Dial 0845 4NHS * – a fond farewell to NHS Direct
Of all the things I have worked on in my career NHS Direct is undoubtedly the thing which has touched the greatest number of lives. I remember lots of conversations which, once I had explained what I did, continued with “Oh NHS Direct….I’ve called them…..” After a nervous pause (for me) they would continue to regale their experience. Sometimes we hadn’t been up to the mark, many times we had and on some occasions NHS Direct had a really special difference for someone.
Last week NHS Direct, after 16 years of operation, took its last call. I do not want to write about the politics of why NHS Direct, despite the very positive regard it enjoyed with the public, has been replaced. 111 has many positive features in its design but I think it is worth highlighting a number of things about NHS Direct which were very special and which the NHS should not forget.
NHS Direct, in its time, was genuinely innovative. Its mobilisation at scale, in only 2 ½ years, was a significant challenge and was only achieved through the extraordinary efforts of many committed practitioners and managers. It threw together people from many different backgrounds and working across many different NHS organisations. The service was staffed by a mix of nurses (themselves from many different clinical backgrounds), health information advisers, call centre experts and the whole was greater than the sum of the parts. Such diversity was an important backdrop to delivering a ground breaking service and, for me, highlighted the contribution of new perspectives in changing service models.
It represented one of the most significant uses of IT in clinical services. Long before such systems had been adopted by other parts of the NHS, NHS Direct was using clinical decision support in real time as part of delivering clinical care. Decision support significantly enhanced the clinical safety of the service, both because it provided staff with evidence based information at the point of care, but also because it automatically documented the decisions they had taken. Together with the recording of all calls, this made NHS Direct one of the most transparent of health services. Routine use of electronic systems also opens a new world of using data to question clinical performance and NHS Direct was again at the forefront in pioneering such approaches.
While better known for its clinical work, NHS Direct played an equally major role around the development of health information and health literacy. This area rarely gets the attention it deserves from policy makers but any expectations of securing a fully engaged population in respect of the use of healthcare warrants some investment by the NHS is health literacy and self-care skills. Self-care is not a self-disciplined restraint in the use of formally provided health care services but rather the product of collaboration with patients, and in particular those experiencing long term conditions, in building up their knowledge, skills and confidence in managing their own condition. NHS Direct made a significant contribution to this agenda through its telephone and online services and through successful offshoots such as the Birmingham Own Health project which provided a coaching based care management service for people with long term conditions.
Finally NHS Direct had a special role around health scares, whether the issues around children’s’ organs at Alder Hey, the aftermath of the 7/7 bombings or a whole range of day to day issues of concern appearing in the media NHS Direct provided a national resource for handling these in a way which took the strain away from local health services.
The final thing which NHS Direct did well was to remain a service which was focused on listening to patients. In the end part of its difficulty was that the service model was caught between an advice service for patients and a gatekeeper role for the urgent care system. 111 as a model is clearer that it’s focus is demand management but that, potentially, has a downside. NHS Direct, at its best, treated all its callers with respect. That’s why it was liked by young parents, inevitably anxious about whether they dealing with genuine issues of concern in relation to their children’s’ health, by older people and others who weren’t sure that should be bothering the doctor, even on occasions when they had something seriously wrong with them, and by marginalised groups such as people with mental health problems who could often find the mainstream system intimidating and difficult to access. A busy shift at NHS Direct, which as a call handler, I had the privilege from time to time to do, covered an enormous range of issues. The trick was deal with all of them non-judgementally and in that way NHS Direct genuinely earned its motto “We’re here to help”. As a telephone based service, NHS Direct valued good listening skills beyond all else and I was full of admiration for how the best of its practitioners could put together crucial information about a caller’s issues by the patient way in which they listened to the verbal and non-verbal signals they elicited from callers.
NHS Direct is no more. I would be the first to admit that it didn’t get everything right but its achievements were considerable and there are things about its bold spirit of innovation and its focus on listening to patients which the NHS should ensure it does not forget.
*The origins of the NHS Direct number come from the American practice (little followed here) of using numbers on the telephone keypad to spell out a word so 0845 4647 stands for 0845 4NHS.