Within milliseconds of the Coalition announcement of the plan to replace NHS Direct with a new non-emergency NHS service, Labour politicians were up in arms.
Because this plan from the Coalition obviously bears absolutely no relation to Labour’s plan, as spelt out on page 35 of the party’s 2010 manifesto.
A new national 111 telephone number will make nonemergency services far easier for people to access and book.
This, we need to understand, is totally different to replacing NHS Direct. What Labour had in mind, as they planned their £44 billion savings, must have been to keep NHS Direct just as it is now, but confuse the hell out of everyone by adding another totally different non-emergency medical service.
Labour’s idea was, apparently, to have both running side by side, and then let us all guess which one we should call when we, or a loved one, is in need of medical attention but probably not an ambulance.
It might seem from this that Labour are being just a little hypocritical in attacking the plans, but I’m not so sure.
Recent research (reported by Paul Goodman on ConHome) suggests that we – humans, that is – can change our entire attitude to a policy based on where we think it came from.
when the subjects were told that the plan they didn’t like had been proposed by their own party, their attitudes changed and they favored the plan they had initially opposed. Liberals thought that cracking down on welfare was a good idea, while conservatives found they could justify opening the coffers for this important social purpose. They even wrote essays explaining why the policy they now favored was appropriate.
This would seem to be a textbook example, and of course it’s no respector of political affiliation. Everyone experiences it to some extent. (Though most Labour people who attacked the plan wouldn’t have realised it was in their own manifesto – it’s a little harder to explain away the opposition of people who had noticed that detail).
The impression given by the study write-up that we simply support anything that comes from our own party is a little wide of the mark, though. It would be fairer to say that we’re predisposed to support measures that come from our own party, and to oppose those from others.
In other words, when the Lib Dems propose something, I may not end up supporting it, but I’ll be likely to give it a fair hearing and look positively at it; whereas if the same proposal comes from Labour I’ll be more likely to be suspicious and think it’s a poor idea unless I’ve a good reason not to.
One interesting aspect of this is Lib Dem views of Conservative proposals (and vice versa) now we’re in coalition – which would be a nice one to study.
My hunch is that each side are far from automatically trusting of the other’s proposals, but are now more likely to give them a fair hearing than before the election.
When I first heard the NHS Direct/111 issue I didn’t know whether it had originated from the Lib Dems, the Conservatives or as a joint agreement. I didn’t know whether it was “my side” that had proposed it or not.
My initial reaction to whether it was a good idea? I didn’t know (and still don’t). My personal experiences of NHS Direct over the last few years have all been less than great. We phone up, go through a long list of questions, sometimes wait a couple of hours for someone to phone us back, and then – in every case – get told to go to A&E or the out of hours doctor anyway.
That’s just my experience, but from the initial comments I saw flying past on Twitter it seemed far from uncommon (though there were also some people saying NHS Direct had been very helpful).
So I had no problem with at least looking at the possibility of offering a more comprehensive service for less money, nor did I think freeing up nurses to work elsewhere (given that we have a shortage of nurses in this country) was necessarily a poor idea – I certainly never felt the benefit of a fully trained nurse on the phone.
I hope that the final decision will be made, after the evidence from the pilot studies has been gathered, on the benefits of each and how well they work. The knee-jerk oppose-first-and-think-later approach from Labour may be perfectly understandable in psychological terms, but isn’t the best way to get good policy.
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19 Comments
Do we want call handlers or fully trained medical people on the other end of the phone? Thats the issue. And I dont think 60 hours of training is enough to replace a nurses qualifications and experience.
I think with Lib Dem and Tory ideas we are reaching a crossroads. Some have started giving them a fairer hearing because they are ‘from the same side’ and have some have started giving them a less fair hearing because they are those evil left wing lib dems / right wing tories who are evil and are undermining the purity of our party, which we love so much, regardless of the actual content of the ideas involved.
Dave – the answer to that question is important, but it depends on the outcomes. Right now as I understand it about 60% of call handlers on NHS Direct are trained nurses and 40% aren’t. If the number of trained nurses were to be reduced, would the outcomes be worse? If my experience is typical, the answer may well be “no”.
I’m also undecided, to be honest. I think Labour’s too readily trying to turn every cut into a “Save Our ….” campaign, and that they’re losing their impact through saturation. We need a leader in place that knows how to pick our battles.
And just because Labour wanted a 111 non-emergency number doesn’t mean it would be constructed the same as the coalition’s proposal. The opposition doesn’t come from the “111″ bit, rather the fear that having a less effective service would put more pressure on GPs. It’s one of those where it may be cheaper in the medium/long-term to put a bit of money into measures like NHS-Direct than to let issues wait until they can’t be avoided.
Mike – that’s a very fair point and, personally, I don’t know the answer and I’m hoping the pilot studies will give us an indication.
The problem with this analysis is that there has been no attempt to widely consult, or evaluate options in Lansley’s plans for the NHS in his White Paper, and announcing the scrapping of a service before a pilot is completed tends to suggest that the pilot is just a paper exercise anyway.
The difference between LD and Lab policy here is pretty non-consequential unless you regard the change in qualified nurses at the other end of the phone to be of huge significance. For the record I don’t.
Lord Prescott seems to want to be the `dog that barks` at the moment – `ooh, a `stranger` went by who happens to be the neighbours sister coming down the road for the first time` – got to do my job and bark. In a dog it’s reassuring – in JP just irritating.
Anecdotal evidence aside, independent research conducted in 2008 found that 73% of callers to NHS Direct would have simply visited their GP or A&E had they not had access to the service. Of all callers, around 39% were in fact referred to their GP or A&E. This means that around 1.7 million visits to GPs and A&E units were avoided thanks to NHS Direct in 2008. Not a bad return if you ask me.
