symptoms.
But the ambulance service running the hotline insists it is always available.
The claims come at the end of a week in which "unprecedented" levels of hospital admissions led to ambulances queuing outside accident and emergency departments across Wales.
The Welsh government also advised the public to think twice before attending A&E or ringing 999.
End Quote Darron Dupre Unison regional organiser
In effect that very many people who call NHS Direct Wales are not getting the service they expect ”
However, Unison claims that this advice might be ignored because of the set-up at NHS Direct Wales, according to documents seen by BBC Radio Wales' Eye on Wales.
Callers to the 0845 number speak first to a call handler who will ask the reason for calling before passing the query through to either a nurse or other relevant health adviser.
During busy periods the call handler will agree a time for an adviser to ring back, within a three-hour timeframe.
But nurses working for NHS Direct Wales also deal with non life-threatening Category C calls to the ambulance service - such as minor injuries or colds and flu symptoms - which ambulances have a target to reach within 30 minutes.Waiting longer
Unison said that once calls are transferred to the NHS Direct Wales queue they effectively take priority over other calls waiting for a call back.
At busy times, the union claims, that can mean callers to NHS Direct Wales having to wait longer for their calls to be answered.
They may also be played an automated message advising them of the high demand for service and to either call back later or expect a long delay.
Gives advice and information 24 hours a day.
A call handler passes a query onto a nurse or relevant health adviser who will call back in a three-hour timeframe
Category C ambulance calls
Are non-life threatening calls which do not require and ambulance immediately, such as minor injuries or colds and flu symptoms.
However, ambulances have a target to reach callers within 30 minutes.
At very busy time and as a last resort, Unison says the 0845 line may be closed, although it does remain open for queries from A&E or minor injury units.
Unison regional organiser Darron Dupre prepared evidence on the issue for an ongoing review of the Welsh Ambulance Services Trust, which was commissioned by the Welsh government and is being conducted by the health economist Professor Siobhan McClelland.
Mr Dupre told Eye on Wales that members of the union working for NHS Direct Wales felt they and the service were being compromised on a weekly basis by the need to prioritise Category C targets over NHS Direct calls.
"That means in effect that very many people who call NHS Direct Wales are not getting the service they expect and on occasions the service has been switched off," he said.'Informed decisions'
"I was very surprised to hear that it has been compromised in this fashion. I don't think it sits well with being a pathway which is going to take people away from their doctor's surgery of from the accident and emergency department."
End Quote Welsh Ambulance Service
Those patients with the greatest clinical needs are prioritised first ”
He added: "If NHS Direct Wales is ever switched off, or it's impossible for somebody to get through because it is dealing with other ambulance matters, it means that people are going to be rushing to their accident and emergency department causing all the troubles we've seen this past week."
"Or, possibly of more concern, people will not seek medical advice."
In response, the Welsh Ambulance Services Trust said it was unable to comment on Unison's claims while the McClelland review is ongoing.
But it insisted that the NHS Direct Wales service was "always available for patients to access".
"This supports the trust in ensuring that those patients with the greatest clinical needs are prioritised first and patients are able to get information and advice which helps them make informed decisions about their healthcare needs," it added.
"The Welsh Government review of the service is currently being undertaken and we are providing all support and assistance to Professor McClelland and her team."