In plain English
Knowing when to call 999, NHS 111 or out-of-hours services is one of the most useful skills for a family carer. This page sets out who to call and when, and how to prepare for any hospital admission.
The decision
Call 999 if
- Sudden severe symptoms suggesting stroke (facial droop, arm weakness, speech change);
- Suspected heart attack (severe chest pain, breathlessness, collapse);
- Severe breathing difficulty;
- Severe bleeding;
- Major injury after a fall;
- Loss of consciousness;
- Severe new pain;
- Significant safety risk that cannot be contained.
Call NHS 111 if
- You think you need urgent help but it is not life-threatening;
- Unsure whether 999 is appropriate;
- Out-of-hours general health concerns;
- Suspected Delirium or significant behavioural change without obvious medical emergency;
- Need urgent prescription advice.
NHS 111 (free) is available 24/7. The advisor will signpost to GP, urgent care, pharmacy, or 999 as appropriate.
Call your GP same-day if
- New cognitive change suggesting Delirium;
- New behavioural symptoms;
- New physical symptoms (cough, urinary symptoms, abdominal pain);
- Recent fall without obvious injury;
- Medication concerns.
Call your GP routinely if
- Ongoing concerns about symptoms or care;
- Medication review;
- Annual dementia review;
- Benefits or social care advice signposting.
NHS 111 service
NHS 111 is available 24 hours a day by phone (call 111) or online (111.nhs.uk). Trained advisors triage and signpost. Outcomes may include:
- Self-care advice;
- Advice to see your pharmacy;
- GP appointment booking or callback;
- Out-of-hours GP service;
- Urgent treatment centre;
- A&E referral;
- Ambulance dispatch where appropriate.
Out-of-hours GP
Routine GP services run weekday daytime. Out-of-hours services (evenings, weekends, bank holidays) cover urgent but not emergency concerns. Access is typically via NHS 111, which routes calls to the appropriate out-of-hours provider.
Hospital admission with dementia
People with dementia are more vulnerable to deterioration in hospital. Practical steps that help:
Preparation
- Keep a current medication list accessible;
- Complete a "This is Me" leaflet (Alzheimer's Society) summarising the person;
- Have a Life Story Book or summary available;
- Note key conditions and recent investigations;
- Know which medication should not be missed or substituted.
On admission
- Give the "This is Me" leaflet to ward staff;
- Make sure hearing aids, glasses and dentures travel with the person;
- Bring familiar objects (a photograph, a small item from home);
- Inform the ward of any specific preferences (preferred name, calming routines, food preferences);
- Family presence reduces Delirium risk; arrange visiting where possible.
During
- Be alert to Delirium (sudden change in attention or alertness);
- Ask about the discharge plan early;
- Insist on access to hearing aids and glasses;
- Ensure any anti-dementia medication is continued.
Discharge
- Confirm medication changes;
- Confirm follow-up arrangements;
- Request a discharge summary;
- Allow recovery time at home; many people are deconditioned after hospital admission.
Mental health crisis support
Severe behavioural symptoms putting safety at risk warrant specific mental health support:
- NHS 111 with the option for mental health support;
- Crisis Resolution and Home Treatment teams (local NHS mental health trust);
- Older adult psychiatry teams where established;
- A&E for immediate safety concerns.
Useful numbers (UK)
- 999: life-threatening emergency;
- NHS 111: urgent (non-life-threatening) advice;
- Alzheimer's Society Dementia Connect: 0333 150 3456;
- Dementia UK Admiral Nurse Helpline: 0800 888 6678;
- Carers UK Helpline: 0808 808 7777;
- Age UK Advice Line: 0800 678 1602;
- Samaritans: 116 123 (24 hours);
- Silver Line: 0800 470 80 90 (24 hours, older adult befriending);
- Cruse Bereavement Support: 0808 808 1677.
Frequently asked questions
When should I call an ambulance?
For sudden severe symptoms suggesting stroke or heart attack, severe breathing difficulty, major injury, loss of consciousness, severe new pain, or significant safety risk. When in doubt, call 999.
What is the 'This is Me' leaflet?
An Alzheimer's Society document summarising essential information about a person with dementia for hospital staff: name preferences, key conditions, routine, fears, things that help. Useful in any hospital admission.
Should we always attend A&E for a fall?
Not always. Falls without obvious injury and with the person back to normal can often be managed at home with same-day GP review. Suspected head injury, hip pain, or loss of consciousness warrant A&E.
What about behavioural crisis at night?
NHS 111 with mental health support is the first call. Where there is immediate safety risk, 999. Crisis Resolution and Home Treatment teams operate in many areas.
Will the police help with wandering?
Yes. Register with the Herbert Protocol through your local police force and call 999 promptly if a person with dementia is missing; do not wait.
References
- NHS England. NHS 111 service.
- Alzheimer's Society. This is Me leaflet.
- NICE CG103: Delirium.
- Royal College of Psychiatrists. Mental health crisis care.