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Wednesday 28 September 2016 Instagram
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NHS reform: policy over evidence?

NHS reform: policy over evidence?

I was mightily cheered to read the headlines in last week's papers reporting that Professor Steve Field, Chairman of the coalition's 'listening exercise', has dismissed the government's proposed NHS reforms as 'unworkable' and 'destabilising'. 

Maybe the government will listen to their own appointee who appears to be reflecting the concerns of thousands of clinical staff, NHS employees and patients across the country?

I think there are probably very few people who work in the NHS (and I use that term in its broadest sense to include GP practices) who are not open to the idea of improvement. More importantly, I suspect that most of us can identify improvements that we would like to make in our own field of practice, rather than assuming that 'improvement' is someone else's problem. However, there is a difference between steering an organisation towards the evolvement of a more clinically and cost-effective healthcare service and imposing a radical reorganisation that will inevitably cost thousands in reorganisation and take attention away from the important task of delivering good clinical care.  

I am constantly amazed by the resilience and wry humour of healthcare staff in relation to the responsibilities they embrace and the lack of respect they receive from the government.  However, I fear that this tolerant and hard-working community is starting to lose patience. Healthcare staff are under pressure to arm themselves with the knowledge and skills to evaluate research and deliver clinical care that is evidence based.

Yet the government seems to have either complete disregard for evidence in relation to policy or lack the ability to adequately critique the evidence. Policy always seems to trump evidence. (If you want to read around this, Ben Goldacre's column in the Guardian, which is available online, is particularly recommended for an entertaining and educational read http://www.guardian.co.uk/commentisfree/2011/may/14/bad-science-ben-goldacre-randomised-trials

Is it too much to expect those politicians who decide the future of the NHS to have sufficient grasp of evidence-based practice in order for them to be able to apply these principles to policy? It is debatable whether 'gold standard' tests of effectiveness, such as randomised, controlled trials, can be applied to policy issues.

But there are other study designs that give us some useful information about the likelihood of relationships between interventions and outcomes. Furthermore, it would be encouraging if there was evidence that the government were using existing data to inform good decision making rather than cherry-picking what best serves their ideological positions.

Before she died, Claire Rayner threatened to come back and haunt anyone who destroyed her 'beloved NHS'. Hopefully she won't be needed but I do hope she's practising her wailing, just in case!

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