Journal of Public Health Medicine 25:362-368 (2003)
© Faculty of Public Health 2003; all rights reserved.
Early warning and NHS Direct: a role in community surveillance?
Maureen Baker, Medical Advisor to Joint Development Team, NHS Direct and Honorary Secretary, RCGP
Royal College of General Practitioners, 14 Princes Gate, Hyde Park, London SW7 1PU
Gillian E. Smith, Regional Consultant Epidemiologist
Duncan Cooper, Scientist (Epidemiology)
Health Protection Agency, West Midlands, 2nd Floor Lincoln House, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham B9 5SS
Neville Q. Verlander, Statistician
Statistics Unit, Health Protection Agency, 61 Colindale Avenue, London NW9 5EQ
Frances Chinemana, Access & Health Protection Project Manager, NHS Direct
NHS Direct, Strawberry Fields, Berrywood Business Village, Toll Bar Way, Hedge End SO30 2UN
Sarafina Cotterill, Research Associate
Department of Public Health & Epidemiology, Public Health Building, University of Birmingham, Edgbaston, Birmingham B15 2TT
Vivien Hollyoak, Regional Consultant Epidemiologist
Health Protection Agency, North East, The Wolfson Research Institute, University of Durham Stockton Campus, University Boulevard, Thornaby, Stockton-on-Tees TS17 6BH
Rod Griffiths, Regional Director of Public Health
Directorate of Health & Social Care, Government Office for the West Midlands, 77 Paradise Circus, Queensway, Birmingham B1 2DT
Address correspondence to Gillian E. Smith. E-mail: gesmith{at}hpa.org.uk
Background NHS Direct is a nurse-led telephone helpline that covers the whole of England and Wales. NHS Direct derived data are being used for community surveillance, the purpose of which is to detect a local or national increase in symptoms reported by callers. The system has the potential to identify an increase in symptoms reported by callers about people in the prodromal stages of illness caused by the deliberate release of a biological or chemical agent. There are no other community surveillance projects existing on a national scale that utilize electronic daily data.
Methods We describe the surveillance system and calls to NHS Direct between December 2001 and July 2002. Confidence limits have been constructed for 10 key algorithms at each site and control charts devised for five of these algorithms at sites covering the key urban areas.
Results Daily reporting has been achieved from NHS Direct sites in England and Wales. High levels of activity in specific algorithms at both national and regional levels have been detected. A sustained national increase in calls about fever occurred in January 2002.
Conclusion Although the project is still at an early stage, daily analysis of NHS Direct data has the potential to detect symptoms in the community that could be related to deliberate releases of chemical or biological agents or to outbreaks of disease. For this surveillance to act as an ‘early warning’ of illness resulting from a microbiological or chemical cause, the NHS Direct surveillance needs to be fully integrated into an appropriate public health response (which may require diagnostic samples to be taken from callers).
Keywords: NHS Direct, surveillance, fever, bioterrorism