Three weeks ago, I found myself taking an involuntary ride on the NHS Direct roller-coaster during a distressing miscarriage.
When I arrived at the Central Middlesex A&E department, it was like visiting the set of the TV show Mash. There was a sense of wartime spirit as nurses and doctors battled fatigue to carry out bravely their long tours of duty. I was placed in a wheelchair and pushed to the Early Pregnancy Unit while I was at the worst stage of miscarriage (too gory to describe here). An orderly arrived to take me for my scan and told me to “put on your coat, it’s raining outside”. I found myself being wheeled through a busy and freezing car park with the orderly muttering, “Bloody ridiculous this. Should be built on to hospital . . . third time today,” etc, as we headed, cross-country, to the unit.
Little did I know that I would make this journey again, in a far worse condition, after advice from NHS Direct.
At the A&E department, I had been warned that further problems would need urgent attention, but not to panic if there was “some” bleeding. Five days after returning home, I was in agony. Unable to get to my local GP because I felt so weak, I called NHS Direct. I spoke to a helpful disembodied voice that told me to “See your GP”.
I held on another 24 hours and then, in tears, I again tried the phone line. I waited for my call to be returned and rerouted. Finally a reassuring lady, who had “been through the same thing, dear”, advised that I curl up with a hot-water bottle. The last thing the kindly but inappropriately placed nurse told me was: “I can’t advise you what to do . . . I’m not a doctor.”
Two hours later, I was rushed on to an emergency ward and placed on a drip, suffering from a suspected ectopic pregnancy. Staying in bed with a hot-water bottle had been potentially fatal advice.
Like many healthcare “customers”, I was confused about the role that NHS Direct was set up to play. The government’s PR for the project has (as is so often the case with spin) clouded the true nature of the service on offer. It does not offer instant access to a doctor or provide faster than normal help to your door if you are seriously injured. As the website explains, “NHS Direct is a new 24-hour nurse-led telephone advice and information service . . . In particular, if you feel that there is something wrong with you . . . an NHS Direct nurse will be able to reassure you.”
So is the latest in new health technology merely a placebo for hypochondriacs and a place where the sick of mind can be “reassured”? Judging by my own experience and the opinions of doctors such as Rosemary Leonard, the answer is yes.
Leonard is a well-respected GP in Dulwich, south London, and, like many doctors, is willing to make her antipathy towards the government’s latest pet project known. Her practice, like all those in the UK, is already contracted to provide a 24-hour service to its patients. NHS Direct, she feels, is duplicating an under-funded service that has existed for years – a service run by better-qualified staff.
Worse still, she says, “many calls to NHS Direct get referred on to GPs anyway”. This means that a loop is formed with distressed patients being asked to wait for an available GP to call them back. The current favouritism for this project also leads, Leonard fears, to less important cases being passed on as “urgent” when they’re not. “I must then bypass all my other waiting patients to answer these calls, simply because they come via NHS Direct.”
Just as some cases labelled “urgent” by the computer programme used to assess each call are not urgent, some seriously sick patients can be misdiagnosed and left at home.
A conversation with a top NHS consultant confirmed these dangers. “One man,” he told me, “was prescribed paracetamol when he called NHS Direct. He had a serious case of malaria. Another man was told to go to bed and rub Vick’s vapour rub on his chest. He nearly died from meningitis.” All GPs know from experience that “prescribing and diagnosing over the phone is one of the most dangerous things you can do. Doctors hate doing it.”
Step into an NHS hospital and you will find hordes of the homeless and elderly, squirming as white-lipped workers try to prioritise their treatment. For potentially fatal cases, the waiting time is two hours; for the walking wounded, five hours. And the rest are sent home to recover. Presumably, this miserable scenario is what health policy wonks hoped to eliminate with NHS Direct. Yet, a year after its triumphant launch, no one, from the general public to general practitioners, seems to understand quite what it is for.
A recent article trumpeted the figures: NHS Direct dealt with 177,000 calls over Christmas alone. Gosh. In business and e-commerce, figures like these show that consumers are using your brand. But what exactly does this mean in terms of healthcare?
As for the much-trumpeted online service, this offers titbits already available on many better-equipped Internet sites. I logged on to its brightly coloured pages and, according to my random search of symptoms, under the heading “hands”, I definitely have “Raynaud’s”, probably caused by a blood disease. The home page sagely offers me this advice: “contact your doctor or go to your local hospital.”
How much is this indispensable advice worth? The running costs alone for last year were estimated at £31 million. As furious doctors such as Rosemary Leonard have worked out: “This figure doesn’t even include setting up the website. There have been no cost-effective evaluations made public for this service either. Where are the figures?”
So, if NHS Direct does not relieve doctors of their 24-hour duties and can actually delay patients from receiving proper, professional care, who is benefiting from the service?
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