NHS Direct staff could face job cuts

Tags: Cuts NHS Direct Out-of-hours website

03 Apr 2006

Jobs at NHS Direct may be cut by up to a third, and nurses replaced by non-medical call centre operatives, according to press reports today.

The Nursing Times will tomorrow report that a closed session of the NHS Direct board, held on 28 February, drafted proposals to cut the equivalent of 960 full-time post through a combination of natural wastage and dismissals.

Nick Bradley, negotiator for Unison, told The Telegraph: "Some of the jobs that are going are administration staff. But the vast majority are going to be nurses and call handlers."

The figures reported roughly equate to 1,250 out of 3,746 posts. Eight call centres are also said to be up for closure, although NHS Direct told the newspaper that that figure had been reduced to seven and that no firm decision has been made.

Ann Grain, interim head of external affairs for NHS Direct, told BBC News Online that one reason behind the cuts was that the website was the "growth area" for the service, rather than the call centres.

"It is difficult to say that the numbers the unions are saying won't happen at this stage because we do not have the firm proposals yet. That will come next month," she said.

"However, we are aiming to keep them to a minimum and are likely to recommend increasing the number of front-line staff answering calls. It is scaremongering to say 1,000 jobs are going."

Unions, however, have been reported as saying that the cuts have come after NHS Direct's failure to win out-of-hours contracts with more PCTs.

Reader's Comments

The impact on the rest of the service

jlgh_consult@dsl.pipex.com

05 Apr 06 12:04

NHS Direct surely does not have a problem with overcapacity? My experience is only anecdotal evidence, but it suggests that average wait times hanging on the line for an answer are pretty long. Will cuts mean more people reaching for their GPs phone number or just dropping in on A&E?

Unmet demand or demand not worth meeting

05 Apr 06 14:04

The fallacy of NHS Direct is that it generates demand that previously did not exist. These 'patients' calling NHS Direct would mostly never have been bothered to go to A&E or phone their GP.

It is another of the black holes into which New Labour's missing billions have been sunk.

The demographic of NHS Direct callers is (predictably) markedly different from that of the sickest members of society, whilst being uncannily similar to that of floating voters.

Nurses have been lost from wards to staff telephones to speak to the (very mildly) worried well and in many cases advise them to go to A&E or see their GP unnecessarily. The more it gets cut the better for everyone!

Expensive bureaucratic service

phil.scott2@nhs.net

05 Apr 06 15:04

I can only go off my experience of NHS Direct and to be hoenst its been poor. Long waits on the phone, then lots of bureaucracy about who I am, where I live etc etc only then to be told to go and speak to my GP. I get better advice from my local pharmacist at times.

Voicemail

05 Apr 06 16:04

The call centre operators are unnecessary - all you need is an answerphone system with a message to the effect that: "If your GP surgery is open, call your GP; if not, contact your local out-of-hours service. If you perceive this to be an emergency, call an ambulance"

This would fit with current protocols at a fraction of the price!

Facts and fallacies

05 Apr 06 17:04

Rather than 'generating demand that previously did not exist', NHS Direct actually meets a need that was not fully met before - the public demand for health information and advice. Generally, the NHS has not catered for this. Of course, you can argue that meeting this need is not a priority in a resource-limited health service, but not that it didn't exist.

As for the redundancies, it represents an enormous waste of time and resources by the DH. As soon as NHS Direct reached any sort of maturity, its funding model was changed to one that was almost guaranteed to wreck the service. Handing the funding of a national service to organisations (PCTs) that generally don't think beyond their narrow geographical limits borders on imbecility.

Doctors next

malcolm.willis@nhs.net

05 Apr 06 17:04

Everyone seems to have missed the point. The computer protocols are now so well developed that medically unskilled personnell can use them and get better results than some of the half baked "clinicians" that have been employed. The next step is to triage GP access. This will help cover the imminent crisis in GP numbers - April 2007 is the golden date for getting all the pension enhancements that came with nGMS!

Non-professional advice can be dangerous

07 Apr 06 08:04

Last time I used NHS Direct (I work in admin), I was told it would be up to 2 hours before a nurse would respond. I was concerned about someone who did not want to wake up, was very uncomfortable, and had just had a medical procedure where there might be side effects. When I responded that I would ring 999 if my concerns escalated, the screener encouraged me to phone NHS Direct back instead. The screener also wanted me to try to get my friend to speak to her directly, even though I had already told her he was highly irritable and did not want to be disturbed. It would be better to have no non-professional staff answering the phones for NHS Direct since they cannot offer the professional judgement of nurses.

