The BBC reports:
The government has confirmed it is planning to scrap the NHS Direct telephone service in England and replace it with a cheaper option. A new 111 helpline is already being piloted in the North East. It was previously reported that the new service may replace NHS Direct, but now the Department of Health has confirmed it will definitely do so. The move comes as the government curtails public spending, even though it has promised to protect the NHS.
NHS Direct is currently used by 27,000 people a day, and provides expert health advice and information to callers, as well as out-of-hours support for GPs and dental services, telephone support for patients with long-term conditions, and pre- and post-operative support for patients. 111 – which provides health advice and information about out-of-hours GPs, walk-in centres, emergency dentists and 24-hour chemist – will offers many of the services, but not all.
My Voice colleague, Sara Bedford, writing on her own blog, is supportive of the move, noting that with 111:
Some of the nurses would be replaced by operators who have the same emergency diagnostic training as that given to 999 operators. That’s right: the person answering your non-emergency call will be as well trained as the person answering your emergency call. Seems like a pretty good deal to me.
She goes on to note that doctors themselves are far from satisfied with the value that NHS Direct is delivering:
Earlier this year, well before the election, a survey of 900 GPs by the magazine Pulse found that a majority thought that NHS Direct should have its funding cut. In June, representatives of family doctors said that the new government should consider scrapping NHS Direct as a way of reducing costs in the health service.
But there’s no doubt that this is a controversial move, and one which Labour is already attacking head-on with shadow health secretary Andy Burnham citing it as evidence that the Coalition is on “a vindictive mission to break up the NHS”.
What do Voice readers think? Here’s the question:
But feel free to express your more considered working in the comments below…
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46 Comments
No! Bloody disgrace! This is a jewel in the crown; I know people whose lives have been saved by contacting NHS Direct.
What are all these nurses doing answering the phone – shouldn’t they be err…………. nursing
NO!
NHS direct *saves money* and time by freeing up A&E space and streamlining NHS capacity.
The cut is ideological, no surprises there! Much like the Audit Commision, will cost the state more than it saves but will open up room for private sector to move into.
LibDems doing themselves no good coming out of the closet of political wilderness to be open, unrepentant Tories.
Yes – If you have that big a problem ring 999, if it isn’t an emergency you can call 111, use the internet, or go to your GP.
NO – stop the 111 plans….
Yes. It has been worse than hopeless, given out wrong or bad or simply useless advice, and its inadequacies were shown up once and for all during the swine flu so-called epidemic.
No ! Simple as.
Yes – each call to NHS Direct costs £16. A trip to your GP costs £20 (according the BMA). As a third of NHS Direct callers get sent to their GP, the real cost is therefore an average of £23 per call – cheaper to have everyone go to their GP in the first place (and few misdiagnoses). When the ridiculously generous GP contract has been renegotiated, the cost of a GP visit should fall too.
I’d say No. I’ve found the service extremely useful myself, and they also successfully cleared up an issue that scared my wife a great deal. I thought NHS funding was to be maintained? And surely this service stops a whole lot of people turning up at A&E who don’t need to?
That being said, it sounds as if we don’t need both NHS Direct and 111. Comparing the services offered, it would appear that what we need is NHS Direct plus the additional services 111 offers, and the use of the 111 number for the combined service. In other words, if you need to save money, roll the two services into one by all means but use NHS Direct as the fundamental service, adding on additional necessary services currently offered only by 111, if any.
No
NHS Direct get a lot of calls because you cant get a GP or a local practice nurse on the phone any more – you get an answering machine that redirects you to phone NHS Direct who take your details and then pass on your number to a local person who phones you back and checks your details… its a big circle, a waste of time and money, and having to spell out your personal issues over the telephone to someone you dont know, then do it again when the next person calls you back, can be excruciating.
How many people *dont* use NHS DIrect because they are uncomfortable with that whole deal, is what Id like to know.
They should just make it so when you dial 111 it automatically redirects to an on call/out of hours nurse in your area, with towns/cities/etc employing as many of those as needed. All this centralised over the phone stuff is rubbish, give us access to staff in the area we live in, and stop all this “tell an unknown third party all of your most personal details over the phone” business.
