Alan Maynard

There is a dangerous new rhetoric in Whitehall with politicians describing their policies as 'evidence based'. If this description were true it would be cause of great celebration. However sadly it often is synonymous with a political desire to con the public.

The Darzi report in October offered some wonderful evidence free wheezes aimed at the creation of favourable headlines. For instance there was the promise of a 'personalised' health service with no definition of the term and no costing of its creation. There was the promise of 'effective' health care when Government policy, as epitomised by the National Institute for Clinical Excellence , is focused on persuading the NHS to adopt that which is not merely effective but what is cost effective.

Of course all this spin was in the context of an election that did not happen. But examine other initiatives. Will investing in more matrons in hospitals be cost effective in terms of delivering better cleanliness and reduced infections? Please show us the evidence.

Are 'polyclinics' cost effective? The podcast linked to the London Darzi report depicts the delivery of primary care, diagnostics, maternity and cancer care in smaller purpose built units. However where is the link between these medical palaces and social care? Where is the evidence that the combination of activities advocated for these units is cost effective?

Both the Healthcare Commission and the Health Select Committee have pointed out that there are poor data to interrogate the clinical let alone the cost effectiveness of the Independent Treatment Centres. This appears to be a product both of poor contracting by the Commercial Division of the Department and the failure of Government to be interested in whether this policy was good value for money. The pathetic implied assumption of 'private good, public bad' is a classic case of evidence free nonsense as epitomised by failures at Northern Rock and Equitable Life.

There are other ambitious policies that beg evidence of cost effectiveness. What has been the cost of driving down waiting times to 18 weeks and how many additional QALYs has this policy produced? In October 2006, the Government merged PCTs and SHAs in England. The cost in terms of change, pensions and redundancy was high? Where is the evidence of cost effectiveness?

There is an increasing tendency for politicians to deploy the 'evidence based' argument in defence of blunders that erroneous focus on changing structures and processes, while ignoring process and outcome productivity. i.e. variation in what providers do and their failure to give consumer protection by measuring outcomes.

The policy problem is how to translate evidence into practice when politicians of all parties would prefer not to be 'confused' by facts. It has been known for decades that there are large and inefficient variations in clinical practice but whilst Government publishes reports about such long term problems, they are rarely the focus of political prioritisation.

Why do politicians fail to engage in mitigating gross and well documented inefficiency? Firstly the impact of analytical groups in Whitehall is clearly imperfect. The evaluation done by able economists and OR analysts is not 'sold' effectively 'up the office' to the ministers.

Of course selling messages that may enrage powerful lobby groups, especially the medical establishment, may lose votes. But if ministers were convinced of problems around practice variation and pervasive ignorance of outcome success for patients, the problem is not to ignore these issues, but gain clinical champions and expedite change. Change is absent, indicative then of unsatisfactory evidence 'marketing' by civil servants and tardiness in deploying political skills to recruit allies in enemy camps and manage change.

The reluctance of civil servants to challenge 'evidence lite' or faith based policy making that dominates Whitehall and their current propensity to support evidence free policy reform wastes scarce resources that could save lives. If we are really to get a NHS 'fit for the 21st century', the use of evidence is essential. But this must be real evidence rather than the product of the fancies and foibles of deranged spin doctors and their political masters!

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