The nature of evidence in public health decision making

This research into decision making around public health in local authorities demonstrates an interesting parallel to decision making in NHS commissioning processes in CCGs.

Evidence-based medicine meets democracy: the role of evidence-based public health guidelines in local government
M.P. Kelly L. Atkins C. Littleford G. Leng S. Michie
J Public Health (Oxf) 2017, p1-7. DOI:

NICE has published a number of public health guidelines developed using classical evidence based approaches. Researchers interviewed public health local authority (LA) employees in four LAs about their experiences of implementing these guidelines following the move of public health functions in 2013. Participants reported tensions between evidence based and political decision making, differences in views about what constituted “good” evidence, and that organisational life is an important mediator in the way evidence is used.

“Political decision making does not necessarily align with decision making based on the evidence from the international scientific literature, and local knowledge and local evidence are very important in ways that public health decisions are made.”




Evidence-based policy-making: the view from a commissioner

“As commissioners we are influenced by a vast range of competing factors…research evidence is one of those factors which I value highly, but it doesn’t always help us out as commissioners.”

This blog post by a CCG commissioner describes the real life issues around using research evidence in policy making.

Evidence-based policy-making: the view from a commissioner. Rachel Anthwal, Delivery Director at Bristol Clinical Commissioning Group, 10 April 2017

Referral management schemes: good for whom?

BMJ has done some investigation into referral management systems through FOI requests. It is hoped that these schemes will reduce costs and improve the quality of referrals. Of the 184 CCGs that responded, 72 (39%) said that they currently commissioned some form of referral management scheme.

Read the report here: Referral management schemes: good for whom? BMJ 2017;356:i6856 (NHS OpenAthens ID required)
This has been added to the GP Referrals and demand management Hot Topic page.

Commissioning to prevent falls

Effective commissioning for falls and fracture prevention will reduce demand and improve quality and outcomes. A consensus statement published by PHE compiled by the National Falls Prevention Coordination Group –  Falls and fracture consensus statement: supporting commissioning for prevention  brings together proven approaches to interventions and activities which help to prevent falls and fractures but which are currently not always managed effectively.

Added to the Older People section of the Resources for Specific Populations page.


Integration resources and outcomes based contracting

In these days of increasing integration with the SPTs the Integration resource library from the LGA will be very useful. It includes definitions, FAQs, tools and resources to support the development of local integrated health and care services.

Also, I found a series of reports from Optimy Advisory on Outcomes Based Contracting, published in 2015 but potentially still useful. Topics include System Readiness, Business Case, Outcome Measures, Business Intelligence, Payment and Reimbursement and Governance. See the series here.

New End of Life / Palliative care knowledge hub

For those involved in end of life care/palliative care this new Knowledge Hub will be of interest:

Ambitions for Palliative and End of Life Care

“A knowledge hub where you can find resources, such as assessment tools, useful information, best practice examples and case studies, that will help you implement the Ambitions framework.” Many of the resources have been transferred from the NHS IQ and the End of Life Care Facilitators’ Network websites.

Now listed on the Specific Conditions page.