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Author: Julie Caulier Grice
Published Date: 22 February 2008

Healthlineis a phone based health advice service which pioneered many of the ideas that were later to be incorporated into NHS Direct.It’s a good example of a social innovation that has made use of available technology to meet acute needs. Itwas backed by the private sector and foundations andwas successfully scaled up with public sector support.

Healthline was originally set up in 1986 by Michael Young and Marianne Rigge. Rigge describes it as the ‘only real information service of its type'. Despite its lack of commercial success, it has proved highly influential and, over the fifteen or so years it existed, has succeeded in bringing about its primary aim: to make health information available to all. Young’s first hand experience of cancer led him totalk with people in hospitals where he became profoundly sceptical of the excessive veneration given to doctors by patients. He believed that patients needed a bigger say in how their healthcare system worked, and so set up a helpline that could give advice, and a College of Health to effectively put patients in the driving seat. Healthline was integral to the College of Health, whichaimed to encourage and enable patients to discuss openly and fully their experiences as consumers of health care. This, it was hoped would have some impact on the way that the health service functioned and communicated with patients.Healthline was both an offshoot of this and a response to the AIDS pandemic of the mid to late 1980’s. Young, among other things, saw the stigmatisation of those with HIV/AIDS and envisaged a confidential and free phone line,so thatthose who were unlikely to confide in doctors could phone with queries and be given sound advice. As Tony Flowerpointed out, Michael spotted a problem long before most people had woken up to its awful consequences. One of the main challenges was how to handle the mass fear and worry that people would have about this major new disease. They would need, above all, information. Through a confidential, free phone line this information could be communicated.

The 'model' for Healthline was an organisation called Tel-Med which Rigge visited on a trip to the United States in December 1983, shortly after the College of Health was launched. Tel-Med was set up in 1973 by a group of doctors who thought it might save them time explaining routine procedures to patients. Rigge saw the potential this had, and envisioned adapting it to suit a British market. Underpinning this model are the ideas that

•Patients are given little opportunity in formal discussions with doctors to talk about their own experiences and feelings;

•When they do get this opportunity they are often inhibited, and their opinions are largelyovershadowed by feelings of both gratefulness and vulnerability;

•Some symptoms or expected conditions are too embarrassing and hard for a patient to communicate in person with a medical professional;

•Communication is more effective in less formal contexts;

•A method of communication and a means of getting advice should be easily available to all.

Healthline was the first of its kind in Britain and used pioneering technology to give people a free service. Using his powers of persuasion, Young convinced BT to generate link lines for Healthline to use. The Linkline 0800 and 0345 service had been introduced and trialled by BT less than a year prior to Young’s request, and were still in early stages of development. They enabled national calls to be made at local rates, and allowed Healthline to offer customers a free service. A massive switchboard was constructed, through which volunteers could take calls, then refer clients to one of their 100 advice tapes which been specially produced and edited for Healthline. These tapes covered a vast array of topics such as minor and major illnesses and how they should be treated; drug and alcohol abuse and where to go for help; advice about maintaining and improving health; diagnostic tests and common operations access to health and community services. To callers Healthline promised reassurance, confidentiality and anonymity, knowledge, and information. It responded and adapted to changing health worries of the time: for example, in 1986 when the nuclear power plant in Chernobyl exploded, Healthline produced a widely used information tape for those worried about its effects.

Healthline existed up until 2003 as part of the College of Health in the form of a fully computerised health and medical information service. It became a diverse service which included the National AIDS Helpline answering over 100,000 calls in 1987. This was followed by the National Waiting List Helpline, the first comprehensive database of waiting times information. It was able to expand to overfive hundredtapes and was widely adopted by many regional health services. Due to the service’s automated nature it became hugely relied upon by people suffering from symptoms they did not wish to discuss with others. This is illustrated clearly by looking at the top ten tapes for 1996-1997:irritable bowel syndrome;depression;rheumatoid arthritis; prostate problems; tinnitus; constipation; alcohol related issues; help for families; endometriosis; and haemorrhoids.

