NHS Direct is a relatively new, nurse-based, 24-hour health advice line run as part of the UK’s National Health Service (NHS). The service delivers health advice remotely via the telephone. A central aspect of the service is the attempt to provide a standard level of health advice regardless of time, space or the background of the nurse. At the heart of this attempt is an innovative health software called CLINICAL ASSESSMENT SYSTEM (CAS). Using a number of qualitative methods, this article highlights how the interaction between the nursing staff and this technology is key to the service. The technology is based on management’s attempt to standardize and control the caller-nurse relationship. Thus the software can be seen as part of an abstract rationality, whereas how it is deployed by nurses is based on a practical rationality that places practice and experience first and sees the technology and protocols as tools.
Adorno, T.W. & Horkheimer, M.Dialectic of enlightenment. London: Verso , 1997. [Original published 1944.]
2.
Apel, K.O.The a priori of communication and the foundation of the humanities. In F.R. Dallmayr & T.A. McCarthy (Eds), Understanding and social inquiry. London: University of Notre Dame Press , 1977. [Original published 1972.]
3.
Ball, M.J. , Hannah, K.J. , Newbold, S.K. & Douglas, J.V. (Eds). Nursing informatics: Where caring and technology meet. New York: Springer , 1995.
4.
Beck, U.Risk society: Towards a new modernity. London: Sage , 1992.
5.
Beck-Gernsheim, E.Health and responsibility: From social change to technological change and vice versa. In B. Adam , U. Beck & J. Van Loon (Eds), The risk society and beyond: Critical issues for social theory. London: Sage , 2000.
6.
Berg, M.Problems and promises of the protocol . Social Science & Medicine, 1997, 44, 1081-1088 .
7.
Berg, M.Patient care information systems and health care work: A sociotechnical approach . International Journal of Medical Informatics, 1999, 55, 87-101 .
8.
Benyon, H.Working for Ford. Wakefield: EP , 1975.
9.
Bolton, S.C.Changing faces: Nurses as emotional jugglers . Sociology of Health and Illness, 2001, 23, 85-100 .
10.
Braverman, H.Labour and monopoly capital. New York: Monthly Review Press , 1974.
11.
Brubaker, R.The limits of rationality: An essay on the social and moral thought of Max Weber. London: Routledge , 1984.
12.
Bury, M.Illness narratives: Fact or fiction?Sociology of Health and Illness, 2001, 23, 263-285 .
13.
Collin-Jacques, C. Professional labour in call centres: A comparative study of nurse call centres in England and Quebec (Canada). PhD thesis, University of London, 2003.
14.
Cressey, P. & MacInnes, J.Voting for Ford: Industrial democracy and the control of labour . Capital and Class, 1980, 11, 5-33 .
15.
Deery, S. , Iverson, R. & Walsh, J.Work relationships in telephone call centres: Understanding emotional exhaustion and employee withdrawal . Journal of Management Studies, 2002, 39, 471-496 .
16.
Department of Health . The new NHS. London: Department of Health , 1997.
17.
DuGay, P.Consumption and identity at work. London: Sage , 1996.
18.
Finch, T.L. , May, C.R. , Mair, F.S. , Mort, M. & Gask, L.Integrating service development with evaluation in telehealthcare: An ethnographic study . British Medical Journal, 22 November 2003, 327.
19.
Friedman, A.Industry and labour: Class struggle at work and monopoly capitalism. Basing-stoke: Macmillan , 1977.
20.
Gann, B.The policy perspective . Paper presented at the Information for Patients and Public: The Role of ICTs conference, University of Brighton, October 2002.
21.
Giddens, A.Modernity and self-identity. Cambridge: Polity Press , 1991.
22.
Greatbatch, D. , Hanlon, G. , Goode, J. , O’Cathain, A. , Strangleman, T. & Luff, D.Telephone triage, expert systems and clinical expertise . Sociology of Health and Illness, in press.
23.
Hanlon, G. , Greatbatch, D. , Strangleman, T. , Luff, D. , O’Cathain, A. & Goode, J.NHS Direct patient empowerment or dependency? End of project report, Economic and Social Research Council , 2003.
24.
Held, D.Introduction to critical theory: Horkheimer to Habermas. Berkeley: University of California Press , 1980.
25.
Hyman, R.Strategy or structure: Capital, labour and control . Work, Employment and Society, 1987, 1, 25-55 .
26.
Lash, S.Risk culture. In B. Adam , U. Beck & J. Van Loon (Eds), The risk society and beyond: Critical issues for social theory. London: Sage , 2000.
27.
Latour, B.Technology is society made durable. In K. Grint (Ed.), Work and society: A reader. Cambridge: Polity Press , 1991.
28.
Lauritzen, S.O. & Sachs, L.Normality, risk and the future: Implicit communication of threat in health surveillance . Sociology of Health and Illness, 2001, 23, 497-516 .
29.
Lawler, J.Behind the screens. Nursing somology and the problems of the body. Melbourne: Churchill Livingstone , 1991.
30.
Leigh Star, S.From Hesta to homepage: Feminism and the concept of home in cyberspace. In N. Lyke & R. Braidotti (Eds), Between monsters, godesses and cyborgs. London: Zed Books , 1996.
31.
Mackay, L.Nursing and doctoring: Where’s the difference? In K. Soothill , C. Henry & K. Kendrick (Eds), Themes and perspectives in nursing. London: Chapman and Hall , 1992.
32.
MacKenzie, D. & Wajcman, J.The social shaping of technology. Buckingham: Open University Press , 1999.
33.
Marcuse, H.Some social implications of modern technology. In A. Arato & E. Gebhardt (Eds), The essential Frankfurt school. New York: Continuum , 1982. [Original published 1941.]
May, C.Nursing work, nurses’ knowledge, and the subjectification of the patient . Sociology of Health and Illness, 1992, 14, 472-487 .
36.
Mechanic, D.Medical sociology: A selective view. New York: The Free Press , 1968.
37.
Milburn, A. Speech to the Confederation of British Industry annual conference, 2002. Available: http://www.doh.gov.uk/speeches/cbi-con-milburn.htm
38.
Monaghan, R. , Clifford, C. & McDonald, P.Seeking advice from NHS Direct on common childhood complaints: Does it matter who answers the phone?Journal of Advanced Nursing, 2003, 42, 209-216 .
39.
Morrell, C.J. , O’Cathain, A. , Warren, K. & Nicholl, J.Impact of NHS Direct on other services: The characteristics and origins of its nurses . Emergency Medical Journal, 2003, 19, 337-340 .
40.
National Audit Office . NHS Direct in England. London: The Stationery Office , 2002.
41.
O’Cathain, A. , Sampson, F. , Munro, J.F. , Thomas, K.J. & Nicholl, J.P.NHS Direct: Using computerized decision support software . Journal of Advanced Nursing, 2003, 45(3), 1-9 .
Wahlberg, A. , Cedersund, E. & Wredling, R.Telephone nurses experience of problems with telephone advice in Sweden . Journal of Clinical Nursing, 2003, 12, 37-45 .
49.
Webster, C.The national health service: A political history. Oxford: Oxford University Press , 2002.
50.
Whalen, J.Making standardisation visible . Paper presented at the American Sociological Association conference, 1993.
51.
Wilkinson, I.Anxiety in a risk society. London: Routledge , 2001.
52.
Williams, A.Nursing, medicine and primary care. Buckingham: Open University Press , 2000.
53.
Wrong, D.Max Weber. London: Heinemann , 1970.
54.
Zola, I.K.Pathways to the doctor - From person to patient . Social Science & Medicine, 1973, 7, 677-689 .
