It is a curiously British disease to trash new initiatives before they start. Your coverage of the new nurse-led helpline, NHS Direct, seemed determined not to look on the bright side.

Your negative spin on NHS Direct ignores the enthusiasm of nurses and others who are looking at new ways to deliver out-of-hours care. Demand for out-of-hours primary medical care, including home visits to patients, has quadrupled in the past 25 years.

Researchers at Southampton University are due to report next month on a large randomised control trial of out-of-hours telephone triage in the Wessex region. The study incorporates patient surveys, clinical guidelines for telephone advice, and an education programme for nurses staffing the line. Early indications are positive, and indicate that proper training and monitoring are vital for successful telephone triage - useful lessons for NHS Direct.

Any new initiative will incur set-up costs, but like many nurse-led initiatives, telephone triage is both cost-effective and good for patients. Evidence from a large Canadian metropolitan hospital found that telephone triage saved more than 25,000 unnecessary visits for A&E annually, generating savings of more than $2m.

Perhaps NHS Direct has been 'welcomed by representatives of health service, lay and professional organisations' because - perish the thought - it is a good idea.

Christine Hancock,

General secretary,

Royal College of Nursing.