Managers have sent an urgent memo to frontline NHS 24 staff ordering them not to put patients at risk from Ebola in a call back queue, just days after the case of Scottish nurse Pauline Cafferkey.
Although it is not clear whether the Lanarkshire health worker used the NHS helpline when she returned home to Scotland, the email to the service's call operators raises questions whether she was given the priority that was essential.
The memo has been circulated across call centres emphasising that patients who visited countries where the disease is spreading and are at high risk of suffering from Ebola, must be treated as "serious and urgent."
In capital letters supervisors are told not to advise call handlers to list such patients among those who can wait for a nurse to ring them back later.
Nurses are told in red ink to sign forms as confirmation they read the memo and understood its content.
NHS 24 declined to comment on whether Pauline Cafferkey, who remains in a critical condition at the Royal Free Hospital in London, had rung the service when she fell ill on her return trip from Sierra Leone just before New Year.
Ms Cafferkey spent most of December working with Save the Children in an Ebola treatment centre and was admitted to hospital in Glasgow shortly after flying back to Scotland. Following confirmation that she had contracted the illness, which has killed 8,235 people in the last year, she was flown to the specialist isolation unit at the Royal Free Hospital in London.
Yesterday(thurs), the Royal Free issued a statement on behalf of her family. It said: "We would like to thank all our friends, family and the members of the public who have contacted us with support following Pauline's diagnosis with Ebola. We have been very touched by the kind words.
"Pauline continues to be in a critical condition at the Royal Free Hospital. We want to thank all the staff caring for her for their kindness, support and compassion. Pauline's condition could remain the same for some time and we would again ask for her and our privacy to be respected."
The memo about potential Ebola cases says: "DO NOT advise call back ..."
Questions have been raised about the screening of volunteers returning from Ebola hotspots after Ms Cafferkey was cleared to fly onto Glasgow after having her temperature taken seven times at Heathrow airport. Earlier this week First Minister Nicola Sturgeon said the procedures had already been revised.
NHS 24 ran a helpline for patients who were on the same Heathrow to Glasgow flight as Ms Cafferkey, and guidance on speaking to these callers was circulated to staff.
However, it is understood that further guidance has also been distributed to all frontline NHS 24 staff about the priority given to patients who call with symptoms and are at high risk of Ebola because of their recent travel history.
Since it was launched NHS 24 has had to ask some patients to wait for nurses to ring them back with health advice and calls are prioritised with the more pressing contacted within an hour and others waiting up to two hours.
Jenny Marra, health spokeswoman for Scottish Labour, said: "I raised the issue of how prepared the NHS in Scotland was with the Health Secretary and she assured me that the government was doing everything it could and that our NHS was prepared for Ebola in Scotland.
"It is concerning to hear that this memo has been sent out after this case and I would look for assurances from NHS 24 and all health agencies that their staff are fully briefed and fully prepared and know what to do in the event that an Ebola case self presents."
Professor George Crooks, medical director of NHS 24, said: "NHS 24 routinely issues updated guidance or reminders to staff in relation to service and clinical developments and this has been the case in relation to Ebola. On Tuesday 6th January the special helpline we had been operating in relation to Ebola closed and all such calls are now coming in through the 111 number. Updated guidance has been issued in line with normal business process."
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