Sarah Boseley on NHS Direct

This is NHS Direct. Name please." "Oh, hello. I wondered if you could just tell me . . ."


". . . what I should do because my child is in real pain . . ."

"Phone number?"

". . . with her ears. I've given her the maximum amount of paracetamol it says on the bottle . . ."

"GP's name?"

". . . but it hasn't helped and all I want to know is . . ."


". . . can I give her any more?"

"A nurse will ring you back in half an hour to an hour's time."

"But she's crying and crying and it's the middle of the night and I want to know what to do RIGHT NOW."

"She'll ring you back."

The government tells us that 97% of patients have been at least satisfied with their experience of NHS Direct, the telephone helpline set up to give us rapid access to the advice of a nurse. That leaves me in a minority of 3%, and I don't believe that. It makes me wonder who they have asked and how they phrased the question.

The 97% figure has been trotted out ever since the first pilot schemes were assessed, and it was trotted out again recently as we were asked to celebrate the extension of NHS Direct to the whole of England. Call me a sceptic, but when does the British public ever give any institution a consistently sky-high confidence rating like that?

As it happens, I'm four-square behind the principle of NHS Direct. Busy people - and anyone with children is a busy person - like nothing better than to pick up a phone and get some help. Few of us want to bundle a sick child up and drive to accident and emergency. Most of us, although I hear the scornful laughs of doctors already, do not want to call out a GP except for something really serious.

This was not a casualty scenario. I am well familiar with the waiting rooms of ear, nose and throat clinics. We have been down the grommet road. I can talk glue ear with anybody. All I wanted to know was what I could do for the pain my hysterical child was suffering, but on the end of the line was what NHS Direct likes to term "a highly trained call handler" who has a script in front of her, just as she would have if she was taking calls to a mail-order catalogue. I told her half an hour to an hour was no good to me - it would be over one way or the other by then. I was right. The eardrum burst and the pain stopped. Thanks a million for the support, NHS Direct.

Maybe I was unlucky to get an automaton on the end of the phone that night who could have been asking me which size and colour jacket I wanted, for all the sympathy in her voice. I am sure that the nurse would eventually have rung me back and given me impeccable advice, albeit too late. But it seems to me that NHS Direct is failing to fulfil a real need if it cannot offer patients immediate and genuine comfort and support.

We are all increasingly healthy. Most of the problems we are taking to our doctors these days are not life-threatening, and many are not all that serious. Doctors complain about being besieged by the "worried well". These are the patients they and the government hope will be offloaded to NHS Direct. Much of the time they don't need medicine or surgery. They may need to be told to go to bed and get better by themselves. That is the role anticipated by government for NHS Direct.

But many may need reassurance. Christopher Bulstrode, director of education at the Royal College of Surgeons in Edinburgh, notes a 7% rise in the numbers turning up in accident and emergency departments in spite of our improving health. He blames it on a sort of hypochondria. The public loves to read about medical conditions in magazines and newspapers, he says. But the more people read, the more convinced they become that they have the diseases they learn about.

He does not think NHS Direct is the answer - diagnosis on the phone is too difficult, he says. And unless they get rid of the robots who protect the caring nurses from the potentially frantic public, I don't think it is either.

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