Doctor knows best? The use of evidence in implementing self-directed support in health care

This new policy paper from the University of Birmingham’s Health Services Management Centre 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 concepts of personal budgets and self-directed support are well-established in adult social care and have been successfully piloted in the NHS. However, a key debate – particular for clinical staff – has been around the nature of the evidence base required to justify a more fundamental shift in traditional ways of working. Against this background, this policy paper explores what comprises valid evidence in the first place and potentially more fruitful ways of considering the ‘evidence’ of what works in future.

In 2009, the UK Department of Health (DH) launched the first national pilot of self-direction in health in the National Health Service (NHS) in England, testing what they named personal health budgets (PHBs). In total sixty-four local areas participated in this three year pilot, of which 20 took part in an in-depth, controlled evaluation (Forder et al., 2012).

Following the publication of the national evaluation in November 2012, the government confirmed its commitment that all recipients of continuing health care should have the right to ask for a PHB from April 2014. A less firm commitment to extend PHBs to all those with long term conditions who could benefit from April 2015 was also made.