NO It doesn’t much matter what things are called. But NHS Direct as is accessed via 111 instead of it’s ? 8-digit including code is cool.
Contracts on NHS Walk Ins and the like (the privatised elements already introduced) are £30 not £20 a throw. Many of the users could’ve been dealt with by NHS Direct, 2/3 without a GP visit if Matt’s figures are correct.
Also notable that Matt isn’t quantifying the costs of the visits to A&R that are avoided by NHS Direct. And Matt also does not attempt to evaluate the cost of the replacement 111 service which will presumably also send people to GPs and which will probably have a rather similar cost base.
Expert call centre staff and qualified but low in the scale nurses costing rather similar amounts and the overheads being exactly the same for the space, desk, PC, line and management. Assuming the service isn’t rationed by cutting capacity and loads of recorded advice trees and the like.
This change *could* drive up queues in A&Rs, increase pressure on GP out of hours, same day, 48 hour etc, *and* therefore cause/permit GPs to play hardball on new contracts.
Clearly it possible to argue both sides. I could argue the other way. Might not be very convincing mind.
Can I suggest that Lib Dems evaluating this proposal imagine for a moment that they are still the third party and that they are in opposition alongside Labour to a Tory government, instead of propping one up for very little reward.
Wouldn’t it then be a no brainer? Would not most of you then be opposed to Tory slashing?
NHS Direct has been a very expensive way of redirecting people to other services or NHS re-direct as some Emergency Department Staff call it.
Emergency 999 call handlers are quite capable of handling and catagorizing your emergency call. NHS direct seem to err on the side of caution anyway and still send inappropriate cases to A&E.
NHS direct is a relatively new part of the NHS that has been expensive and unnecessary. It should not be seen as and attack on our core wonderful NHS but trimming of the fat that has become the bloated NHS.
If this place was staff with a bunch of Band 6 & 7 admin managers instead of wasted Band 6 & 7 nurses would people be so up in arms.
We have been in power for 3 months, theres another 5 years to go. We need to stop obsessing about every tiny detail & concentrate on the big picture. Compared to the scale of cuts we will be making this is microscopic. Lets move on.
Craig: “No! Bloody disgrace! This is a jewel in the crown; I know people whose lives have been saved by contacting NHS Direct.”
But lives can still be saved by a less expensive service on 111. They’ve got three years to makethe transition, so this is not an abrupt overnight change.
Indeed, the idea of an easily memorable non-emergency is an excellent one.
My mother in law works for NHS direct and disregarding her specific complaints about it, it does seem to be a useful service to an awful lot of clueless people who come through in droves. Stories range from “my son has fallen over bit not scratched himself, should I call an ambulance?” to “I’ve just fallen over and can’t get up, I can’t move my left side, I have a pain in my chest and my face has gone all funny. Should I make an appointment with my GP?”
Both cases are valuable. In the latter, an ambulance is on its way before the call ends. In the former, A and E doctor’s time is saved. Those with common sense and basic first aid knowledge don’t need it but not everyone has this knowledge.
I joke with my mother in law saying NHS direct only has 5 outcomes and that a much simpler system will do. If the new system maintains all the good points but trims away the fat, then all well and good. The following list of outcomes should also include the many referrals to The Samaritans but seriousness aside, this is what happens:
1) Don’t be so soft
2) go to a pharmacist
3) make an appointment with your GP
4) go to A and E
5) phone an undertaker and cancel the milk.
The problem with direct democracy is that only the wise realise they don’t know what they’re talking about and keep their mouths shut.
Yes – a reasoned look at the facts and all the examples of NHS Direct help that people have put forward shows that NHS 111 would offer exactly the same level of advice, but without wasting nurses’ time on unimportant calls. The only downside being that it might take a bit longer to speak to a nurse if that is deemed necessary. So basically the same service, miles cheaper. Wish people would actually consider what’s being proposed before going crazy about more “coalition cuts”… http://prologue.squarespace.com/prologue/2010/8/27/nhs-direct-another-victim-of-the-silly-season.html
The 111 number was in the Labour Party Manifesto this year.
