NHS Direct Needs Greater Focus

A new Public Accounts Committee report on the NHS Direct telephone information service says that callers are currently waiting too long to speak to a nurse, with many patients having to wait up over 20 minutes.

The report also says that the service needs to improve response times and review productivity at individual sites to cope with increased demand. It urges the DoH needs to provide greater strategic focus for the service.

The MPs who authored the report say further work is required to determine whether the helpline is value for money and whether it is having a positive impact on the NHS.

NHS Direct has become the world’s largest provider of telephone healthcare advice, receiving 5.3 million calls in 2001-2002.

NHS Direct employs the full-time equivalent of 1,150 nurses, 80 per cent of which have been recruited from elsewhere in the NHS. The report says there is a fear in other parts of the NHS that NHS Direct might be creaming off key staff, particularly from A&E departments, and calls for a strategy to manage HR issues

Overall the PAC report praises the successful establishment of NHS Direct, noting the high levels of satisfaction among users, and has a good safety record, with very few recorded adverse events.

The report says the DoH should consider what wider lessons they could learn from the successful introduction of this significant and innovative service on time.

However, it calls on the Department of Health to set a clear strategic direction and development plan for the service in order to avoid it becoming a victim of its own success by trying to do too many things at once. "The plan should include a clear statement of the priorities and timetable for the integration of NHS Direct with other parts of the NHS," says the report

Immediate priorities set for NHS Direct include full integration with out-of-hours healthcare providers followed by the handling of 999 calls deemed non-urgent by ambulance services. But after this it notes that there are "a large number of other possible scenarios for future development of the service".

It reports that the key priority for NHS Direct is to integrate with providers of general practitioner services out-of-hours, and notes that the service is making progress in overcoming the initial technical problems experienced.

In particular the report notes that NHS Direct has experienced teething problems in achieving integrated working with general practitioner out-of-hours providers, including difficulties with integrating different systems and ensuring information collected from patients can be shared electronically.

Crucially it says that callers are currently waiting too long to speak to a nurse and reports that the service is not achieving its internal target for 90 per cent of calls reaching a nurse within five minutes, or the NHS-wide target for 90 per cent of out-of-hours calls which require nurse advice to be completed within 20 minutes.

The report states: "Callers are currently waiting too long to speak to a nurse."

NHS Direct expects that its capacity to handle calls will be improved by forthcoming technological improvements in call routing and staff rostering, but it also needs to improve response times overall and review productivity levels at individual sites to cope with increasing demand.

There are currently wide variations in productivity between sites with big variations in the number of calls handled per full-time equivalent nurse.

New computer call-routing software is to be introduced to allow calls to be distributed more easily to sites with spare capacity.

The report says that NHS Direct expects that its capacity to handle calls will be improved greatly by forthcoming technological improvements in call routing and staff rostering, but it also needs to improve response times overall and review productivity levels at individual sites to cope with increasing demand.

Another area for improvement identified is the low awareness of NHS Direct among groups including ethnic minorities. The extremely low use of interpreting services — used in just 1,000 of the 3.5 million calls taken in 2001-2002 — indicates that NHS Direct is only reaching a tiny proportion of its potential non English-speaking callers.