New service design in the NHS: an evaluation of the strategic alignment of NHS Direct

Awareness of inconsistencies and variability in the delivery of health services across the UK has heightened in recent years, leading to general acknowledgement that a move away from “health care by post code” is a strategic priority for the National Health Service (NHS). NHS Direct, a call centre service for patients and their carers, is unique in the NHS in that it represents an entirely new service concept, with a rare opportunity to design a single nation‐wide service from scratch, and to manage and co‐ordinate a delivery system consistently throughout the country. Evaluates the strategic alignment of NHS Direct during the first three years of implementation through an analysis of its service concept, its operational objectives, the design of its delivery systems and its volume and variety characteristics. The evaluation reveals an absence of a central design specification which has resulted in wide variation in the call centres’ service portfolios, resource bases, competences, telephony and clinical expert systems. Contends that variation and variability in the design of the call centres has severely compromised NHS Direct's ability to meet its strategic and operational objectives, resulting in strategic misalignment. Also identifies missed opportunities to learn from the growing call centre literature and from service shops in other industries.