Moreover, 41% of callers (i.e. over two million of them) were advised to treat themselves at home. Contrary to some of the ignorant comments above, nurses are highly trained professionals and you are *not* going to get anything like the same results from call centre operatives with a few hours training under their belts.
This move will inevitably increase the workload of GPs – at a time, let’s not forget, when GPs are also being expected to take over the work of local NHS managers.
GPs working as managers, call centre flunkies working as Google-powered medical advisers, and nurses presumably flung on the dole. These are bad proposals and Lib Dems ought to disown them.
@ Stuart
But on the reported figures 40% of those callers would have been dealt with by non-nursing qualified staff. There’s no evidence that this has presented any problems to date
It’s important to realise that what NHS Direct is providing is not treatment but is a very broad initial assessment of the patient with (presumably) a very large discretion towards A&E referral. Probably signficant numbers of those cases could be referred to A&E on a common-sense basis (eg any pain that has persisted for several hours/not responded to self-medication). A lot will be people who would have self-presented to A&E but wanted a reassurance that it was the “right” thing to do first.
The key to how the system operates is how more complex/less easy to recognise cases
Two items of well informed comment from ’E-Health Insider Primary Care ’ [a free e-newsletter]:
‘Row brews over end of NHS Direct’ http://www.ehiprimarycare.com/news/6197/row_brews_over_end_of_nhs_direct
and
‘NHS Direct – number not service to go’ http://www.ehiprimarycare.com/news/6199/nhs_direct_-_number_not_service_to_go :
‘ . . The real issue is the utterly inept way that the anouncement has been handled. Almost as if it were designed to cause concern and ill-will amongst NHSD staff. Lansley’s administration appear to be running down their stocks of good will at an alarming rate.’
This should concern us politicos much more than the pros and cons of the decision.
The ‘knee-jerk reaction’ thing sadly seems to be true for many people, right and left. Any idea the government has is instantly branded “an attack on the most vulnerable.” Me, I look at any idea on its merits, whoever’s proposed it.
If Labour attack everything, with no positives, it won’t do them any favours with the public, who don’t like negative campaigning.
>Moreover, 41% of callers (i.e. over two million of them) were advised to treat themselves at home.
This topic is becoming old ground!
But I’m beginning to think the best way to save the NHS billions and give doctors time to treat people who are actually ill would be for the government to buy every household a basic Family Health Guide.
One of those flow chart ones you can get in cheap bookshops: do you have a headache? yes/no. Do you have a temperature? yes/no. Have you injured your head recently? etc.
After all, that’s pretty much all the nurses are doing: if you can’t see the patient, all you can do is work through a check list to ‘diagnose’ them over the phone.
But when people dial 999 to report they’ve been delivered a pizza without onions, or they’ve been splashed by puddles, perhaps it’s too much to hope they won’t still turn up at A&E with a bruise or indigestion.
But what are you going to do with the 1,000 registered nurses at NHS Direct
sack them ??? before, during or after the pilot
either way they have a right to know
@Cassie: That service exists, its pretty good and probably costs a lot less than the NHS Direct line. It’s the NHS Direct website, and as far as I know isn’t being cut. If it’s not, I’d prefer to see the 111 service re-branded NHS Direct so there’s no confusion between the services on offer.
Mike, novel idea – give them nursing jobs? We can always balance the books by offloading a few central bureaucracy managers?
many nurses at NHS Direct
1) live in rural areas (some from home)
2) have a disability (ie back injury after lifting, MS etc
most would not be able to secure posts in a hospital because of distance
anyway, most hospitals now have a freeze on nursing post recruitment
so we still end up with 1,000 nurses on the dole
unless the Coalition looks at how it merges NHSdirect and 111
But will Mr Burstow step in to sought this out
Mike(The Labour one)
“I’m also undecided, to be honest. I think Labour’s too readily trying to turn every cut into a “Save Our ….” campaign, and that they’re losing their impact through saturation. We need a leader in place that knows how to pick our battles.”
Good for you. Completely agree. I think it would be good for the country to have an opposition that targetted the weaker coalition policies, rather than all of them.
It would mean you’d be more formidable opponents for us, but better opposition means a better government.
Iain
You have like many fell into the trap of saying this idea will free up Nurses to work in Hospitals to help with the massive shortage of highly trained Nursing staff. On the face of it it sound and looks good but just where are the extra Nursing jobs coming from. Nurse are being sacked up and down the county. Take a look at the RCN website , my own wife (a nurse and RCN steward) is in weekly meeting with her trust over job losses.
Also a number of NHSD Nurses cannot work in many traditional Nursing roles as they have become disabled by injury or illness.
60 hours training is not enough fair more people who contact NHSD are stopped from going to A and E or GP than are sent to them so something is working. The Quality Care Commission are happy with the current set up.
I am just Glad that my wife no longer works as a Practice Nurse as it will be them that will have to manage the 1000′s more that will be knocking on the door who need not do so. God help the many hard working under paid Practice Nurses they will need it.
Tom – fair point. Even though NHS spending is protected, increased non-staff costs (e.g. drugs, expensive equipment, buildings) means a squeeze on staff spending. I’m not suggesting that there are lots of vacant posts for nurses to simply walk into right at this minute.
Here is a petition to support the NHS Direct health advice phone line. It is quick, easy and good to sign and don’t forget to tell your friends and relatives about it.
http://www.gopetition.com/petitions/save-nhs-direct.html
And by the way, here is the man behind the scrapping of this reassuring service.
http://www.telegraph.co.uk/news/newstopics/mps-expenses/5305406/Andrew-Lansley-sold-home-after-expenses-renovations.html
http://www.telegraph.co.uk/news/newstopics/mps-expenses/6989408/Andrew-Lansley-bankrolled-by-private-healthcare-provider.html