I started this research project in October 1999!
I had just completed an MSc at Lancaster University, looking at Primary Care Groups within the NHS and trying to understand some of their organisational complexity using Checkland’s Soft Systems Methodology (Checkland and Scholes, 1990). Part of my research strategy during this period was to look at the new (at the time) NHS strategy that was proposed by the Labour Government – the New NHS – Modern and Dependable. The strategy included the introduction of new services that should enable the consumer to great access to healthcare provision. One of these new service was NHS Direct – a telephone advice service that would be ‘manned’ by highly qualified nurses.
NHS Direct was launched in 1998 after having been developed by operational researchers , in conjunction with what was being utilised within Healthcare Management Organisations (HMOs) in the US. As I had enjoyed my MSc project I embarked on the idea that it would be really interesting and useful to undertake some research into NHS Direct. As an IT practitioner I held the view that a service such as NHS Direct would be extremely beneficial in helping Primary Care Groups in helping them deliver some aspects of their ‘service integration’ initiatives, especially in relation to Our of Hours provision. I felt that Primary Care Organisations were the most relevant part of the NHS to look at as they were the considered as ‘the gatekeepers’ of the NHS and so the introduction of NHSD could potentially have the most impact on their service.
Therefore, I embarked on the PhD project, with the view that NHSD could be classed as an Information Systems and using Checkland’s SSM I could try to understand as how Primary Care Groups were utilising the service within their area of healthcare.
Following extensive interviews with stakeholders within four Primary Care Groups in the NorthWest of England I began the analysis of the data. This was two years into the research project. By the time NHSD had expanded and now included an internet presence and also a TV channel. A key document in 2002 the Carson Report on Out of Hours care was published in which outlined the revised for Out of Hours Care provision in England, with NHSD at its centre.
At this point I stopped the research and did not come back to it until 2009. By this time the situation on the ground had changed in relation to NHSD.
- There had been a number of evaluation reports as to whether the service had been a success ie it had done what it was set up to do. These evaluations were inconclusive.
- Primary Care Groups had now merged into larger organisations and were referred to as Primary Care Trusts.
- NHSD was no longer perceived as the ‘linchpin’ for Out of Hours Care provision. In fact, the Carson report has disappeared off the agenda.
- The new government had initially indicated that the NHSD service might be stopped despite its high levels of ‘patient satisfaction.’
The PhD research was resurrected at a different institution. The view now was that NHSD could not be identified as an IT/S system and that Checkland’s SSM had not been utilised for conducting the research, although some of the tools from within SSM had been utilised.
These changes resulted in a number of alterations to the research project:
- additional data had to be collected. This was so that a more realistic picture could be developed in relation to NHSD utilisation within primary care. Only one of the previous organisations agreed to participate again.
- Following a lead from a key member of NHSD another organisation, in a different part of the country, was approached. This was suggested as this particular organisation was an active user of some of the services that NHSD provided. By adding this organisation there was richer data to be analysed.
- Literature review has had to be completely refreshed and there was now a need to look at different possible areas.
- The research questions that had been developed ten years ago had to be reviewed taking into account the changing circumstances
It almost feels as if I am back at square one but the difference now is that I have the data! I have to find a suitable way to proceed but at the moment I have still to find it!