Saturday, August 28, 2010

NHS Direct

It looks like NHS Direct is to be replaced by a different deskilling call centre masquerading as part of our National Health Service. 'NHS 111' which is being trialled in two counties at the moment may well take over the functions of NHS Direct "within three years".

NHS 111 will employ less qualified nurses but rather will train its staff to the standard of 999 operators who, as it happens, are very good. Some people are up in arms about this but I'm slightly more cautious.

I sympathetic with Luna17 when he says that "I wonder what does count as a 'frontline service' in the minds of government ministers". The phrase frontline services has always been a perplexing one as it is unthinking populism that implies that workers not involved in face to face contact with the public are less useful, essential or cost effective than emergency workers - which isn't true.

Mr Andy C says that the government "are using some of the funding for a pointless and dangerous re-organization of the NHS and to pay for it they are cutting services." Well, I'm certainly for less NHS re-organisations. As someone who worked in the NHS for eights years and underwent a number of Labour led shake-ups I can testify they are a pain in the bum, tended to lead to a worse service and when laid on top of each other disorientated and demoralised staff.

However, I wont be signing the Save NHS Direct petition. I'm opposed to the slash and burn cuts of the coalition government, I'm not going to make it a point of principle to be opposed to any reorganisation or more efficient use of resources.

As far as I'm concerned when the service was set up it was part of an ongoing process of deskilling the professions. So we have PCSOs, teaching assistants, and call centre workers instead of police officers, teachers and doctors. All of the former do good things, but as a trend it undermines the quality of public services. It restricts the number of professional jobs that command professional wages available. Many teaching assistants and PCSOs actually want to be in fully qualified positions but find the opportunities closed.

When NHS Direct was set up Socialist Worker said "Advice line NHS Direct, one the flagship proposals of the government's health service "modernisation", is endangering people's lives... by giving wrong advice and not recognising emergencies" and reminded us that "New Labour touts schemes like NHS Direct, where patients ring up for advice on the phone or, as announced this week, on the internet. But these schemes do not substitute for the lack of resources and facilities."

At the time NHS Direct was set up (1999) doctors criticised the new service as misdirecting resources, creating its own demand and described it as a substitute for adequate "frontline" resources. There's been a consistent criticism, that substandard advice was being given - for example see Earwicga today - and in those all important emergency cases it can delay the time from when the first call is made to when the ambulance arrives.

More recently, the British Medical Journal reported that the BMA had recommended scrapping NHS Direct along with other costly initiatives like PFI and the NHS Database. This is not because the BMA want to scrap the NHS, but because they want the money used in the most efficient way possible.

If NHS Direct goes it does not mean that suddenly there will be no medical advice available, it means it will be provided in a different way. I'm perfectly happy to believe that people have been given good advice and even some lives have been saved when calling this service - but this does not mean we shouldn't find better ways of doing things or forget the numerous problems. Private doctors save lives but it does not mean I have to be in favour of a privatised health service.

As far as I can see the NHS budget is still ring-fenced and, while I don't trust the Tories with the NHS, I'm not against value for money or scrapping services that aren't that great. I am against a slash and burn economic policy but I'm not so sure this is an example of that and the reaction against smacks more of tribalism than anything else.


Cllr Jason Kitcat said...

I agree with your over-arching argument regarding de-skilling and people in those jobs often wanting to do the 'real thing' if just given the chance. It does cheapen all these worthy professions.

One has to be cautious about what the replacement is though... In Brighton & Hove for example there is just one doctor for the whole city's night service number. So if NHS Direct is cut will the local health services get sufficient new funds to mop up the redirected demand??

On PCSOs I have to say I used to think of them as just PCs on the cheap... but I think it depends on what you think of their role being, and as a Councillor I've had many very positive dealings with PCSOs. A Police Foundation briefing offers some alternative views - for example PCs are often redirected as needed throughout their shift, whilst PCSOs cannot be moved off their beat so easily, keeping a more consistent neighbourhood overview. Perhaps that could be fixed by changing Police management structures, but still interesting...

The briefing is at

Jim Jepps said...

I agree with you Jason.

I actually find neighbourhood PCSO's rather more useful than PC's and the fact they can't arrest you and don't carry a big stick forces a different role upon them even if they wanted to be a mini-cop.

I've less experience of teaching assistants but I'm sure lots of them do good work.

However, I am concerned about structures that are about either direct cost cutting or undermine the quality of service - both of which I think NHS Direct certainly was/is.

That doesn't mean the replacement '111' thing is going to be better but not having nurses staffing phones may actually be a good thing because they can work in hospitals instead and no-one will think the advice they get over the phone is cast iron medical gospel.

Owen said...

Very good post. There's no sense in opposing something just because it's the Tories doing it, and sometimes 'efficiency' really does mean efficiency, not cuts. I'm not sure what I think about getting rid of NHS Direct either, but it certainly isn't an obviously terrible idea.


The proof of the pudding is in the eating - how many people do you know who have used NHS Direct? very few I'm guessing.

I still regard PCSOs as toy Policemen i.e. policing on the cheap and have as little faith in them as I do the normal Police who are essentially rascist thugs in blue who hate working for a living which I have some sympathy with as the CPS tend to favour addicts and criminals alike.

Get rid of the lefty CPS and the Police will regain their self respect.

Anonymous said...

Well for a long time you could not call an ambulance unless it came from NHS direct, in my area for years you phoned NHS direct and they phoned the ambulance if they thought it was worthy, this stopped after I phoned the ambulance service for my wife they refused to attend until I called NHS direct, NHS direct demanded I phone the out of service medical company, the NHS phoned the out of service provider who was based in Germany, an hour later nine phone calls, I took my wife with three neigbours to the A&E she was in a coma suffering from meningitis, doctors told us it was touch and go as we had taken to long to get her into hospital. I was interviewed by the NHS who came to the conclusion the NHS direct was hampering the use of the 999 emergency service.