notalwaysaande, get it?

yellow men east londonOn first glance, I certainly didn’t get it.  I thought notalwaysaande was a word in a foreign language I didn’t recognise. Sort of Dutch, kind of maybe?  But then I saw that it was part of a web address.  Staring at it harder, I eventually deconstructed it to read “not always A&E”  =  Then I got it.  But what is it and what is it trying to tell me?

It’s about helping me make the right choice

Great. Now there’s an online way to find out if you are bleeding seriously enough to go to A&E.  Now residents of East London boroughs of Barking and Dagenham, City of London, Hackney, Havering, Newham, Tower Hamlets, Redbridge, and Waltham Forest can find out how not to go to A&E simply by consulting this handy resource.  That’s the theory anyway.

How does it work in practice? Here are the steps to find out what to do. First get on the net, then type in the URL – no mistakes mind, then from the long list in the drop down box “simply find your symptom, enter your postcode and hit the ‘Find treatment’ button.”  Simple, isn’t it?

Of course by the time you get to the answer, “where to go” you may have passed out through loss of blood or given up in frustration or both.  On a smart phone you can imagine a blood smeared screen being only the most obvious problem.

Barriers unintentional but real 

Whatever its good intent, this website puts too many barriers in the way of people using it –  starting with its odd name recognition.  I have yet to show “notalwaysaande” to anyone who recognises what it says within one minute.  Did anyone test this for intelligibility? People around East London use dozens and dozens of languages.  The website seems to be only in English.  Were local residents involved in planning or piloting any of this I wonder?  If so, what were their views?

Injured or unwell? Don’t just go to A&E if it’s not a serious emergency.  That’s what it says, but what does this actually mean to the average reader? Double negatives are hard to get your head around and invite confusion about what action to take.  This is a classic case of “swamp words” – you think you know what they mean, but when you press them a bit they give way into mush.

Big yellow men everywhere in East London

And then there are the hoards of giant yellow plastic figures lying around public spaces in East London   promoting the campaign and showing up on Facebook.  The press release says

… huge yellow figures depicting different types of injuries will be on display at Spitalfields to promote better use of A&E by the public. The event will take place today as latest official statistics show that Monday mornings are the busiest days for A&E departments. It has also been estimated that up to 40 per cent of people use A&E who do not need to.

Is anyone evaluating how the public reacts to this street theatre? Do they get the message?  Is it likely to change their behaviour?  I worry that if they follow some of the directions literally, they may not only not end up in the right place, they may end up much worse off than when they started.  For example, the campaign’s Facebook platform instructs readers to remember five things:

Only go to A&E for 1. loss of consciousness 2. acute confused state and fits that are not stopping 3. persistent, severe chest pain 4. breathing difficulties 5. severe bleeding that can’t be stopped. For everything else, use our website to find other NHS services that can treat you quicker and closer to home

Where are broken bones, serious burns, anaphylactic reactions, convulsing toddlers and other not minor things in this list? If you followed it literally, you might end up dead.

Is this a good use of social media? 

Let’s use social media to reach out to the community by all means, but is this social media initiative well thought out and likely to be successful?  I’d like to see the metrics that will be used to evaluate it.  The new Local Health-watches are supposed to have a signposting service to direct people to the right service.  Will notalwaysaande be part of it?  Is it connected up?

With all the confusion there is already around using emergency services, and a review of emergency care about to start which may add to it from the NHS Commissioning Board, it might just be safer for people in these East London boroughs to stick to what they know and trust – namely the A&E brand.  At least they will get seen there and everything that’s needed is on tap in the attached teaching hospital.

The road test verdict

That man about East London, blogger Diamond Geezer, road tested the notalwaysaande website and came to pretty much the same conclusion about this campaign in his posting of 26 January.  Here’s his verdict.

It’s a sad truth that unthinking patients regularly make bad choices about where to take their symptoms, and the NHS frontline often suffers as a result. It’s also true that when we’re ill, we often don’t have the best information about what to do at our fingertips.

Alas it seems isn’t the best way of changing things for the better.

I’d have to agree with Diamond Geezer on this one.  But what do people around East London think of it and the yellow men in particular?  Is it going to get you thinking about alternatives to using A&E?  Let us hear from you below or on Twitter @publicinvolve

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


  1. Lynn Young says

    It took me a while and much concentration before I understood the subtlety of ‘notalwaysaande’ and I am home grown UK with many years of working closely with NHS policy and practice matters as a community nurse. So, what hope for people with limited English and understanding of how the NHS is supposed to work?
    Most members of the human race do better with a simple approach to dealing with challenge. Experiencing sudden onset of confusing symptoms requires the most simple of actions if anxiety is to be avoided. Anxiety is a major issue when coping with the unexpected and trying to do the right thing creates more anxiety which renders us less intelligent and therefore more challenging for the professionals who strive to do the right thing for their patients.
    Effective solutions to dealing with A and E contacts will only be achieved if anxiety is diminished, they work at 2am, anxious mothers of babies and young children are considered and binge drinkers and domestic violence are taken into account. I would challenge anyone to ‘do the right thing’ when the advice given is complex and creates yet more anxiety for people who are struggling with the ‘unknown’ and human suffering in the early hours of a cold morning.

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