Save NHS Direct?

Friday’s “inadvertent” revelation by health secretary Andrew Lansley that NHS Direct is to be scrapped (and replaced by an “NHS 111” service with fewer medical staff) caused immediate outrage across most of the Labour Twittersphere.

I found myself feeling more ambivalent about the proposal. My personal experiences of NHS Direct in recent years have not been wholly positive: it’s hard, when being told that a nurse will call back in two hours to discuss your distressed child, to feel that this is a jewel in the NHS’s crown. Personally I’ve found local out-of-hours services (such as EMDOC) more useful. These have improved greatly in recent years, at least in our area, and are surely vulnerable to “stealth cuts” that will be more damaging than the high-profile axing of NHS Direct.

Other people’s experience of NHS Direct may well have been different (in which case please let me know in the comments), though I wonder how many of those rushing to post #saveNHSdirect tweets have had first-hand experience of the service. The Guardian report points out that GPs recently called for the service to be abolished, as it had failed in its stated aim of reducing pressure on A&E wards and GPs’ surgeries. In practice, a large proportion of NHS Direct callers were simply referred onwards to casualty or their GPs, which tallies with my own experience.

There are some broader political points to make here, however, concerning how Labour responds to such developments.

First, if our response to every proposed cut is an explosion of anger, this will open us to claims that we are not serious about reducing the deficit (even though even the leadership candidates all agree that between 50% and 67% of deficit reduction would need to come from cuts, in contrast to the government’s 80%). It will also lead to “outrage fatigue”, as we use up our reserves of energy and credibility before the really serious cuts begin with this autumn’s Comprehensive Spending Review.

Having become exhausted by the debate on Twitter on Friday night, I picked up the book I’m currently reading, Anthony Beevor’s D-Day, and immediately came across the following quote from Frederick the Great:

He who defends everything defends nothing.

In other words: pick your battles. (One reason the leadership election can’t end soon enough: a large part of the leader’s job will be to help us to do so.)

Second, though, and more importantly, this incident says something about the terms in which Labour frames its opposition to government actions. “Save NHS Direct” expresses the issue in essentially institutional terms: “The service currently known as NHS Direct must remain in largely its current form”. That may excite some people, but will leave many others cold. And the Tories will delighted to see Labour turn into the party of the status quo.

Instead, we should be framing the debate in terms of what this means for ordinary people’s lives: “It’s 10 pm and your child is crying in pain. What help can you get from the NHS right now?”

It’s far from obvious that NHS Direct (in its current form) is the only, let alone perfect, answer to that question. It’s equally far from obvious that an “NHS 111” service which provides details on how to access local out-of-hours services isn’t a reasonably good answer to that question: provided the local services are there to back it up.

Which is the big question. Will NHS 111 actually be an effective service providing useful information about good-quality services? Or will it end up as a series of recorded messages directing you to underfunded out-of-hours services where you sit from 11 pm to 3 am in a darkened hospital waiting to see an exhausted junior doctor?

That’s where Labour’s attention should be focused: on doing what it can to ensure the government provides an effective NHS service outside “normal working hours”, and exposing the Tories’ almost-inevitable failure to do so. A campaign to “Save NHS Direct” is unlikely, in itself, to achieve either of those aims.

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3 thoughts on “Save NHS Direct?”

  1. “Save NHS Direct” expresses the issue in essentially institutional terms: “The service currently known as NHS Direct must remain in largely its current form”

    I agree. And now, how about ‘Save the NHS’? That refrain, surely, is defending an institution every bit as much, rather than asking how the delivery of free-at-the-point-of-use healthcare can be maintained and reformed for the twenty-first century.

  2. Phil: the difference there is that the NHS is as much an idea as it is an institution (think how many administrative upheavals it has had since 1948). To dismantle the NHS isn’t to find an alternative way of delivering healthcare that is free for all at the point of use: in practice it’s a way of finding an alternative /to/ a universal FATPOU(!) service. (Co-payment, “safety net”, etc.)

    Quite apart from that general point, Andrew Lansley’s specific proposals do not inspire confidence: destroying the NHS as a single organisation, removing its massive bargaining power when dealing with pharmaceutical companies and other suppliers (to which I can testify from firsthand experience of advising NHS suppliers), handing over procurement (in effect) to private sector companies who will step in to help the new GP commissioning groups…

  3. As a cancer patient, who has found that UK medical care is woefully bad for this disease, I have learnt to use NHS Direct.
    When it first started it wasn’t good – too many errors etc. However, it is now finding its feet, but it has taken several years.
    So now we are going to have another service, but this time ‘manned’ by staff who are basically call centre people. With the current service, those of us who use it have learnt to recognise if the person who calls us back is an SRN – and if they aren’t one makes an excuse, and hangs up.
    But I would say that 80-90% who have called me back, when I have asked a clear question, have given me excellent advice.
    So – having got NHS Direct staff trained and working efficiently, Andrew Lansley is going to close this down, and start up with a new service. And knowing what so many NHS start-ups are like, I am deeply suspicious.
    1. How much is it going to cost in redundancy pay for current staff?
    2. A spokesman’ tells us it will be easier to remember the new number. Hasn’t anyone explained that telephone companies can now divert calls to any number?
    3. We are told the staff will now be able to call an ambulance directly; didn’t anyone think that it would be easy to get NHS Direct staff to do this?
    4. But what is most worrying aspect is that we are told the staff ‘will receive 60 hours training’. Does this mean that 1-1-1 will use nurses, or are we going to have untrained call centre ‘operatives’? If so, I don’t want to trust them and their limited knowledge, or give out intimate details.
    If anyone reassure me that I don’t know of what I am talking – please send me a comment under my story on http://www.after-cancer.com.

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