Published: 31/07/2003, Volume II3, No.5866 Page 19
One of the questions I am often asked, particularly by doctors, is why we do not have evidence-based policy.
The beginning of the silly season this year marks the beginning of a potentially much longer one - the search for political manifesto ideas. Is there any hope that the manifestos might be based on evidence?
Well there is some. The Conservatives have been on a tour of Europe and are consulting. The other parties have mechanisms for searching out and testing ideas. But unfortunately, we know from the literature that the policy process is often far from the rational ideal - the problems are not necessarily understood and the options are not evaluated dispassionately.As the process starts, what could be more useful than a cut-out-and-keep guide for everyone involved in policy making, me included:
Beware of solutions looking for problems. Think tanks and other 'policy entrepreneurs' desperately want to see their exciting solutions adopted and will suggest them as the answer to whatever problem is top of the agenda, whether it is relevant or not. The most recent example has been countless think tank discussions on public interest companies.
Also beware of borrowing solutions from other countries or sectors without understanding the cultural issues and all the other parts of the system.Having found the solution to a problem, do not try and use it to solve all the other problems.
Develop the policy before the snappy phrase.Having a good phrase and a compelling story to tell is important in policy making as it is in leadership generally, but it is useful to know what the policy means before you announce it. 'Retrofitting' the detail to the big idea is often difficult and unsatisfactory.
Healthcare is not the same as elective surgery.NHS people know this but many think tankers and policy commentators appear to ignore chronic disease completely.As a result, almost all public debate about healthcare seems to think that most of it consists of single episodes of definitive treatment.
Beware of well known facts. These are not necessarily true.
Very often they started as good ideas but have been stripped of the subtleties and qualifications needed to understand them. Favourite examples include ageing increases costs and increasing day surgery produces bed closures.
Changes in structure are not a solution to problems of relationships or quality. Policy makers like structure change because they are able to make it happen in a way that is not possible for the detail of how care is delivered.
Do not bash bureaucrats in the middle of major reforms.
Claiming that you are going to deal with red tape and make changes in the system simultaneously may create problems later. The current government was not the first to be caught out by this - and it may not be the last.
Test the policy with real people - preferably real people who know about healthcare - and especially the end users.
Remember that implementation is not instant and that there are limits to what the system can handle. As Einstein is supposed to have said: 'The only reason for time is so that everything doesn't happen at once.'
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