Doing the right thing wrong

When in doubt about health, “who you gonna call?”  It should be NHS 111. But this communication from the new Wandsworth CCG, launching the new service in mid December makes me doubt that the public will understand what it is and how to use it.   We’ve commented before on the need to “do the right thing right” where the new NHS 111 service was concerned.  However good the call handling, assessment and transfers and clinical services linked to NHS111 are, if the communications to the public aren’t effective then the whole initiative will suffer. The muddled piece of  NHS prose that emerged in mid December announcing NHS 111 to our population shows that they didn’t do that part of the job right.

Remember Rule 1

My personal “Rule 1″ for effective public communication about health is “don’t explain things in the negative” –  especially something new.   So what do we have in the Wandsworth NHS 111 press release? An explanation of how to use the service which is couched in the negative and blithely ignores the ambiguity – which we’ve pointed out before – of that hoary phrase beloved by PCTs –  “urgent care”.  We really have to dispense with that expression: the public simply does not understand what it means.

Here’s what the local 111 announcement said.

You should call 111 if:

• it’s not a 999 emergency
• you think you need to go to A&E or another NHS urgent care service
• you don’t think it can wait for an appointment with your GP, or
• you don’t know who to call for medical help

For more routine health needs, you should still contact your GP or dentist in the usual way, and for immediate, life-threatening emergencies, continue to call 999.

“Bad comms could kill it”

We said that before, now I have to say it again on the basis of this real (bad) example – getting the communications wrong around NHS 111 is likely to kill it in terms of public understanding and changing public behaviour towards emergency services.

Take the first two bullet points: they are clearly contradictory.  The first says use 111 if  it isn’t a 999 emergency; the second says use it if you think you do need to go to A&E.  The subtle distinction – if there is one – between these will be lost on 99.9% of people.  Myself included.  For Joe and Jane Public, 999, A&E, and ambulance are essentially synonyms.  And they always will be.

And then there is the phrase “NHS urgent care service”.  As a PEC lay member, I asked for years  – since I first got involved in 2009 locally with respecifying and procuring a new out of hours service –  what “urgent care” actually meant.  I never had a direct answer that made much sense.  There still isn’t one for the public.  And the way it is written in this announcement, it implies that A&E and “urgent care” are in the same group of services.  Clearly they aren’t.

“Non emergency”  (another negative definition of course) might have been used instead, but really that and “urgent care” are terms with little meaning for the public – how urgent is urgent? It is entirely subjective to a non-clinician.  Someone who is distressed and frightened especially at night or with a small child or elderly relative who is ill is not going to rationally assess things. They are going to go where they know they will eventually be seen and where everything that could be needed is available – and that will always be the nearest A&E department. “Am I bleeding enough enough for 999?” is not a question I want to ask myself before deciding whether to blue light it to A&E or have a nice chat to the new 111 operative instead.

Evaluation? What evaluation? 

Now that my tenure as lay member on the NHS 111 Clinical Quality Review Group has been terminated by the new CCG, I can say that I asked many times for evidence that these comms messages around NHS 111 had been evaluated with the London public for comprehensibility and as a call to changed health behaviour.  I never got a shred of evidence that they had been evaluated with anyone, much less Londoners who can be a perverse lot where the NHS is concerned.  I can see why. Had a garbled message like the one above been evaluated, the result would have been “what the hell are you talking about?” Or words to that effect.

The killer question

With this big new service coming just at the time that the biggest reorganisation of the NHS in England is also clicking into place, the question has to be: “Will the introduction of NHS 111 change behaviour and demand for A&E services?” I have always hoped that it would.  It has the potential to do so.  I believe our local service will be a good one, but on this showing we are still miles away from being able to explain something really important to the public. But what we must NOT be really good at is blaming them when they “don’t understand” and continue to make “inappropriate” use of emergency services.   That would compound ignorance with arrogance.

The Moore Adamson Craig Partnership supports user and public participation,  trains lay representatives and develops responsive  health, care and education organisations.  Feel free to contact us to discuss the opportunities.  Follow MAC on Twitter @publicinvolve


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