Patients life threatening conditions missed.
The deaths of two people from Aberdeen, has raised questions as to the effectiveness of the NHS 24 helpline.
The helpline depends on nurse advisors making accurate diagnosis and clinical judgements over the telephone.
Sheriff James Tierney said that the system had failed the two patients by not identifying their life threatening conditions and by the nurse advisors not adhering to the strict practise of erring on the side of caution.
His findings followed a lengthy joint fatal accident inquiry. His report said that while the system was "not inherently defective" it had failed both these patients.
It had failed to identify the fact that they were each suffering from a life threatening condition or at least from a condition that the nurse advisors did not properly understand.
The report questioned the techniques of the nurse advisors, which were central to the safe operation of the system. In most cases the techniques were defective.
One of the patients had been told by the nurse advisor to take paracetamol for flu-like symptoms, she sadly later died from meningitis.
The report stated that if the other patient had been seen by a doctor at the time of the first call her life would almost certainly have been saved. It went on to say that a further two calls failed to recognise the seriousness of the symptoms and incorrectly recorded answers.
Suggestions were made that training needed to be reviewed and a formal system put into place to make it clearer to nurse advisors when they should exercise clinical judgement rather than follow protocol.
Dr George Crooks, Clinical Director of NHS 24, said it would carefully assess the sheriff's observations.
He said that improvements made to the service over the past 18 months included advanced training to raise awareness of meningitis symptoms and changes to the method of dealing with repeat calls.
The most constructive outcome is that the NHS can learn from these events and continue to improve services for patients in the future.
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