No. No. Find NHS Direct far more valuable than my GP Practice which is BTW largely staffed by nurses. GP appointments never given.My son had pleurisy. It was picked up by NHS direct and missed by the out of ours GP service. The proposed abolition of this frontline service is a disgrace. What else lies in store for our NHS.
If you phone NHS Direct you will be screened by a call centre person, and if you require clinical help to speak to a nurse or a doctor.
The 111 will be almost entirely call centre staff reading off automated screens. (Anyone who called the Swine Flu line will know the frustrations this approach leads to). It will not be fit for purpose.
And of course, it will lead to more pressure on A&E and GPs – both of which carry considerably more cost than a nurse-led helpline.
Announced on a bank holiday weekend too – hoping the flak will be minimal. This is a cut to a frontline NHS service – a breach of those Dave election posters.
Do the Liberals no longer care about the NHS? Why are you allowing the Tories to get away with it?
We should at least have waited until the pilot project is completed. This is appalling.
Amazing the number of Labour people on twitter who don’t seem to realise that NHS 111 was an idea that the Dept of Health came up with last year. (Presumably when Andy Burnham was Health Secretary)
Well, here’s a little reminder for the likes of Champagne Socialist Prescott – http://www.smarthealthcare.com/111-pilot-09jul09?CMP=twt_gu
The issue is closing NHS DIrect – not introducing 111, which in the Labour manifesto was to be for arranging Choose & Book and non-emergency appointments at primary & secondary care.
Having had a newborn who contracted meningitis I am very much aware of how something apparently quite trivial in a very young child can rapidly develop into something life threatening. My experience of NHS Direct is that it is very helpful with advice about baby and toddler health when the child is too young to explain its own symptoms (and the health visitors’ office is on answerphone – which round here is most of the time!)
Perhaps some GPs don’t like NHS Direct because it empowers patients. When my grandmother’s GP completed messed up her medication for Parkinson’s Disease I contacted NHS Direct and the nurse who advised me gave me lots of helpful information.
Can’t say one way or another on this one. Doctor’s seem to think it’s a waste of funding, but as they’re competing for the same funding I might take that with a pinch of salt, and unlike what seems to be nearly everyone else in the country I don’t have much faith in Doctor’s management abilities, as compared to for instance an actual manager. Every call to Direct saves something like 25% over the equivalent GP visit, and at 10 million calls a year that is quite a saving.
On the other hand, like PCSO’s it seems the service costs almost as much as the service that you will inevitably end up using anyway, and it seems like a great majority of the calls could have saved everyone the bother by looking it up on the internet. The website doesn’t seem to be being cut away and the 111 number can probably tell you just as easily to book an appointment with the GP or call the ambulance for you if you are having shortness of breath and chest pains, and it would put more nurses back in patient care, doing the job they wanted and are trained to do. I also don’t personally think NHS spending should be ringfenced if cuts are happening, or the burden will then fall disproportionately on other services, and there are a bunch of bloated areas and dead end projects where money could be saved.
So, more data please, and then I’ll take a full position, but for now it must be “don’t know”.
@Thomas:
“it would put more nurses back in patient care, doing the job they wanted and are trained to do”
This is patient care! In fact acute hospitals and GPs are moving towards telephone appointments – precisely because they are more cost effective in many instances. Scrapping NHS Direct and replacing it with a call centre with no clinical input is ludicrous.
BTW the online reaction to this is massive – will Call Me Dave make his people do another U-Turn like he did with the milk episode? If he does, will it prove he has more progressive principles than the entire Lib Dem rank and file?
Of course, if we were to stick with our promise to cut back and slow down plans to replace Trident nuclear weapons, there might be more money available to spend on NHS Direct ….
Presumably the examples of specific conditions being diagnosied here were actually done by a docotor after NHS direct said ‘go and see one’ – not just by a nurse over the phone? How will the new 111 service?
Yes, it is a good idea as long as care is taken to determine how many trained nurses are actually needed per number of phones to maintain levels of service. The new number is also obviously an improvement.
Just to add my statistically meaningless anecdotal evidence the few times I’ve rung NHS direct they’ve been absolutely useless and usually just wasted my time for a bit and then told me to book an appointment with a GP or go to A&E. I’ve got the distinct impression each time of people just covering their asses and trying to unload me by just telling me to go to a doctor or hospital, something I could have guessed on my own.
