NHS Direct, the telephone helpline hailed by the government as the way forward for the health service, could be risking lives because of shortcomings in the way calls are handled, it was claimed yesterday. Research by Health Which? found that potential emergencies were missed while other patients were unnecessarily referred to overstretched accident and emergency departments. Nurses staffing the line offered inconsistent advice.
NHS Direct, launched in 1998 and enthusiastically endorsed by Tony Blair, covers two-thirds of the country and is due to go nationwide by the end of October.
Its principal aim is to reduce demand on other NHS services - but recent research by Sheffield University found there was no evidence to suggest that this had happened.
Researchers from Health Which? tested several scenarios based on everyday medical problems and made 30 calls to NHS Direct call centres.
Calls by a man pretending to have angina were poorly handled. A panel of experts said nurses should have asked enough questions to establish that he had already had one heart attack and his angina attacks were becoming more frequent. But in only one out of 10 calls were enough questions asked to discover that his condition was worsening.
In another case, a woman claiming to be the mother of a five-year-old child with vomiting and diarrhoea was given "inappropriate" advice to take her daughter to A&E.
Sally Williams, principal researcher for Health Which? said: "Our research raises a number of questions about the role of NHS Direct call handlers, the remit of nurses and about the protocols they use. One of the key challenges is getting the balance right between drawing on the skills of nurses and ensuring that advice is consistent and sound. The nurses' listening skills weren't always up to scratch."
She said her biggest concern was that there were gaps in the system. NHS Direct should take a close look at the way it deals with calls about repeat prescriptions to ensure that potential emergencies do not slip through the net.
At its annual meeting in June, the British Medical Association called on the government to halt the expansion of NHS Direct. The BMA has already demanded more evaluation of the service.
Dr John Chisholm, chairman of the BMA's general practitioners' committee, said yesterday: "Clearly in some circumstances it can do a good job - but the research from the Consumers' Association reveals potentially dangerous discrepancies in the quality of information given."
But a Department of Health spokesperson said: "NHS Direct has safely delivered health care advice to more than 3m callers, and on many occasions has acted as a lifesaver. As a result of the report we are reviewing the protocols call handlers and nurses work to if a caller rings about repeat prescriptions."
According to DoH statistics, 97% of callers were satisfied with the service.
Useful links:
www.nhsdirect.nhs.uk/main.jhtml NHS Direct online
www.nhs50.nhs.uk/healthy-direct.htm NHS questions and answers on the scheme
www.nhs.uk/nhsplan NHS national plan