Ex call centre employee

gillian.stokes@barnet-pct.nhs.uk

07 Apr 06 09:04

As an ex local call centre employee (past life) I can say your respondent 'voice mail' has a rosy view of the realities of call centre life. If callers are asked to define their own case as an emergency the ambulance service would be plagued with calls from the worried well, the anxious lonely, which the centres triage now while the true emergency may go untreated when many (particularly elderly) patients regard the prospect of an amulance/hospital with fear and would not call one. For all too many, an emergency is having no aspirin at 3am!

just wait

birth_mum@yahoo.co.uk

09 Apr 06 22:04

Wait until the service is dessimated - when 1/3 of the staff are made redundant as predicted - just wait and see what happens to A&E and GP out-of-hours service demand, then we will find out exactly how much NHS Direct has done for these services... and no, these staff will not return to the mainstream NHS to work as they are work injured nurses who are physically not able to nurse in an acute setting any more. It's not that they were 'poached', but NHS Direct provided them with a way to continue to using their expertise and ensure all the money put into their expensive training was not wasted and thrown on the scrapheap.

NHS Direct: benefit or burden?

10 Apr 06 10:04

So where's the hard evidence that the NHS Direct call centre service has significantly reduced demand on other services? Hasn't it simply created an additional burden for the NHS to fund? And the reality is that - now it is having to try and pay its own way by attracting funds from local holders of the purse-strings - they are unable to find any money released through reduced demand on other services. Because none has been.

The idea that NHS Direct is a provider of jobs for injured nurses is interesting but - when job cuts across the NHS are being announced almost daily - hardly amounts to a robust case for its retention. NHS Direct has had a fair run for its money, but it is operating in an environment where demand continues to outstrip available financial resources. Unless it can attract funding by providing demonstrable overall benefits, then it is only right that it should succumb.

NHS Direct - evidence

10 Apr 06 11:04

If you look at the evidence produced by James Munro's team at Sheffield (http://www.shef.ac.uk/scharr/sections/hsr/emergency/nhsd.html) you find little evidence of it having reduced demand, but some evidence that it has helped people to use the NHS more effectively. It has also been well recieved by the public.

As for the costs, in national terms these are quite modest (it was 80M a year about 5 years ago). Unfortunately, the idea that NHS Direct could attract funding from PCTs was never really going to work. All national-level NHS services are a bit like public goods as far as local organisations are concerned - ie most, but not all people want them, but individually, there is no incentive for anyone to pay. That's why the PCT funding model for NHS Direct is wrong, and it's why the centralised funding of national-level IT infrastructure is right.

Costs of public goods

10 Apr 06 11:04

But the problem with public goods is that there are limitations on the number of these that any government can afford to fund. And it looks as if NHS Direct has now dropped off their list of priorities - despite the benefits reported in the DH-funded research cited in the previous comment.

Hmmn, N3 and care record might be next

10 Apr 06 17:04

"All national-level NHS services are a bit like public goods as far as local organisations are concerned - ie most, but not all people want them, but individually, there is no incentive for anyone to pay. That's why the PCT funding model for NHS Direct is wrong, and it's why the centralised funding of national-level IT infrastructure is right. "

The cost cutting around the edges of the NPfIT programme that sees PACS, some N3 capacity, and some essential elements of the care records as optional extras to be locally funded will also call into question the funding for NCRS. Organisations are being sucked into contractural commitments for Core Services, which have an increasing number of unfunded gaps to make truly effective systems.

Those same PCTs who can't afford the luxury of NHS direct often can not afford the inflated prices negotiated by CfH on their behalf either.

Which begs a question

Injured NHS Direct Nursing Staff?

11 Apr 06 21:04

Sorry to hear that some of the NHS Direct Nursing Staff will not be able to return to the front line because they are injured. For a number of them however NHS Direct was a convenient refuge when they fell short on their appraisals in hospitals, community posts and GP practices. What we may never know is how these individuals compared with some of the excellent non-clinicians who used the decision support systems appropriately. Redundancies are inevitable in an organisation that has always been superfluous to need. Now that artificial demand has been created it is certain that out-of-hours calls to GP's and their paramedic colleagues will increase.