Evidence-based policy and practice: riding for a fall?

Hard on the heels of evidence-based medicine (EBM) comes evidence-based policy and practice (EBPP). At all levels in healthcare systems there is a hunger for better knowledge to inform policy and practice. Is this yet another of the fashions and fads that continually beset the National Health Service, or does EBPP mark a development that could fundamentally change the way in which health policy is made and implemented? There are good reasons to be sceptical about some of the claims made for EBPP. Rudolf Klein1 has written about ‘the new scientism’ with its promise that greater knowledge will reduce uncertainty and release us from the dirty business of political decision-making. A forlorn hope, he indicates. Coming from a different perspective, Gore Vidal has written: ‘it is the spirit of the age to believe that any fact, however suspect, is superior to any imaginative exercise, no matter how true’. Policy-making and management are often creative activities that fly in the face of the ‘evidence’. In the past, the application of EBPP has been the exception rather than the rule. Even where evidence exists in favour of change, to achieve that change remains a challenge. Too little attention has been paid to implementation and the factors that govern its success or failure. The position in clinical medicine is similar. Despite these doubts, the prevailing view today is that evidence-based policy should temper, if not replace, opinion-based policy. In this paper I comment on three features—the challenge posed by getting evidence into policy and practice; the disconnect between the evidence base and policy reality; and the place of evidence in policy.