LETTERS

Anticipating reaction to my letter about NHS Direct (14 June), written as a carer rather than a professional, I would like to make the following points.

I have always appreciated that NHS Direct cannot provide a diagnostic service. I phoned to find out whether I could give my mother an extra teaspoon of medicine to tide her over until the morning. Since during the day I could phone the pharmacist, it seemed possible a senior nurse would be able to give me the same advice at night. I have since discovered that NHS Direct has given other carers precisely that advice about the same drug.

Speaking on the radio about my comments, Jill Springer of NHS Direct said it was more appropriate for someone who knew the patient and their history to advise on medication, and we'd all agree with that. But in the five months before my call, my mother had had 16 face-to-face contacts with NHS clinicians, yet it was a different one each time, none of whom knew her, her medical history or her medical notes. This had resulted in many severe allergic reactions to drugs despite most already being noted in her records.

My remarks were made from genuine concern for patients and carers, not criticism for the NHS, and to widen the debate. Neither my mother nor I have considered a formal complaint as this invariably turns into a witch-hunt about an individual rather than a fresh look at the systems.

My job for many years has been to look at how different parts of the NHS can provide consistent information to patients and carers when they most need it. I am desperate for modern technology, like the telephone, to assist us. But if every time you used telephone banking you were referred to your own branch it would never have caught on. I am eager to promote new forms of dialogue between the NHS and its users, and promote proper evaluation. I was pleased that on Radio 4's PM programme, Dr James Munro from Sheffield University agreed we needed more sophisticated studies than those relying on responses to general satisfaction questions which mask problems that easily come to light with factual questions about specific experiences.

The public needs to be educated about access to the NHS. If NHS Direct has limitations, they need to be spelt out clearly. Its very name implies callers will receive a direct response. In my limited experience it would be better called 'NHS Indirect'.

If senior nurses are unable to answer frequently asked questions, NHS Direct should employ pharmacists and doctors, or some of its resources should be redirected to GP out-of-hours services.

It is strangely paradoxical that although I spend my life educating people to use robust and representative research, rather than anecdotes from people's mums or grannies, one anecdote about my own mother made more impact than all my years of careful study. I wonder if I should become a professional letter writer rather than remain a quality manager.

Dr Pat Straw Quality manager Lothian University Hospitals trust