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

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 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 GlasbyProfessor 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.

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


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  Out of hours contact 077889 921165 or email

Notes to Editors

  • Read the full Policy Paper 16 'Doctor knows best? The use of evidence in implementing self-directed support in health care' here
  • Prof Glasby is professor of heath 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 integration.
  • Prof Glasby has previously been involved in:
    • Advising the NHS Future Forum and the social care White Paper on health and social care integration 
    • Presenting evidence to the previous Ministerial Working Group on Health and Social Care Integration
    • Providing expert input on this topic to Downing Street, the Department of Health, the Cabinet Office and the All Party Parliamentary Group on Adult Social Care
  • This policy paper is published jointly with the Centre for Welfare Reform (, 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.