Friday, September 10, 2004

Experience of NHS Direct

We can also look for existing problems in live systems within the NHS, to understand the nature of the beast.

Some time ago I worked with an NHS Direct team to look at their risks. I think the things that struck me were:

The one-size-fits all triage system emphasises common standards above common sense. The system is heavily used at night by people who want a visit from doctor for whatever reason. I asked whether people knew how to answer questions in order to get the result that they wanted and the answer was it took a matter of days for this to happen.

The professional divide between nurses who staff the system and doctors in local practices is such that the complete triage system was being rerun when patients were referred.

There was an alternative to NHS Direct that was hospital based being funded nationally.

The major operational problems concerned load sharing/balancing with other offices and the problem appeared intractable based on the management structure.

If I reflect these issues back into the current debacle I suspect two things need to happen.

Firstly there need to be a meaningful agreement between the relevant parties that they will work towards a common system, rather than indulge in wrecking by independent development.

Secondly the question of information use needs to be tackled. I suspect that the current systems are as much about hiding information as about making it available. If information is officially always there, then it may make a wide raft of current procedures inoperable legally and morally.

How do we connect to the NAO study?

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