NHS Direct: A Public Service Cut or Public Service Improvement?

It was with a little sadness that I noted the announcement of the closure of NHS Direct.  It was a service I used myself twice. Once they saved me a trip to the doctor and left me reassured. Once they advised that I see a doctor, at least leaving me guilt-free when I then booked an appointment that I would not be wasting the doctor’s finite time (a guilt that would never enter the heads of the huge swathe of our population who book appointments every time they have the smallest sniffle).  There was some genuinely innovative use of technology in both call-centres and the use of the internet by NHS Direct at the time it was launched and it was something we could be very proud of in the UK.  Sadly, over its lifespan the organisation didn’t quite keep up with the pace of technological development although its budget certainly kept up Government largesse.  Nevertheless, the concept was something I would remain keen to advance and champion.  A couple of months ago I was even, very briefly, in the running to be a Non-Exec Director of the organisation. It was a service I would wish well and a service I genuinely regretted first hearing was going.

Predictably (and as we shall see hypocritically) Labour have gone into full mock-rage at this cut.  The principal cheer-leaders are Two-Jags who has started a petition to ‘Save NHS Direct’ and leadership pretender Andy Burnham who claims it proof absolute that the Coalition (he really means the Tories) are hell-bent on dismantling the entire NHS.  Out there (here?) in the Blogosphere the parroting of this outrage by the red faithful fills many identikit rants.  For a flavour of the hyperbole in them take a look at this typical example from ‘Jay’s Political Blog’.  The common objections in all the Labour attacks boil down to two substantive accusations:

  • A)      The ‘111’ service that will replace NHS Direct will not be manned by medical professionals.  This will ‘inevitably’ lead to a poorer service.  The sound-bite attack is “Would you wish to be diagnosed by someone with no medical training?”.
  • B)      The Tories said ‘NHS Funding was ring-fenced’, this is a cut to the NHS, thus the Tories are evil liars.

Both charges need unpicking.  The attack by Labour on the 111 Service, particularly by Burnham, is so bizarre as to be perverse.  The 111 service was a project that was originally initiated by Burnham himself when he was Health Secretary. Labour, whilst in Government, were rightly troubled by the cost of NHS Direct.  In fact – they’d been caught a bit on the fly – in September 2008 they thought the average cost per call was £15.35 (source: Hansard).  The Lib Dems smelt characteristic dodgy Labour accounting and demanded more detail and asked the question again. A month later an embarrassed Labour Government revised its figures and accepted that it was actually costing the taxpayer £25.53 per call (Source: Hansard).  The troubling thing here is that at this point a call to NHS direct was actually costing more than seeing a GP.

Trying to figure out scope for lowering this cost you see that in order to minimise risk of mis-diagnosis calls were handled with a protocol-led workflow.  The nurse you were connected to at the call centre had a narrow script on a computer screen in front of them – he or she clicked options depending on your answers and this delivered the next part of the script.  This would culminate in a recommendation e.g. forget about it, or take a few aspirin and see your GP if it isn’t better in 48 hours, or make an appointment with your GP now, or go to A&E immediately or whatever.  They had only a little leeway to deviate from the script and make use of their professional knowledge.

One of the genuine achievements of Labour’s time in power was that Nurses now receive something comparable to a professional wage.  It doesn’t take the sharpest commercial mind to spot that if you are doing a role controlled by computer script and that in practice this role requires the same skill to deliver that it would to sell insurance or deliver any other call center script, then it does seem rather an extravagance to have professional equivalent people’s talent wasted performing the role – particularly if they may be better deployed on front-line wards.

Labour realised this and set up a trial for the 111 scheme.   The pilot has been a success.  It was in Labour’s manifesto (page 35) that they themselves would go with 111 if elected.  The Coalition are doing the right thing in picking up and running with it.  Rather than celebrating their success Labour are now disowning their own brain-child.  That, I guess, is everything that is wrong with politics.

The vision of NHS Direct was that via the telephone or internet you could have access to a 24 hour service that would triage your condition and stop you from making a needless doctors visit if unnecessary but quickly get you to the right medical help if necessary.

The 111 service does exactly that and more:  it also allows you to  book your appointment on the same call rather than having to make a separate call to your local practice afterwards (and then consume the time of another medical receptionist in addition to your own). It is also free (NHS Direct was charged as a national rate call). In short it does more for less.  In these tough times that is something to applaud.

I suppose the Government has invited these attacks by using the language of ‘cuts’ in the way it has positioned these changes.  Cuts to me (as the end user) suggests a service will no longer be available.  Having investigated what it means it seems the service I expected from NHS Direct will still be available and better – it will just be delivered by different people, under a new badge, at less cost to the tax payer.  I concede that it is genuinely a ‘cut’ from the perspective of current NHS Direct employees and I do wish them well.  But for the end-user?  At worst it’s no different, at best an improvement.

As to the charge that the Tories are therefore evil liars: the promise was that the NHS Budget was ring-fenced and will actually increase year on year through the life of the Parliament.  So far the Government  is on track to deliver that.  And if it can supplement this by doing ‘more for less’ in other areas of NHS delivery then again – it should be applauded.

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1 Comment

Filed under Center right, Health, Politics, UK, UK Politics, Uncategorized

One response to “NHS Direct: A Public Service Cut or Public Service Improvement?

  1. Clive Sinclair

    I agree with you about NHS not keeping up with technology available.

    I think the problem was that anyone with a small amount of common sense and access to the web would able to decide if a visit to A&E, or ‘wait till the morning’ to visit a doctor.

    In my experience the final word fro NHS Direct were words along the line of… ‘if your not happy, go to A&E’. I’m this respect they probably increased A&E patients.

    I used them twice. Once they had a ambulance at my house in 8min – which saved my life – as it was an heart attack.

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