Articles Day 7: making the debate relevant

Day 7: making the debate relevant


Not everybody thinks that evidence is the most important thing in the world. But most would recognise that knowing whether a programme of intervention is going to be harmful to them, their family or friends, is a big deal.

At an event earlier in the year, Michael Little from Dartington Social Research Unit said we should strive for 5 per cent of UK’s children’s services to be evidence-based. If 5 per cent is a realistic target, how low must the prevalence of evidence-based programmes be now? How many programmes or policies are a waste of money, demonstrating little or no impact, or worse still, are actually damaging to the children receiving them? Are the parents and the general public aware of this?

Parents are quite rightly concerned about the drugs and healthcare their children receive. This is clearly demonstrated in the media by the controversy surrounding the prescription of anti-depressants to adolescents or vaccines such as the MMR, for instance. Yet do we have the same level of scrutiny in other areas of our public services? For instance, we may not wish to receive an untested and unknown type of medicine but are we willing to receive a dosage of a treatment programme in another area, such as social care or education, that is yet untested? Indeed, even when certain interventions, such as the education programmes Scared Straight or DARE have been tested and are shown to be ineffective, they remain in use worldwide. How can we ensure the evidence generated in areas beyond health is more accessible and useable so people can make more informed judgements about the services that they or their family receive?

The voice of service users is gaining strength, with people able to influence the decisions that affect their lives, accessing information to decide upon what they deem to be the best types of treatment. Take health for instance. There are numerous examples of public campaigning to the National Institute for Health and Clinical Excellence (NICE) when a treatment that patients, their relatives and campaign groups believe to be effective is being withheld. Is there access to such information to enable people to make informed decisions and judgements in other areas of public services? Or do people believe that the supposed lack of evidence is an indication that services are effective, rather than that they may actually have not been tested at all?

We have noted previously that the public are a key ally in advancing the evidence agenda, with a lead role to play in helping demand better evidence to underpin the decision making in public services. If we are to successfully stimulate demand for rigorous evidence on effectiveness, then we need to ensure that we don’t cut the public out, ensuring they are able to decide what are the best quality programmes and treatments for them and their families. This means ensuring the debate and discussion is relevant to what people want: which is positive, impactful public services. This means we need to talk in terms of improving quality of life, which is what driving the evidence agenda is all about.