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30 August 2010

Hands off NHS Direct!

Scrapping the call-in health service will not help build a “big society”, still less a “modern solid

By Sholto Byrnes

The Health Secretary, Andrew Lansley, has indicated that the government is to scrap the NHS Direct phone line, which receives 27,000 calls a day. It will be replaced by a “111” service, the difference being that whereas 40 per cent of NHS Direct staff are trained nurses, the new line’s operators will be “call advisers” who have undergone 60 hours of training.

NHS Direct costs £123m a year. Money better spent in a time of belt-tightening, some may say, by transferring it, as the coalition’s Programme for Government puts it, “to support doctors and nurses on the front line”. And isn’t 60 hours quite a lot of training?

Well, I recently spent two and a half days — around 20 hours in total — on a National Childbirth Trust course. While it was certainly very useful, I would hardly say it provided sufficient expertise for me to qualify as a “call adviser” on a baby delivery phone line. But multiply that by three and you have the total training time these advisers will receive. It’s not a terribly comforting thought.

The move also makes no sense. The point of NHS Direct was that it could provide worried members of the public with authoritative answers. Whom do you trust on health advice? The internet is awash with sites on ailments, but type in one symptom and all sorts of different diagnoses come up, frequently alarming in their extremity; the internet is never knowingly understated. GPs are not open all hours, while a trip to A&E — as I found in the days before I registered with a local doctor — can involve waiting for five or six hours.

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That 12 per cent of callers to NHS Direct are sent to A&E or provided with an ambulance and 22 per cent referred to their GP is a sign not of the line’s failure, but its good practice. When nurses feel they can provide all the help necessary to the callers, they do so; when they are unsure, or think the problem requires greater expertise, they urge callers to take the next step. Precisely how you would want the line to operate.

Talking to someone with such little instruction as the new alternative promises could be worse than useless. When it comes to matters of health, “a little learning is a dangerous thing” indeed.

The old solidarity dies

There’s another point here. While David Cameron talks of a “big society”, Ed Miliband recently put it more strongly: “What we have to search for as a country is a sort of modern form of solidarity.” I agree, although some of us were always quite keen on the old variety, of which the NHS was the greatest emblem. It does not have to be repeated how this sort of solidarity was undermined not only by the public actions of New Labour ministers — tuition fees, etc — but also by their private choice: sending their children to schools with selective intakes, for instance.

But there are also those on the left who, while mourning the diminishment of the old solidarity, suggest that its time may have passed or that it’s a luxury we can no longer afford — and the benefits it entailed favoured the wealthy middle classes disproportionately, anyway. The NS‘s own Peter Wilby has often taken this line, writing in the Guardian this March that “it’s hard to justify the range of allowances to which retired bankers as well as retired roadsweepers are entitled”.

As ever, Peter makes a fair point. But once more, I find myself agreeing with Ed Miliband, who wrote in the Observer: “It is essential that we defend these payments [child benefit and the winter fuel allowance]. The alternative is a dangerous erosion of the social solidarity that comes from a universal system.”

The universality is key. And it is absolutely necessary if we are to regard what are we are sharing as a good in itself. The logic of Peter’s argument — the end destination, if you like, even if he would not actively wish us to travel down that route — would be that the better-off, such as retired bankers, pay for operations while health care remained free for retired roadsweepers. I suppose that’s fine if you see the NHS as merely an organisation that dispenses a product. If you view it as something much more than that, as a magnificent national achievement above and beyond what it actually does in its wards and clinics, then I think it is essential we have not only universal availability, but universal participation, too.

“Goodbye and good riddance”

Not so long ago, this was a widely held view. When I interviewed Colin Blakemore, the distinguished neuroscientist and former head of the Medical Research Council, for the NS, I was delighted to find it was one he still shared.

I ask him if he would disapprove of any MP or government minister going private. There is a very long pause, which I take to mean yes. “I’ve never had private health care, I must say,” he begins. “If you’re a very busy politician, then ahhh” — he sounds as though he’s desperately trying to think of some attenuating circumstances — “you could argue that your time is of more use to the country than the principle of you waiting for NHS treatment. I would just say that it’s unfortunate to have to make that choice.”

Maybe it will strike some as old-fashioned or utopian to take the view that there is something noble in us all availing ourselves of the NHS — that in some sense it is a duty for us to do so, otherwise its creation and maintenance ceases to be a national, common endeavour of which we should all feel proud.

If it is outdated and unrealistic to believe that, then why not chip away at the health service, beginning with goodbye and good riddance to NHS Direct? Those who can afford it can call up (or call out) their private doctors, while the rest can go to their GP. For those who cling to the notion of universality, however, the disappearance of any worthwhile service that is free for everyone is a great loss.

It may not mean much to a Tory like Andrew Lansley, but it should be felt by the heirs to Beveridge and Lloyd George.

Liberals were the founders of the welfare state. Their successors in the Con-Lib coalition have an obligation to defend it.

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