Does NHS Direct empower patients?

• Published in: Social science & medicine (1982) Vol. 61; no. 8; pp. 1761 - 1771
• Main Authors: O’Cathain, Alicia, Goode, Jackie, Luff, Donna, Strangleman, Tim, Hanlon, Gerard, Greatbatch, David
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.10.2005; Elsevier; Pergamon Press Inc
• Series: Social Science & Medicine
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Communication; Decision making; Delivery Systems; Empowerment; England; Female; Health care; Health Care Services; Health education; Health services; Hotlines; Humans; Interviews as Topic; Legitimacy; Male; Medical sciences; Middle Aged; Miscellaneous; National Health Service; National health services; NHS Direct; NHS Direct UK Patient empowerment Self-care Legitimacy; Patient education; Patient empowerment; Patients; Patients - psychology; Patients rights; Public health. Hygiene; Public health. Hygiene-occupational medicine; Self Care; Self Efficacy; Self-help; Selfcare; State Medicine - organization & administration; Telephone; Telephone hotlines; United Kingdom; Wales; United Kingdom; Europe; England; Wales; United Kingdom > UK; Legitimacy; Self-care; UK; Patient empowerment; NHS Direct; Human; Health system; Telephone; Empowerment; Selfcare; Telephone call; Social aspect; Public health
• ISSN: 0277-9536; 1873-5347
• DOI: 10.1016/j.socscimed.2005.03.028

NHS Direct is a 24 h telephone helpline established in England and Wales, UK to offer advice and information for people about health, illness and the National Health Service (NHS) so that they are better able to care for themselves and their families. In 2001/2002 we undertook in-depth home interviews with 60 users of the service in two NHS Direct sites in England. In this paper we consider the extent to which NHS Direct facilitates patient empowerment in terms of helping people to be in control of their health and health care interactions. Our research suggests that NHS Direct facilitates patient empowerment by enabling patients to self care and to access health advice and services. It is also seen to offer the prerequisites for empowerment perceived to be lacking in the wider NHS, including time, respect, listening, support, and information. The service also functions by offering an alternative contact point for people seeking to avoid being labelled ‘time wasters’ by other busy health care providers. In the context of a wider health service which appears to problematise individuals’ ability to make decisions about the appropriateness of seeking health care, NHS Direct legitimises help-seeking actions. Empowerment in the context of NHS Direct has been associated with self care as a way of reducing ‘unnecessary’ demand on health services. However, health professional and patient perspectives on what is considered necessary demand differ, and in certain contexts, patient empowerment may involve service use as well as self care. Further, our data reveal the context-dependent nature of a concept like empowerment. For example, when people are ill, in pain, or anxious about a loved one, they may value being cared for more than being empowered. Our research suggests that, in addition to its other functions, NHS Direct is also valued as contributing to a sense of being cared for.