NHS Direct is a nurse-led telephone helpline covering England and Wales. The intention to develop this helpline was announced in December 1997 in a White Paper, The New NHS, Modern and Dependable (Department of Health, 1997), following recommendations in the Chief Medical Officers' report, Developing Emergency Services in the Community (Caiman, 1997). Three initial pilot sites were set up in Lancashire, Milton Keynes and Northumbria and began taking calls in March 1998. The project was extended in April 1999 to cover 40% of the population of England and by November 2000 was available throughout the whole of England and Wales. NHS Direct provides 24-hour advice and information via 22 call centres and is the largest telephone health care service in the world. A similar system is planned in Scotland, NHS 24.