NHS Direct: Patient Empowerment Or Dependency

Abstract

As part of the modernisation of the NHS, NHS Direct, an innovative 24 hour service staffed by nurses and offering health advice via the telephone, is to be fully operational by the end of this year. The service is designed not only to provide patients with easy access to professional medical advice but also to enable callers to improve their own knowledge about their health and well-being through use of the service. In addition, there is an expectation it will be cost-effective and reduce demands on other parts of the NHS.
The research also examines how the caller-nurse interaction is structured by both the caller and the nurse. This means that every interaction is both different to the last one and a learning experience for both parties which may be either positive or negative and which will help to structure future interactions.
Our research will interview nurses, callers and will examine transcripts of telephone interactions to assess the extent to which the service users and providers have the same aims and the degree to which NHS Direct achieves these aims.

In particular, we will answer three questions:

1. To understand how NHS Direct is both used by and meets the needs of different social groups?
2. To develop an analysis of when people use the service and whether or not the enact the advice, information and reassurance they receive from NHS Direct.
3. To ascertain whom callers see as accountable for the advice given and action taken, how this impacts on trust and confidence in the service and what the implications of this are for patient empowerment?

back to top

Summary

Background

NHS Direct was announced in the 1997 White Paper The New NHS: Modern and Dependable. It started in 1998 and was to cover England by the end of 2000. It provides medical advice and information via the telephone and its objectives are

• Provide reliable and consistent healthcare so people can self-manage healthcare independently or know where to access such care.
• To help improve quality, increase costs effectiveness and reduce demands on other NHS services
• To encourage professionals to develop their role in enabling patients to be partners in their own healthcare, and thereby allowing professionals focus on more needy cases.

NHS Direct is a response to the perceived desire of patients to contribute to their own healthcare and it anticipates a new type of patient - an active, confident patient who wants to be a partner in his/her healthcare. In this sense the service is responding to or creating something novel. However, it raises a number of issues. If patients are participating in their healthcare then the service is partially created by them and their responses to it. This means NHS Direct will be constantly unfolding and hence cannot be managed and planned in traditional ways - it needs to become a learning organisation. Secondly, are patients becoming more active and confident? These issues shape our central research questions, which are:

• How is NHS Direct used by different social groups and does it meet their needs?
• How do people use the advice and information given by NHS Direct and does this coincide with what NHS Direct anticipates?
• To discover whom callers and nurses feel is accountable for the advice given and action taken

Ask how trust and confidence in the service can be established and maintained.

Research Design

We use a variety of qualitative methods. Conversational Analysis (CA) will be used to examine how people interact with the service and extensive interviewing of service users and providers will answer how these groups perceive NHS Direct and its services. This research will also allow us analyse how the service affects patients' perceptions of their health needs and responsibilities.

Policy and Academic Implications

The research will examine why and how people use the service, who uses it, can call management be improved, how nurses feel about the service, what advantages and disadvantages this form of nursing brings to those engaged in it, etc. These areas are vital to the service's future success and orientation. The research also analyses how 'ordinary people' engage with new technology based healthcare and examines whether or not such technological innovations are socially inclusive or exclusive - a key issue for the New NHS White Paper.

Our work has implications for other groups. It analyses how software enables/hinders service provision, it provides data for improving tele-services generally, and it analyses how work is organised in tele-services - a fast growing area of employment.

back to top

Contacts

Professor Gerard Hanlon

Dr David Greatbatch

Dr Donna Luff

Dr Alicia O'Cathain

Dr Tim Strangleman

back to top

Outputs

Research Findings

Findings are available here - pdf

Conference Papers

Hanlon, G. et al 'NHS Direct: Technology, Risk and Trust', New Technologies and Social Welfare Conference, University of Nottingham, 2001.

Hanlon, G. et al 'NHS Direct: Patient Empowerment or Dependency?', NHS Direct London Research Conference, King's College London, 2002.

Hanlon, G. et al'Risk Society and the NHS: From the Traditional to the New Citizen?', European Group of Organization Studies, IESE Business School, Barcelona, 2002.

Hanlon, G. et al 'Assessing Levels of Pain: Establishing Trust and Managing Risk in Nurse Telephone Triage', International Conference on Organizational Discourses: From micro-utterances to macro-inferences, King's College London, 2002.

Hanlon, G. et al 'Technology, Trust and Expertise in a Risk Society' Information for Patients and the Public: the role of ICTs, University of Brighton, 2002.

Hanlon, G. et al 'Empowerment and Dependency in NHS Direct', North and Midlands Medical Sociology Group, University of Sheffield, 2002.

Hanlon, G. et al 'NHS Direct: Is it Nursing?', BSA Medical Sociology Conference, University of York, 2002.

Hanlon, G. et al 'Technology, Knowledge and Nursing: The Case of NHS Direct' to be presented at the Employment Relations Unit Annual Conference, University of Cardiff, 2003.

Hanlon, G. tba. Annual NHS Direct Conference. 2nd, 2001, London, UK.

Publications

Hanlon, G. et al 'In Search of the New Citizen - Risk and Expertise in Late Modernity' in Critical Perspectives on Accounting, Vol. 14 2004

Hanlon, G. et al 'Risk and the Responsible Health Consumer: The Problematics of Entitlement Amongst Callers to NHS Direct'. Critical Social Policy Vol. 24, No. 2.

Hanlon, G. et al 'Male Callers To NHS Direct: The Assertive Carer, The New Dad, And The Reluctant Patient', Health, Accepted subject to revisions

Other Outputs

Hanlon, G. et al Brochures containing 'Findings' have been distributed to those NHS Direct staff and callers who participated in the research.

Hanlon, G. et al East Midlands NHS Direct Trust Annual Report (2002) - NHS Direct: Patient Empowerment or Dependency - A Project Report, pp12-18.

Hanlon, G. et al In-Direct (2002) 'King's College Project Update, Vol.1, pp1.

back to top

News

No news

back to top

---