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More Questions About the OOH Data Collection

A Challenge to the Questionnaire from the Centre for Rural Health

‘Evaluation of Community First Responders in Rannoch and Tummel’

Research Ethics and Ethical Practice

It is my view that this questionnaire has been devised and drafted as a weapon against the local campaign to restore full time, locally based GP emergency cover in this area.  This is because there are a number of strategic questions in the questionnaire that are highly likely to solicit answers which will provide NHS Tayside with what it might claim as ‘evidence’ that local people prefer first responders to GPs when it comes to emergency care.

It is because of this that the use of the questionnaire raises issues of research ethics and ethical practice both for the Universities involved in the survey (Aberdeen and University of the Highlands and Islands (UHI) in Inverness) and for NHS Tayside.

The Title

Evaluations usually occur after an event.  This questionnaire is therefore not seeking to evaluate First Responders.  The title is therefore misleading.  However, this is the title of the relevant Project which the Centre for Rural Health (CRH) publishes on its website.

Background Information

Independent evaluation?  The authors, Professor Farmer and Dr Heaney, emphasise that the ‘evaluation’ is independent.  This, in my view, is a false claim.  They, as consultants, are technically independent from their client, NHS Tayside, but the authors are the primary intellectual promoters of First Responder schemes in Scotland.  They are committed to a vision of the future of rural health care in which rural doctors play but a small part.  They personally are members of the First Responders Reference Group set up by NHS Tayside in Kinloch Rannoch.  This group meets periodically in the local GP surgery with senior NHS managers and a very few local people hand-picked to implement, and not to question, NHS Tayside’s decision to provide First Responders for this area instead of reinstating local GP OOH emergency cover.

The CRH has been brought in as a consultant by NHS Tayside to implement a project of delivering First Responders to Rannoch and Tummel and, in these circumstances, it cannot be an independent ‘evaluator’.

Deadline for return of questionnaire?  No deadline is given.  The use of the questionnaire and responses returned are therefore open to significant misinterpretation.  For example, my answers to the questions given today are likely to differ from answers submitted in 1 or 6 months time.  This, on the face of it, suggests sloppy research planning.  However, if there is another explanation, they have not revealed this to us, the local respondents.

The publication of findings?  It is usual in academic and planning circles to indicate how and when the findings of a piece of research or survey are to be published.  No such information has been provided.

The full questionnaire is available at http://www.commentonline.co.uk/supplement/Questionnaire06.09KR.pdf 

You and the Rannoch & Tummel Community:

It is difficult to understand how answers to the questions in this section can help the enquiry as the section relates to community involvement and participation and not to health care.

I am mistrustful of the way in which the researchers will analyse the resultant data – especially given the political and ideological motivation of the CRH (ie the promotion of Community Resilience).

Two questions merit special comment.  Qs 13 and 14 have no subject – ‘I feel supported in the community and I feel I am listened to as a member of the community’.  Supported by whom?  Listened to by whom?

Health and Health services:

This section contains some of the most leading questions of the questionnaire and is ideologically motivated (Qs 21A to 21D).  In these four questions, respondents are invited to state what they would do or who they would call upon first if they experience a severe chest pain or had a suspected broken leg (a) during the weekday and (b) at night or at the weekend – when no local GP cover is available. 

The questions do not solicit what strategy might be employed by a carer who might first call their neighbour and then, immediately afterwards, call the GP or NHS24 or 999.  For example, if people respond that the first person they would contact in an emergency is a family member, friend or neighbour – which is most likely to be the response of someone with a person experiencing this sort of problem in a rural area – this is likely to be interpreted by the data analysts as (a) a vote against traditional NHS services and (b) an indication that the GP is not the first port of call.  It may also be used to defend the claim that First Responders are the people’s choice.  I consider these questions to be unprofessional. 

Community First Responders and Emergency Response:

This section of the questionnaire appears to be reinforcing the Scottish Ambulance Service’s recruitment drive for First Responders yet does not make this explicit.

Perhaps the most disturbing question is Q24 – ‘Did you attend the public launch about the proposed community first responder scheme…?’  There has been no such launch as of 28 June.  There have been recruitment pitches and NHS Tayside organised meetings – but no launch.  So why on earth is this question in the questionnaire?

The questionnaire should specify that persons answering ‘no’ to Q 23 (Have you heard of the proposed first responder scheme…?’) should not answer questions 24, 26 and 27 all of which assume knowledge of the scheme.  I wonder whether the data analysts will disregard answers to these questions if Q23 is a ‘no’.

Your views:

The preamble – which again asserts independence – is suspect.  It is also highly misleading as this is the other section of the questionnaire, together with ‘Health and Health services’ where questions are ideologically motivated and are very likely to produce a deeply distorted picture of people’s views in this area when analysed by conventional quantitative data analysis methods.

The most objectionable questions are Qs 32 and 36. 

Q32 asks ‘I believe that GPs from the local GP practice should be available 24 hours a day, all week…’.  There is widespread appreciation of our local GPs and the service that they provide.  Few people, I think, would wish that their voice be used in any personal attack or demand on existing GPs and therefore it is likely that this question will receive a strong majority of ‘I disagree’ votes.  However, as campaigners for local GP OOH cover constantly stress, the issue is not against our GPs.  On the contrary.  Campaigners are challenging NHS Tayside’s policies – not their GPs.

Then Q 36 invites respondents to say whether they think that this issue of OOH cover for emergency healthcare is ‘the most important problem for Rannoch and Tummel’ to deal with.  At a time when so many families are experiencing so many frustrations and difficulties ranging from employment or housing difficulties to concerns about their children’s education, the answers to this question are likely to be impossible to analyse responsibly.  If a majority of respondents answer that they disagree with the statement in Q36, does this then reinforce NHS Tayside’s view that they can continue to impose their will on this community without consultation?  Or why else would such a question be included?

Qs 33 and 35 are also objectionable.  Q33 asks if the ‘ambulance service is the most appropriate organisation to deal with a healthcare emergency’.  Quite obviously, it depends on the emergency – so how will answers to this question be analysed?

Whatever is meant (in Q35) by ‘seen by an appropriately trained and skilled’ person?  We are asked if we would be ‘satisfied to be seen by anyone who is appropriately trained and skilled in a life-threatening emergency’. 

Of course most people will reply ‘yes’ to this.  And will this therefore mean that NHS Tayside will assume that this community actively wants First Responders as opposed to doctors or paramedics for example?  One of the most heated debates locally is precisely about what type of professional is best qualified to handle a medical emergency. 

Certainly, a ‘yes’ answer to this question allows NHS Tayside to decide, and would attempt to close this valuable debate. 

A final question

It would, indeed, have been a great use of NHS Tayside’s considerable resources to have conducted a survey into the diverse specific needs of different sectors of the community in this area.  And of course, the $25,000 question is really: ‘Do you want to know that a doctor could be with you quickly in case of a life-threatening emergency?’ and ‘Do you want a fully staffed ambulance to be with you quickly in case of this same emergency?’  If only…

Pat Stocker, Rannoch

See also:

http://www.commentonline.co.uk/health/TheQuestionableQuestionnaire.htm