Charlotte Leslie is a member of the Health Select Committee and MP for Bristol North West.
Last weekend, my parents’ neighbour, Mrs K, had a fall. It wasn’t serious: she slipped on a wet path as she went to put the bird food out. But since she is elderly, she was badly shaken. Whilst my dad patched up her cut hand and elbow, I called 111 to make sure she got the on-going care she needed.
The last time I had made a call like this was back in 2005 when I called NHS Direct from my lonely London flat, convulsed with pain. Since I had what felt like a warzone exploding in my head, I had every expectation that I’d be told I was having a brain hemorrhage and, in the calm that descends when things get urgent, simply wanted to know if I was dying and, if so, what I should do about it.
It turned out that this drama was nothing more than a very nasty ear infection. But the voice on the end of the NHS Direct phone didn’t tell me that. She put me through a whole set of irrelevant questions, despite the fact I kept explaining I was having trouble speaking as I was in so much pain.
So after a 40 minute call, I phoned my Dad, who raced up from Bristol. Yes, maybe I should have called 999, but I didn’t want to burden A+E. (Dads are there to be burdened, I figured.)
I wondered if the 111 story was going to be any different. With the benefit of more experience, I told the
operative that I knew she had to go through a procedure, but could I simply outline the problem when we started, so that after she’d ticked her boxes, she could pass me onto a district nurse who could come in and re-dress Mrs K’s cuts tomorrow. (It was obvious this was all that was needed, even if I had never done my first aid and emergency resuscitation training as a lifeguard, and even if my dad wasn’t a surgeon.)
The algorithm concluded differently and dictated that an ambulance was essential. I finally managed to speak to a doctor who, instead of calling out an ambulance, arranged for the District Nurse to visit the next day.
It seems that despite our vaunted progress, in many ways we are going backwards. 111 and NHS Direct Calls are in fact among the more humanised of processes we now have to go through. For most interactions with the state or large organisations, we are put through an infuriating sequence of pressing numbers, are told that the organisation is experiencing an unusually high level of calls (no matter what time you phone), and most infuriatingly, that our call is very important to them. Usually, the options we are given don’t meet the query as it is too complex, or we are put through a labyrinth of options to sort one really small, quite simple issue.
As technology improves, we are intent on replacing as much human interaction as possible with a machine. But as we increasingly live not in “One Nation”, but a “111 Nation” of algorithms to talk to, the logic of this becomes ever more questionable. We all know how dispiriting it feels to hear an automated announcement at the railway station tell us that “I am very sorry to the delay to this service”, when we know that there is no “I” behind that voice at all, only a machine. It reinforces the impression that in fact, no one cares at all, and there is no use even in trying to approach that identity-less void.
If we really do aspire to a “One Nation” in which everyone feels included, this is a sure way to discourage those who are not as confident or resilient as others from interacting with the state or any large organisation.
And in the long term, it seems inefficient. Mrs K didn’t need an ambulance; she needed a nurse.
I have written previously on this site about how impressive it was to see my local food-bank at work, precisely because it provided not only food, but a very human interface to individuals, to guide them through the state systems which could help them in the problems that had led them to the food-bank in the first place.
These were almost entirely failures of mechanised state systems that had no room for individual circumstances, and no ability to use intelligence to steer an individual to a solution that most suited them. The consequences of that impersonalised, megalithic state system was not only costly in human terms, but it was economically costly too.
Civilisation has travelled this far because of human interaction and communication. It seems folly to eradicate that efficient and ancient means of communication. The consequences can be seen in the failure of major government departments like the DWP. Politicians can issue different policies and different demands but, if the machinery at the other end of the levers they pull are broken, we cannot expect any constructive change. If we really want to change the way our state interacts with the individual, we have to turn it inside out and make human beings the first port of call for those who need the state to help them.
But there is another lesson too. Too often it seems that politics itself is driven by some algorithm, periodically issuing automated announcements, which the public treat with a similar despairing contempt as that telling us our train is late. If politics is to reconnect with the public it serves, we need to ditch the algorithms, and get back to human instinct, intelligence and understanding. We have become sick of a 111 Nation.