@Paul B:
It’s call centre work using a fraction of their training and ability, and could be done by someone with a fraction of the training and ability. Anyone they believe might be at actual health risk will be directed to come and physically see a nurse or doctor, so why can’t this be achieved with a check list of warning signs in the same way that the website is run? And if the point of the NHS Direct exercise is to save money, it doesn’t seem to be working, as a call costs nearly as much as a GP visit, and maybe even more if some sources are fully accurate.
I worked for NHS Direct for many years from its inception and it became a dysfunctional monstrosity, run by people who did not have the necessary clinical know-how. The waste was palpable and yet they worked the nurses and call handlers like pack animals. It was well paid compared to other options in nursing but very hard and unsatisfying work. Everyone is alarmed at the levels of training the 111 staff will have but I can tell you that many of the nurses did not have much training compared to the range of problems that callers have. Anybody with a brain and the internet can now work out for themselves what to do with a minor ailment whereas the plethora of urgent care options was as much of a bafflment to NHS Direct nurses as it was to the public. I hope 111 can help people to be clear about that.
I am inclined to support the empirical workface views expresed by the majority of GP`s who want the NHS Direct in present format scapped.This will undoubtedly release more trained nurses to care for their patients in clinical situations in community and hospitals.
It is essential to note the actual work time evidence of Lol Lossip who clearly knows how the NHS Direct has malfunctioned and has outlined its shortcomings in line with GP findings.
Prospective patients using NHS first base contact require precise and helpful and concerned communication but this is not dependent on trained nursing staff but a competent answering service.
One problem encountered by NHS first contact is that people still vist A and E for minor ailments that overloads and puts additional pressure on front line health human resources.
The L/D Manifesto contained a pledge to cut unnecessary wastage in the NHS.
Labour has demonstrated over 13 years to have been the most wasteful form of Government and that includes the mis-and over management of the NHS.
YES – This is a lot of fuss about nothing. Andy Burnham looked a proper wally defending NHS direct last night. My friends in the NHS tell me that it costs £25 a call and that the new pilot service will call £15 a call and provide a more joined up service through an easier to remember number. That seems rather sensible to me. Interestingly, my area the North East (which has some of the highest levels of ill health) had a particularly low level of NHS direct take up and it was higher in more affluent areas. Seems like it was another well intentioned policies to help people that got taken up by the middle classes. Hopefully the new 111 number will be more inclusive. If not, at least it will be cheaper!
Glad the Lib dems are defending the scrappage of the NHS Direct. When people start heading back to the doctor’s and a&e, which will cost far more then £132 million year, I am sure Lib dems will be changing their tune.
It seems people want the NHS to be like the one in the eighties and nineties, underfunded and market orienated.
No one can be diagnosed for sure over the phone. And no one can be treated at all.
So surely, it’s just a triage service?
And the advice is always going to be see a GP/ go to a pharmacy,/ go to A&E or dial 999.
No wish to undervalue the skills of the professionals, but I could probably tell you that, in many instances, based on a (Saturday/vacation) job in a pharmacy for a few years (as a sixth former/student).
If it stops people wasting time at A&E depts, that’s good. But how many people are even aware NHS Direct exists?
matthew fox:
“It seems people want the NHS to be like the one in the eighties and nineties, underfunded and market orienated.”
This is a daft statement. Some people want the NHS to be market oriented – that would mean it would be better funded. The NHS in the 80s/90s has been neither market oriented nor underfunded. The NHS has always been a fabian style government institution and despite record high funding is worse value than ever.
“We will cut the cost of NHS administration by a third and transfer resources to support doctors and nurses on the front line.” Page 24 of the Liberal Democrat and Conservative Coalition Agreement. Crown Copyright. May 2010
I always thought NHS Direct was the front line. Now it appears it is going to be scrapped. Another commitment not worth the paper it was written on!
