Since it was set up in 1998, NHS Direct has been, by all accounts, a success. The telephone helpline handles 7.5 million calls a year. Even the National Audit Office said earlier this year that it had achieved high patient satisfaction and had a good safety record.
But there are other less high profile ways of accessing information from NHS Direct—including digital television, touch screen machines in shopping centres, and its website, NHS Direct Online. It online site (www.nhsdirect.nhs.uk), first launched in 1999,was relaunched in November last year and in January 2002 alone had 250,000 visitors.
With the government trumpeting NHS Direct, it is vital that the information it gives out, both on the phone and through its other portals, is accurate, up to date, and appropriate. The recent publicity when a young baby died after NHS Direct staff failed to pick up meningitis showed that such a high profile service cannot afford to get things wrong.
Bob Gann, chief executive on NHS Direct Online, is only too well aware of the importance of information. It has been his business. He started out as a medical librarian before moving into patient information and becomes passionate as he talks about empowering patients by giving them good quality information—not just on the website but across the whole of NHS Direct.
An example of his fervour comes out when we talk specifically about NHS Direct Online. He has resisted using too much new fangled web design, such as “Flash” animation. Despite its visual attractions, he knows that if they used it, some people's computers would just keep crashing whenever they hit the site—if they can get onto it at all.
“We don't want to disempower the two or three per cent of the population who are still using old-style browsers,” he said. NHS Direct Online can be viewed by anyone, even on an old “version 3” browser (most people now use a version 5 browser).
Monitoring the website
To ensure high quality medical information Mr Gann turns to Mike Sadler, a GP with public health experience who, until recently, lectured part time at Southampton University on web related health information. Dr Sadler is medical adviser for the entire NHS Direct operation but has recently been appointed head of the website's editorial board, set up eight months ago to monitor the content of NHS Direct Online.
This includes a self help guide—giving advice on how to treat certain complaints—and an encyclopedia of some 400 conditions giving details of support groups for further help and advice, which was added when the site was relaunched in November. The encyclopedia is prepared by DPP 2000, a joint venture company of the Doctor Patient Partnership, Radcliffe Medical Press, and Software Production Enterprises. It won the contract after a rigorous tendering process in which one of the specifications was that NHS Direct should retain editorial control.
The editorial board is the final judge of the overall content of NHS Direct Online. It also monitors the information on other linked websites to ensure that their standards are of suitable quality.
The board has 22 members representing a broad range of clinical interests. As well as checking existing information, members are expected to notify NHS Direct Online of any new research findings reported in the medical press, so the site can be updated. They sometimes take on board information from other professionals who view the site.
“We revised our information on treating headlice, for example, after two or three people pointed out that the emphasis on non-medical treatment as a first line defence was no longer considered appropriate,” said Dr Sadler.
When it comes to judging the quality of material on linked sites, the board had, until recently, been relying on the DISCERN criteria. This is a system of checking the appropriateness of any medical information (primarily in print, but also on the web) that was devised by researchers at Oxford University in 1997. It includes questions such as “Is the publication reliable?” and “Is it balanced and unbiased?” Each element is scored on a 1 to 5 rating before a final assessment is made.
“The problem is, it is enormously time consuming,” said Mr Gann, explaining that many of the linked sites already used the DISCERN criteria.
“To take material that has already been produced and then to “MOT” it was a worthy intention, but very difficult to implement,” he admitted.
New directions
They have therefore decided to abandon the DISCERN model 62 in favour of developing a system used by Canada's health website (www.canadian-health-network.ca).
The Canadian Health Network has developed partnerships with organisations that, so long as they produce information to a pre-agreed quality standard, can both contribute to the network's pages and have their own organisation's web page linked to the main network's site. A similar scheme works on the Australian health site, HealthInsite (www.healthInsite.gov.au).
As part of its quality assurance programme, Canadian Health Network has strict criteria for judging appropriate information. These include whether the resource is credible, the content is suitable, and the information relevant and timely. It will not link to sites of private organisations or any outside Canada.
At the moment, NHS Direct Online does not have such explicit criteria. But it is moving towards a similar approach, working in partnership with existing health organisations.
The first potential partner is CancerBacup. If CancerBacup's site meets standards agreed with NHS Direct, it will be linked from NHS Direct Online as a “gold star” approved site, possibly by the end of the year. The criteria could then be used as a basis for other similar partnerships, initially with organisations representing the main areas identified in the government's national service frameworks, such as mental health and coronary heart disease.
Mr Gann said that as well as introducing gold star ratings (for the best linked sites), NHS Direct Online may also introduce a silver star rating—to indicate linked sites that are good but do not perhaps meet all the criteria perfectly.
It would be a symbiotic relationship. “The partners will get the benefit of a close association with NHS Direct—and probably a greater profile than they would on their own,” said Mr Gann. NHS Direct Online, meanwhile, gets the quality information it needs.
But whether members of the public will eventually turn to NHS Direct Online for information on a specific condition, rather than to Ask Jeeves (www.ask.co.uk) or Google (www.google.com), only time will tell.
“To take material that has already been produced and then to “MOT” it was … very difficult to implement,”
Figure.
Bob Gann (left) and Dr Mike Sadler of NHS Direct Online