Healthline also received a variety of subscriptions which meant a greater number of users introduced to its services. These included the Consumers’ Association, Help for Health Trust, Western Provident Association, Candis Magazine, Yorkshire Northern Health Information Service and Health Which Magazine. To these clients customisation options were available, including a choice of how much the call will cost the caller, and an introduction anouncing that the service has been endorsed by them. They were also given regular printouts by Healthline on how their particular tape is doing terms of calls. Originally the Healthline service was launched in July 1984 in London, Exeter and Gloucester. They worked with the Health Authorities in Exeter and Gloucester and each funded their own service. The central service was funded, as was the College itself, by charitable grants at the start, which included the King's Fund and Elmgrant, and then later by membership subscriptions. The college had just over 10,000 members by the end of 1984 each paying ten pounds per annum. Eventually Healthline succeed in getting the Department of Health funding for the AIDS service and this enabled the automating of the service so that far more people could use it as a time. This was in itself ground breaking.

In April 1990 Michael Young built on the Healthline model and established Language Line, a telephone interpreting service. It was developed to address the difficulties facing ethnic minorities who spokelittle English when attempting to access public services. Telephone interpreting aimed to enable organisations to communicate effectively with everyone, whatever their language. Healthline was essential to the development of this service, without the already tried and tested technology, Language Line would not have been achieved with such success. Initially the service was used to enable communication between patients and staff at the Royal London Hospital, but gradually, due to media and corporate coverage it became more and more widely known. This led to the service becoming availabletwenty fourhours a day, and eventually sold on. It is now known as ‘the leading UK supplier of Total Language Solutions.’

In 1998 the NHS introduced NHS Direct: a nurse-led telephone information service that delivers twenty four hour health advice and information to patients and the public. It was supposedly the product of extensive debate as to how to combine old and new technology in order to give the public a more extensive and cheaper way of accessing healthcare. The service formed a key part of Labour’s 'The New NHS' White Paper in which ‘growing pressure on GPs and accident and emergency departments across the country’were cited as key reasons for such a service to come into existence. It was also hoped that the service would iron out many of the regional inequalities in service provision that had hitherto plagued the NHS. The idea itself is said to have stemmed from a recommendation made by Sir Kenneth Calman, the new Labour government’s Chief Medical Officer, in his September 1997 report, ‘Developing Emergency Services in the Community.’ In this report, Calman emphasised what overstretched ambulance and accident and emergency services stood to gain from the provision of an alternative access to a high quality telephone advice system. Calman’s report identified a need for further action in six main areas:

•Setting up and evaluating pilot schemes that provide telephone advice lines on immediate care in the event of an emergency;

•Mapping emergency services in the community;

•Analysing how people react to and handle emergencies;

•Agreeing and publicising key messages about emergency care;

•Defining a core curriculum for first aid training;

•Modernising and standardising first aid kits.

Those involved with the formation and running ofNHS Directare quick to stress that Healthline was a pioneer, the first of its kind in Britain. It led to similar services being conceived. The success of these types of help lines was brought to the attention of the Department of Health who, in 1998 cited 'work pioneered by colleagues in primary care during the past five to ten years, in many parts of the UK', as the inspiration for NHS Direct. Telephone help lines had been used in the past in projects such as the Health Information Service which provided information to callers and a number of GP practices. Healthline was one such help line, the first in a long line of more commercially based services. Healthline boasted a ‘no spiel’ policy, whereby callers were directed only to the information that they requested. Its automated, direct approach meant that confidentiality was breeched at no point, and this was much appreciated by those who called.

In this respect it stands out as a unique service, one that is fundamentally different to that currently offered by the NHS.Healthline disappeared as a result of its success in prompting the creation of NHS Direct – and the emergence of a host of other health advice services. In NHS Direct’s early stages, some callers were transferred to Healthline, depending on their particular health query or their region. This implies that the two could peacefully coexist, as, despite some similarities in the service offered, they did fundamentally differ. NHS Direct is primarily an emergency service, whereas Healthline boasted a much wider spectrum of information which, as Young intended, put patients in the driving seat. Interestingly NHS Direct is now evolving in this direction – becoming much more of a platform for a wider range of advisory services, mostly web-based.