There’s no doubt NHS DIrect has had problems – try driving 30 miles and then sitting outside a CLOSED dentist on NHS D’s advice when you need emergency treatment. If NHSD were kept it should be sorted out. Personally, I’ve not used it since the Dentist incident, so with regret and on the basis of no other facts – YES
Matthew: “…NHS 111 would offer exactly the same level of advice, but without wasting nurses’ time on unimportant calls.”
You (and others here) make it sound like the nurses who work for NHS Direct would be redeployed on wards or something.
You don’t think it’s more likely they’ll simply be thrown on the dole?
Non-medically-trained phone operators dishing out medical advice, and trained doctors replacing NHS managers – it’s crazy.
At the risk of sounding stupid, can anyone explain how we arrived at the point of needing this service? It wasn’t so many decades ago that everyone had a family doctor (one person) who knew you personally and therefore your medical history, and very often that of your complete family. In a serious situation you would phone him (or her) day or night and he would come out to see you, but because you had a personal relationship with the doctor most people would not call at unsocial hours for trivial reasons. Have we become more ill? Are we greater hypochondriacs? Are there fewer GPs per head of population? Do GPs work dramatically fewer hours than they used to? Has the job description of a GP changed so that they don’t deal with (mostly) trivial complaints? Has the NHS accreted unnecessary layers of complexity over the years? If it has, and I’m not expressing an opinion, then maybe stripping some of them out and getting back to a simpler way of operating might be sensible, even if this could be portrayed as cutting the service.
I am slightly appalled by the comments from some apparent Liberal Democrats here who are sounding like flint-boned Tories. The announcement to scrap NHS Direct appears to be another bad decision by an out-of-control Tory Minister – certainly not in the coalition agreement but how much of what they are doing is?
Many people here may not be aware that it’s now impossible for most people to get a doctor’s visit outside 9 to 5 hours (and hard in that time). You can go and sit in surgeries for hours waiting for an emergency slot – just the job with a poorly child for instance. Or you can go to A & E (oh yes? – how many tens of miles away and no public transport?) Call an ambulance? For a sore throat?
NHS Direct is not perfect but it has been a success and a real boon for many people. Think of all the people who are not even registered with doctors. I suspect that it’s real benefit is for the 10-20% of people at the bottom of the heap – the POOR – and that this is another Tory Cut that will do more harm to those people.
And yes, anecdotally, it’s been of real help and use for a lot of people I know. But many of them are the kind of people that this government does not, sadly, seem to care much about.
Tony Greaves
As for the comment that the change is a good idea because the nrew number will be easier to remember – of that’s the level of debate we are getting, god help us all.
Well here we go again. Never mind the quality just call in Capita,
give the contract staff a script and leave them to get on with it.
Result-a new service available at the swipe of your plastic.
Was this another idea the Tories forgot to mention or part of the
small print of the coalition agreement? No don’t tell me it was our
idea all along damnit!
>Call an ambulance? For a sore throat?
No. Gargle with Disprin, or salt water, or go to the chemist’s and buy some pastilles. And get a sense of perspective. How is a sore throat ever going to be a medical emergency – unless you’ve swallowed a razor blade or something?
Even if it’s glandular fever, there’s no cure as such. And if there was, they couldn’t dispense it over a phone.
>You can go and sit in surgeries for hours waiting for an emergency slot – just the job with a poorly child for instance.
Tell me how a phone line cures a sick child?
If the child needs treatment, the phone person will tell you to get down to the surgery anyway. Or to go to the pharmacy to buy something to help. The phone service can’t send you Calpol or anything else you don’t already have, so you’ll have to go out if you need it.
It’s not like the service is going to be scrapped – are the 900 GPs who thought it was poor value all evil haters of the poor and disadvantaged?
If the NHS budget truly is ringfenced, then the money saved by this will go elsewhere, hopefully to somewhere it’s really needed. Cutting waiting times in surgeries or extending out-of-hours walk-in clinics would be good.
After all, surely the problem historically is that GPs were given loads of money a few years ago – and in many cases, responded by upping their own wages and cutting their hours?
Surgery I go to has nurse clinics (to free doctors from wasting their time on minor treatments) and a walk-in emergency clinic during surgery hours. Never any problem getting an appointment any more. Seems a good pattern to follow and a good use of funds.
just pitch up at A&E or wait days for GP to answer the phone