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.