Welfare hotline

Care Direct, the Department of Health’s new
initiative to provide an internet and telephone portal to advise
older people, will be pioneered in the south west of England from
the end of the year. Natalie Valios reports.

E dith is 80 years old, and has just come out
of hospital after a minor stroke. She’s been referred to social
services, where she finds that she may be entitled to attendance
allowance and invalid care allowance. Her home needs adaptations,
and she needs to see an occupational therapist, speech therapist
and community nurse.

Unfortunately for Edith, each stage demands a
separate phone call and the repetition of myriad personal details
to a succession of faceless people at the end of the line. It’s a
bewildering, frustrating and exhausting situation for an older
person to find themselves in. But with the advent of three pilot
Care Direct schemes last month, it is a situation that the over-60s
in Somerset, Plymouth and Gloucestershire should no longer be
facing (News, page 16, 18-24 October).

The aim behind this new Department of Health
initiative is to provide a single telephone and internet gateway
for information and advice for older people, covering social care,
community health, housing and benefits. Schemes in Bournemouth,
Bristol and Devon are expected to be up and running by the end of
the year. The plan is to cover the whole of the south west of
England from October 2002 and to roll it out across England over
the next four years.

The freephone number for older people and
their carers initially goes through to NHS Direct staff. If they
cannot answer the query and the caller lives in one of the pilot
areas, the call is transferred to the relevant Care Direct help
desk. Callers living outside the pilot areas will be put through to
Help the Aged’s SeniorLine helpline instead.

An evaluation of Care Direct is currently
being carried out by the personal social services research unit at
the University of Kent in Canterbury. With funding from the DoH,
the programme will evaluate the first two years of the pilots’
lives. A final report is expected in March 2004, but there will be
interim reports at six-monthly intervals.

The purpose of the evaluation is to inform
decisions about whether and how to roll out Care Direct as a
national service. It will examine its impact on agencies, in
particular its effect on outreach and duty services; its cost
effectiveness; user experience and satisfaction; and whether it has
achieved its objectives.

Although it is led by social services, Care
Direct is not a social services organisation. Indeed, for it to
work properly it will need to be truly multi-agency in its
approach, says Peter Coysh, project manager of Care Direct
Somerset. He has worked hard to create partnerships with the
statutory agencies and has also enlisted the support of the local
Citizens Advice Bureau and Age Concern.

Care Direct focuses on being a customer-led
service, says Coysh. To this end, the main number will be open 24
hours a day and local helpdesks will have longer opening times than
normal. In Somerset, weekday hours will be from 8am to 8pm and 10am
to 4pm at weekends. This is in stark contrast to the normal hours
for most voluntary organisations and statutory agencies which
usually shut for weekends and evenings, the most convenient time
for carers to call.

In Somerset, a team of 20 includes four people
on loan from the local Benefits Agency and a team of five from the
Signpost service. This was a joint community care and health
information helpline service that has been incorporated in Care
Direct.

Three weeks into its inception, Care Direct
Somerset has taken between 450-500 calls. Coysh believes the single
gateway premise will work. He cites the case of a woman who called
a couple of days earlier with a benefits query. During the course
of their conversation, the member of staff noted that the woman
also needed a referral to Age Concern’s toenail cutting service and
assistance to look at whether she needed supported accommodation.
The member of staff talked to others on the Care Direct team and
rang the woman back with relevant information for all issues.

“The big difference with Care Direct is we
will take the call, figure out the services they need and do the
referring on,” says Coysh.

Further west, staff at Care Direct Plymouth
are equally optimistic. Less than three weeks after the service’s
launch, a letter appeared in a local paper from a satisfied
customer saying: “I had a problem with the housing benefit
department for months. I made one phone call this morning to Care
Direct and in less than one hour my problem was settled.”

Operations manager Carole Northmore’s
experiences over the weekend have left her with a personal belief
that it will work. A couple of older people she knew contacted her
with their problems after reading about the scheme in the local
papers. Although they have always known she works for social
services, they have never asked her anything before.

“I do think that older people have queries,
but because they are not in life or death situations and they don’t
know where to get help, they wait until it becomes imperative and
then they get frustrated when they have to make lots of different
calls,” says Northmore.

There are three ways to contact Care Direct:
the freephone number, the website, and through drop-in facilities
where users can speak to Care Direct advisors in person.

But, how many of its target audience will have
access to a computer? And what if they have mobility problems and
cannot get to a drop-in centre?

“Care Direct complements all the other
services,” says Northmore, who believes it will relieve pressure on
frontline staff within social services and its partner
agencies.

But will it? Certainly, NHS Direct, on which
Care Direct is based, appears to have made little impact on the
pressures consuming the NHS. According to an independent evaluation
of NHS Direct, there was no measurable effect on the number of
visits to accident and emergency departments, or on calls to
emergency ambulances in its first year.¹ There was a
small effect on out-of-hours calls to general practices.

James Munro, clinical senior lecturer at the
University of Sheffield’s medical care research unit, led the
evaluation. “It may be that in due course there will be a more
substantial effect as the use of NHS Direct goes up, but it is
still a minor player in comparison to out-of-hours calls to GPs,”
he says.

People over 55 used NHS Direct less than had
been expected, says Munro. This may have been because they have
already built up a wealth of experience in dealing with health
problems and need the service less than younger people, explains
Munro. But, it could reflect a low awareness of the service,
uncertainty about what the service offers, or a reluctance to
access health care through the telephone, he adds.

Although Care Direct has the potential to be a
useful and convenient service, Munro has concerns: “The question is
whether the people providing the service can achieve a strong
awareness among the client group and overcome any reluctance to
access advice through the phone, rather than face-to-face.”

Elizabeth Lodge is national advice line
manager for Help the Aged, as well as being on the Care Direct
steering group. Initially, at least, she thinks workloads may
increase as Care Direct is implemented. “The plan is for more
people to approach social services than before. So in the short
term it may mean more work but it should smooth out.”

Her main reservation is whether the scheme
will be able to fulfil people’s high expectation of the service.
They may ring up only to be told that there is no service available
or there are long delays. “If someone needs an occupational
therapist visit to assess their needs and they get through to a
number that just tells them there is a lack of OTs, it won’t
actually help them.”

So, for the time being, it’s wait and see. As
Lodge says: “I’m cautiously optimistic – very cautiously.”

¹ J Munro, National
Evaluation of NHS Direct, Medical Care Research Unit, University of
Sheffield, 1998, 2000, 2001

For more details, visit www.caredirect.gov.uk
  The freephone
number for Care Direct is 0800 444 000.