Website of the Department of Health

In the NHS, the Department of Health, including the NHS Executive, sets the national framework within which services are delivered. The Department uses a range of policy instruments in this process including legislation, white papers, circulars and guidance, corporate contracts, review meetings and financial levers. These levers include earmarking funds for specific purposes and determining payment systems for health care professionals and institutions. In addition, a range of bodies at a national level influence the delivery of services indirectly, for example the Audit Commission, parliamentary committees, the Clinical Standards Advisory Group, the royal colleges and specialist associations and the Mental Health Act Commission. All of these bodies may have an impact - either positive or negative - on research implementation which requires further evaluation.

Effect on evidence based practice of general health policy measures

Description and Justification

The impact of initiatives directed at particular services should be examined. These include recent changes in the organisation of maternity services. The impact of such initiatives on increasing uptake of research findings and enhancing evidence-based care.

Policy measures can sometimes have unanticipated consequences. These may conflict with policy goals emanating from another source. For example, the Audit Commission's basket of day case procedures included D&C. From the R&D perspective, provider units should be discouraged from using this procedure, which is often performed inappropriately, but this could conflict with the Executive's efforts to encourage greater use of day case procedures, including D&C. Other examples might include the Efficiency Index, the Waiting List Initiative, and the Patient's Charter which, depending on the way in which they are interpreted locally, may inhibit attempts to promote evidence-based practice. These unintended consequences need to be researched so that conflicts are identified from which solutions and local guidance can be derived. The impact of the NHS reforms themselves on evidence-based care need evaluation, although particular areas such as the role of commissioning have been covered in other priority areas.

Research Approach

Descriptive and hypothesis-generating studies would be helpful in this area.

Studies are needed to examine the process of research implementation and the role of policy influences. This would be particularly helpful in particular services where policy guidance has resulted in changes in practice. The influence of policy should be compared with other drivers for clinicians and managers to change practice, including direct utilisation of research findings by individual clinicians or managers. Research in this area might use case studies to examine particular policy initiatives and explore the factors affecting changes in practice in health care.

References

Department of Health (1993). Changing childbirth (part I): Report of the Expert Maternity Group. HMSO, London

Ham C J (1992). Health policy in Britain. Macmillan, London

Klein R E (1989). The politics of the NHS. Longman, London

Audit Commission: A short cut to better services: day surgery in England and Wales; HMSO; 1990