Dr. Carl Heneghan, a UK urgent care general practitioner, called an ambulance for a patient using a dedicated clinician line.
In the past, his clinical assessment of the patient would have been sufficient for an ambulance to be dispatched. But something has changed.
The NHS is now remotely assessing the need for an ambulance response requested by doctors using a score, a number. This number is replacing the requesting doctor’s patient examination, experience, pattern recognition, context and knowledge of the patient’s history.
Related: Numercide: When doctors use numbers to prescribe medicines to healthy people
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Tales from the Front Line: Computer Says NEWS2
By Carl Heneghan, as published by Trust the Evidence on 1 September 2026
“What time response do you need?” the ambulance call handler asks.
“Level 2. An 18-minute response,” I reply.
“What’s wrong with the patient?”
“He has urosepsis on a background of myelodysplasia, and needs admission.”
We go through the usual details: Age, address and location.
Then something unusual happens.
“I need to refer you to someone else,” the call handler says.
I wait on the line. A second person answers and introduces himself as a consultant paramedic. He wants to discuss whether the patient really requires the Level 2 response I have requested.
That’s new, I think to myself.
Telephone triage is necessary when nobody has assessed the patient. That is one of the purposes of 999: someone has to establish what has happened, how sick the patient might be and what response is required.
Yet, somewhere between my clinical assessment and the dispatch of an ambulance, another assessment had been inserted. A health care professional who hadn’t seen the patient was now being asked to validate the judgement of the clinician who had.
But I hadn’t called 999.
I had called the dedicated number for healthcare professionals – the route that allows a clinician who has already assessed a patient to request an ambulance response. And this patient had been assessed by me. I had taken the history, examined him, reviewed his medical background and decided that he required urgent admission.
“What is his NEWS2?” I’m asked.
“Four.”
And suddenly, four seems to become the most important fact about the patient.
Except there is a problem: I can’t record his blood pressure because it’s unrecordable.
NEWS2 gives clinicians a common language for describing physiological deterioration. But it isn’t a diagnosis, and it isn’t a replacement for examining a patient.
A NEWS2 of four means one thing in an otherwise healthy person with an infection. It may mean something quite different in a patient with myelodysplasia, suspected sepsis and a blood pressure I cannot even record. The score is the same; the risk is not.
Then there is something NEWS2 cannot know: Myelodysplasia can cause low white blood cell counts, leaving patients vulnerable to serious infections such as sepsis and pneumonia. Infection accounts for up to 1 in 4 deaths in patients with myelodysplasia.
NEWS2 doesn’t know the patient’s neutrophil count, the consequences of their bone-marrow failure, or how dangerous an apparently modest physiological disturbance might be in this particular patient. Unless the health professional on the other end of the telephone knows the patient’s history and understands its significance, neither will they.
Yet here I am, standing beside an acutely unwell patient whom I have examined, explaining to someone who hasn’t seen the patient why the number on the scorecard doesn’t adequately describe the person in front of me.
Previously, the process was straightforward: I assessed the patient, decided they needed hospital admission, explained the clinical problem and requested the appropriate ambulance response.
But all of a sudden, another clinical layer has appeared between my assessment and the ambulance.
Why? Presumably, the answer is demand.
Ambulances need to go to the patients who need them most. But there is an important distinction between triage and re-triage.
There is also something increasingly seductive about healthcare numbers: Scores look objective and reproducible, and they can be entered into boxes, audited, and incorporated into protocols.
However, clinical judgement is messier; it involves experience, pattern recognition, uncertainty and context. It includes noticing that the person in front of you looks considerably sicker than their observations suggest.
What worries me is a system in which clinical validation gradually becomes demand management, in which a numerical score begins to acquire greater authority than the clinician who has seen the patient.
There is a particular irony in using NEWS2 this way. The score exists to help us recognise the deteriorating patient; it should not become a reason for failing to recognise one.
There is a brief pause.
“Oh, that’ll be a Level 2 response then,” he says.
“I’ll hand you back to the call handler.”
And on I go.
About the Author
Carl Heneghan is a professor of Evidence-based Medicine at the University of Oxford, Director of the Centre for Evidence-Based Medicine (“CEBM”) and NHS Urgent Care general practitioner (“GP”) who regularly appears in the media. Together with Tom Jefferson, he publishes articles on a Substack page titled ‘Trust the Evidence’.
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