Does doctor know best? A new approach to "evidence" based health care

Posted on Thursday 19th December 2013
Jon Glasby

Prof Jon Glasby

Leading health care experts have today called for a fresh approach to evaluating treatment amid claims that dog walking and singing classes can lead to greater health improvements than traditional medicine for some patients.

A new policy paper published by the Health Service Management Centre at the University of Birmingham and the Centre for Welfare Reform argues that the NHS has become too dominated by quantitative and medically orientated notions of what constitutes valid evidence and suggests there needs to be a shift in focus from services to outcomes.

The report, entitled Doctor knows best? The use of evidence in implementing self-directed support in health care, states: “The question isn’t ‘do personal health budgets work?’ – but rather who decides what success should look like in the first place and what outcomes can services users and staff working together with greater scope for innovation and creativity achieve that might not have been possible with mass purchased or produced services?”

Professor Jon Glasby, lead author of the report, said: “When it comes to personal health budgets there has been a lot of media attention about what people use the money for, like an overweight person who used their personal budget to buy a dog.  There are no NICE guidelines on the cost-effectiveness of dogs for weight loss, but it does seem like a simple way of getting someone to walk more and could work better than more traditional weight loss programmes. The point is that the focus has to be on the outcomes achieved, rather than on the process itself.”

The report points to an example of a woman with a serious mental health condition who used to make frequent ambulance call outs and visits to Accident and Emergency. She used her personal health budget to by art materials, which provided sufficient distraction when she heard voices to prevent more emergency visits. In another example, several people used singing classes as an alternative to pulmonary rehabilitation to stabilise their breathing and provide a greater sense of well-being than the traditional service.  In all these examples, the focus is not on what is purchased but on whether or not it is a good way of meeting desired outcomes.

“The challenge for healthcare professionals will be to see these kinds of approaches as genuine innovations in healthcare,” the report states. 

Ends 

For more information or to interview Prof Glasby, please contact Deborah Walker, PR Manager for Policy and Social Affairs, University of Birmingham, 0121 414 9041 or email d.s.walker.1@bham.ac.uk Out of hours contact 077889 921165 or email pressoffice@contacts.bham.ac.uk

Notes to Editors

A full copy of the policy paper can be found here www.birmingham.ac.uk/hsmc-policy-paper-sixteen

Prof Glasby is Professor of Health and Social Care and Director of the Health Service Management Centre at the University of Birmingham. HSMC is the leading UK centre for research, teaching, consultancy and policy advice around health and social care. 

Prof Glasby has previously been involved in:

1. Providing policy advice to the Department of Health, the Cabinet Office and Downing Street on the extension of personal budgets from social care into health

2. Advising the NHS Future Forum and the social care White Paper team on health and social care integration

3. Advising Downing Street on the future of social care reform

This policy paper is published jointly with the Centre for Welfare Reform (http://www.centreforwelfarereform.org), an independent think tank which promotes more person-centred approaches to the delivery of welfare services.  The Centre’s Director, Dr Simon Duffy, developed the initial concept of personal budgets in social care, and was awarded the RSA Prince Albert Medal for civic innovation in recognition of his contribution.

Vidhya Alakeson is the Deputy Chief Executive of the Resolution Foundation and coordinates the personal health budgets for mental health demonstrator programme for NHS England.  She is the author of Delivering personal health budgets: a guide to policy and practice, due to be published by The Policy Press in 2014. To contact Ms Alakeson please call 07929 157987.