In response to the article by Stewart et al1 on a review of calls to NHS Direct related to attendance in the paediatric emergency department, we think it would be helpful to set some of the findings in context.

When NHS Direct was first set up it was anticipated that, in such a high profile service—the first national nurse telephone clinical assessment service in the world—there would be a significant degree of risk aversion. The paper relates to circumstances in late 2002 …