NHS Direct

Dr Nicholas Robinson, Associate Director for Long-Term Conditions and Tele-Care at NHS direct, presented on how “new digital platforms” can support people in leading healthier lives.

Where’s representation from the NHS?

The presentation got off to a shaky start when he remarked that there were only two speakers from the NHS at the conference. Not only was this incorrect but I know that plenty of NHS representatives did attend and the organisers did not decline any speaker requests from members of the NHS so I can only see the fault being with either the NHS’s lack of interest or support for members of staff who want to talk about their mHealth initiatives. Those in glass houses…

Liberating the NHS White Paper

Nicholas introduced the “Liberating the NHS” White Paper which is set to “drive the agenda for the next five years”. According to Nick’s presentation the paper reports on how the government will seek to break down barriers between health and social care funding to encourage preventative action (or “telecare” as Nick refers to it). Despite claims that there will be increased self-care and use of new technologies for people with long-term conditions Nick went on to explain that patients will be able to communicate with a clinician about “their health status online” and will be “encouraged to generate information which will contribute to tools such as patient reported outcome measures (PROMs), patient experience surveys and national clinical audit”.

Apparently patients will have control of their health record which will start with their GP record and then all health records held by providers of care. Although again it wasn’t clear how/if the NHS Direct Service is going to work with this or be responsible for its delivery given the recent news on its future.

Whilst it’s good to see that outcomes are eventually being placed at the heart of health policy and that there will be a strategy to encourage intelligent preventative initiatives and early diagnosis I don’t really think that there are that many people who actually have the first clue about how to make these concepts a reality.

Unsurprisingly the one bit that Nick didn’t mention was the bit in the White Paper on competition and privatisiation. With every patient being given “the power to choose any healthcare provider that meets NHS standards, within NHS prices” the £100+ million per annum tax payer funded NHS Direct service is at last set to face some competition.

“The Pyramid of Doom” & NHS Direct’s plans for getting you to go to bed early

Nicholas then presented his “pyramid of doom” which he adapted from the US managed care market to act as a proxy for dependency on hospital services, before suggesting that this represented just the tip of the iceberg and that the “general public” represented the other 80% of patients who he claimed had unmet needs including challenges which the government was well placed to help them manage such as smoking, drinking, eating, sedentary, bad habits, and mental health.

Nicholas then suggested that “lower intensity and longer duration models” were emerging to serve the needs and the focus was on “cheap enough and good enough”. As is always the issue in government provided healthcare: whilst it might sound great to tax payers, “good enough” isn’t too popular amongst patients and with the rise of the informed patient it’s not going to be long before communities realise what’s being metered out to them/their loved ones…

One thing that was left hanging in the air for me was: If £130 million is already being spent every year with the NHS Direct to give us a call center that is only used infrequently by a minority of patients, based on their track record what on earth is it going to cost to get the rest of the population to change their everyday bad habits?

“What does NHS direct do? Who are we?”

I think it’s interesting to look at the differences between what they think they are and what a tag cloud look at the website reveals:


Nicholas then presented how the NHS website is serving patients interest in annonymity as they tried to help manage the publics response to Swine Flu with a service prescribing TamiFlu:

Maybe I’m totally on the wrong track with patients but I always thought considerable amount of value was created in the healthcare experience as a result of personalisation and clinicians knowing their patients, and after watching the NHS spending $20 billion assembling an electronic record system (NPfIT) I’m surprised we’re not in agreement.

I cannot see why the NHS Direct service is so interested in providing anonymous communications? What research shows that patients want this? Why don’t they try doing the opposite first or is that too difficult/involve too much responsibility? Isn’t our healthcare experience today already anonymous enough?

Web First approach

Nicholas then talked of the benefits of a”web first” approach. When Google CEO is publically stating that they are going mobile first, to me this seems several years behind the curve and a considerable distance from where the majority of patients are at (as confirmed by Pew Internet Research’s time and again).

Using the example of how the NHS direct managed public concern over swine flu was also not in my opinion the best choice of examples as it’s all linked to particularly hard to measure initiatives, eg. what was the value of these expensive TV adverts running during 24 hour news broadcasts which where already running extensive headline coverage of the Swine Flu Pandemic?

Maybe it’s just “Web First” because the NHS Direct hasn’t worked out how to use readily available call handling technologies? A good example of this can be found in this BBC report on how the NHS Direct website wasn’t offering advice to children, yet the telephone was only answering calls with a prerecorded message instructing callers to visit the website.

As far as I know there is not a call management service provider in the country that hasn’t pitched NHS Direct to trial it’s services. Until they deploy these technologies (alongside SMS of course!) the management should not even start thinking they’ve got a web first problem.


Nicholas then presented “the new landscape for phone-based care” which will be the 111 service a National Freefone to direct care for which the NHS direct will be a “major supplier” (so that’s the free-market for you!). Nicholas also referred to how web will become a major source of patient support and how NHS direct already not only create their own website content but also supply NHS Choices – who also presented at the conference. Disappointingly there was no mention of mobile access to web.

New NHS Direct Services

Nicholas then referred to how the NHS direct is already working to offer “Clinical support in patients lives and homes” via “nurse coaching and tele-monitoring” with Birmingham OwnHealth and South East Essex NHS service. The proposed new services including “web based decision aids for THR, prostate” (for non medical readers: THR refers to Total Hip Replacement) and “NHS Wellness Direct” something I find very interesting:

Will competition with “NHS Wellness Direct” kill off chances for UK entrepreneurs?

As analysts point to wellness services being a potential growth market promising some long-term employment opportunities and the ability to create some valuable intellectual properties. It truly amazes me that a tax payer funded initiative is going to be helped dominate this sector. The UK has precedent for this in the form of what happened when the BBC Online services were set up. These have been shown to have actively discouraged investment and innovation in early-stage online content companies which some people (who I agree with) feel reduced the growth and resulting competitiveness of services developed by the UK online content industry (which is now dominated by US companies such as Amazon, YouTube, Google).

I can’t help but get the feeling that this new NHS Wellness Direct service will directly be competing with the free market, discouraging UK entrepreneurs from entering this exciting area and preventing investment, partners and patients from engaging with other providers. It’s important to note that there was no mention of these tools being developed together with partners or plans to integrate solutions developed outside the NHS into these services.

Social media buzzwords

As Nicholas then turned to future developments for supporting patients he made great job of listing practically every social media buzzword he could find:

In my opinion the following tweets give a much better example of how the NHS Direct is losing the battle with patient privacy and social media:

Let’s hope the Coalition cuts get rid of this nonsense and helps us draw a line under uninformed discontinuous care from inexperienced and underqualified staff, as I can’t think of a poorer use of public resources than developing services based around the “Nintendo” branded knickers that Nicholas suggested where a part of NHS Direct’s future…

This blog post is part of a series of mHealth reviews from the 2nd Mobile Healthcare Industry Summit 2010. Click here to get the full review.

About David Doherty

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1 Response to NHS Direct

  1. Dr R says:

    if NHS Direct is admitting its goal is to provide “cheap enough and good enough” in 2010, I’ll bet this time next year they’ll be striving for “cheap and adequate”

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