U-turn over NHS Direct

Earlier reports that NHS Direct was to be abolished signalled the determination of the new coalition government to implement bold cost-cutting measures to reduce the public sector deficit. Yet, after a brief campaign fronted by former deputy prime minister John Prescott (who has changed his twitter picture to a ‘Save NHS Direct’ button), and former health ministers Frank Dobson (who launched the service in 1998) and Andy Burnham (trying to raise his profile in the current Labour leadership tussle), health secretary Andrew Lansley has backed down. It turns out that he now merely plans to change the NHS Direct phone number. It appears that the government has belatedly recognised that the symbolic value of the national healthcare advice telephone line is well worth the cost of £123 million a year.

No doubt Andrew Lansley and his colleagues relished the prospect of striking a blow against the legacy of New Labour by getting rid of NHS Direct, a service celebrated by Tony Blair as the greatest achievement of his first term in office. But NHS Direct serves an even more important function as the most prominent public expression of the therapeutic ethos that is at the centre, not only of the health policies of Labour, but also those of the new coalition government.

GPs have long complained that NHS Direct does nothing to relieve the burden of demand on primary health care (of course, it was introduced, in characteristic defiance of the principles of evidence-based policy, after pilot studies had confirmed this).1 Every GP can report cases of misdiagnosis, inappropriate advice, usually amplifying anxieties, and duplicate consultations. Yet these criticisms miss the central point of NHS Direct: its central concern is not with health or health care, but with promoting and reinforcing a new relationship between the state and the individual, through the medium of health.

The great symbolic value of NHS Direct is that it establishes a ‘one-to-one’ link between the post-modern subject, an anxious and fearful person preoccupied by a wide range of threats to health and wellbeing, and a healthcare professional, a proxy for the caring, sharing, feeling prime ministerial role so successfully pioneered by Tony himself (and now faithfully continued by Dave and Nick). The popularity of NHS Direct reflects the high level of individual concern about health matters, the sense of vulnerability to a wide range of environmental dangers (from diverse plagues of infectious disease to climate change), and fears about whichever variety of cancer is currently under the media spotlight. In a more fragmented and individuated society, people experience health anxieties in a particularly intense form and seek reassurance from professional authorities rather than through personal relationships. It is striking that most callers to NHS Direct are young (and female)2 and likely to be at low risk of disease. In the official 2001 report promoting NHS Direct as a major achievement and innovation, the Department of Health claimed that it was ‘a response to the desire for patient empowerment'.2 In his thoughtful new book on his experience of psychosomatic illness, the novelist Tim Parks observes that ‘empower’ is a verb he dislikes, as ‘easy currency for those who tyrannise us with their piety'.3 Although the wave of public spending cuts may spare NHS Direct, the pious tyranny it embodies seems set to continue.

• © British Journal of General Practice, 2010.