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Politicians have scant regard for evidence

Former health tsar calls for evidence-based policy, not 'policy-based evidence'

Louise Prime

Wednesday, 24 September 2014

Politicians must stop the cycle of eye-catching short-term initiatives and pilots whose promised benefits are illusory, argues a former health tsar. David Oliver, who was national clinical director for older people at the Department of Health, argues in The BMJ this morning that when it comes to reducing urgent hospital admissions, the people running the NHS, as well as local service leaders and management consultants, “have little regard for evidence”.

Professor Oliver calls in his personal view* for an end to the “farcical game” of projecting large and rapid cuts in admissions – not informed by any credible peer-reviewed evidence – following hasty implementation of unproven new service models. He points out that once there is proper, controlled peer-reviewed evaluation, there are in fact no such reductions. He points out that for over a decade there have been similar annual projections. Yet, he writes, although about a third of acute and emergency hospital beds have been lost in England over the past 25 years, emergency admissions have risen by 37% in the past decade.

He claims: “This farcical game represents a triumph of management consultancy over evidence, and of hope over experience. Local plans are based on how much money commissioners need to ‘save’ on acute activity rather than any realistic expectation of service delivery. Savings are rarely made just by shifting the setting of care even if community alternatives to hospital are available, effective, and cheaper.”

As one example, David Oliver refers to the Department of Health’s partnerships for older people projects, which it initially claimed had saved £1.20 for every £1.00 spent; yet formal evaluation showed that they had been disappointing “despite the earlier spin”. And, he added, the big benefits and savings the DH claimed from its integrated care projects actually seemed to increase secondary care activity with no increase in patient satisfaction.

The professor is highly critical of the current approach, where ministers search for evidence to back up their policy, rather than basing policy on evidence. He comments: “The Department of Health is a serial offender of seeking ‘policy-based evidence’. A minister has a bright idea. He or she commissions an ‘evaluation’. The minister and NHS leaders prematurely overclaim benefits before any research is published. The evaluation is rigorously scrutinised by independent researchers, using control data. The promised benefits are found to be illusory. The minister has moved on. The next minister with the next big idea starts the cycle anew. Researchers and frontline services receive no apology for the spin, wasteful service changes, or the hijacking of the research process.”

Professor Oliver also points to the negligible impact on urgent bed use, costs, or outcomes of the “much vaunted” Whole Systems Demonstrator Trials of telecare and telehealth, which the Department sponsored and which it initially claimed saved money, transformed lives and was backed by evidence.

He insists: “Nationally, politicians must stop the cycle of eye-catching short-term initiatives and pilots or at least follow the spirit of the Health and Social Care Act by really letting go and devolving operational leadership to NHS England and to local services.”

As part of a constructive solution, he suggests: “Services should make 3-5-year plans for sustainable service change, based on evidence of what works and, crucially, what doesn’t. We should stop wasting money on costly and often poorly evidenced consultancy reports and short-term pilots leading to no sustainable services.”

* David Oliver. Preventing hospital admission: we need evidence based policy rather than “policy based evidence”. BMJ 2014;349:g5538. doi:10.1136/bmj.g5538

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