NHS

NHS

NHS

1. NHS Direct—gateway to the new NHS?

NHS Direct is an innovative way of delivering health advice to the UK. It is a 24 h helpline formed to offer easier and faster advice and information to people about health, illness and the National Health Service so that they are better able to care for themselves and their families (Department of Health, 1997). Currently, it is the largest telephone healthcare advice line in the world. It received 3.5 million calls in 2000-2001—a figure which was to double in 2001-2002 (National Audit Office, 2002). Callers to the service are triaged by nurses and depending on their situation are advised to go to emergency care, primary care or self-care. In doing this, they are assisted by computer decision support software. The organisation is nurse led and is supposedly one way of getting nurses who have left the NHS back into it. It is anticipated that NHS Direct will become the first point of contact for most people with a health query, thereby alleviating demand on other elements of the NHS such as GP services. It has set a target of integrating GP out-of-hours calls which will increase its call intake by 10 million. As such, the service is of growing importance for the NHS as a whole and, if successful, it will increasingly mediate between the citizen and their health care. Thus, the organisation is growing rapidly.

2. Debates around risk society and reflexive modernity: existence of the new citizen?

Beck's seminal work Risk Society argues that we have shifted from a world wherein class shapes our outlook to one where risk is paramount. Central to this process is reflexive modernity which enables people to question their actions and world in a de-traditionalised manner. This questioning brings advantages because we challenge our environment, take nothing for granted and query what were once fundamental truths. In the wake of this change comes a less hierarchical and less status-oriented society. These changes are exacerbated by a growing individualisation and the breakdown of traditional institutions such as the family, community and/or employment as the source of one's identity. On the whole, Beck suggests that these are positive things although not without their dangers. Accompanying this change is an ever growing uncertainty and distrust of science and professional expertise whilst he simultaneously acknowledges a seemingly contradictory dependence on science and expert knowledge. Giddens, 1991 and Giddens, 1994 echoes many of these themes suggesting we are locked into a reflexive modernisation process centred around radical doubt that may well be irreversible. At the heart of both writers, thinking is the belief that reflexivity is a key factor in determining how the individual engages with his or her milieu. Reflexivity brings with it unpredictability, uncertainty and diversity because individuals engage, provoke a response, assess and adjust to that response and re-engage, thereby setting off a chain that is unknowable at the outset.

Finally, a risk society is one wherein all knowledge is political and indeed risk, our ability to claim some things as risk-laden, our ...