“Success is in the eye of the beholder”
One of the things that we have to consider when thinking about NHS Direct as an innovation is that its purpose has changed over the ten years period since its inception. Not only has the purpose changed but also how it functions has also changed. Evidence of this can be obtained by comparing the Carson ‘Out of Hours report that was commissioned by the government in 2002 and the report by Steven Field on GP Out of Hours working in 2010 and bringing control of this function back within the remit of the GPs.
Despite the changing purpose and associated functions, evaluations of such service such as NHS DIrect are usually set in stone when the service is first delivered. By the time the evaluations of NHS Direct had taken place a number of shifts had taken place:
NHS shift – new structures, organisational change, power shifts, new imperatives
Social shifts – democratisation of health, internet access, information literacy
As NHS Direct matures it appears to become part of the NHS ‘furniture suite’. So the question one asks then is what model of evaluation is suitable for public sector services such as NHS Direct and can applying a system thinking approach assist with a richer understanding when undertaking this evaluations?