Editor—We were pleased to see Greenhalgh et al's formal evaluation of two quite different informaticist services.1 Our own experience in facilitating evidence supported policymaking suggests that some of the points raised apply to policy as well as to practice, though additional points must be considered. Our developing approach has some commonality with both projects but is aimed at policymaking bodies comprising health professionals and lay representatives rather than groups of practitioners.
We decided that a “laboratory test service” approach would not be appropriate in policymaking, although as an academic unit we found it intuitively attractive, at least initially. We were obliged to recognise that health policy issues rarely resolve into a question that can be answered in three stages. Often, several questions need to be tackled simultaneously as policymakers need to consider local processes, structures, times scales, and concerns.2,3
The outcome is a set of options rather than an answer. Over time we have increasingly favoured an approach closer to the Basildon model. We aim to arrive at best accepted wisdom by accessing authoritative sources of pre-appraised guidance,4 particularly those whose methodological approach to evidence appraisal is both explicit and systematic.
We have worked closely with local policymaking bodies and have designed dissemination tailored to each issue. The close relation between our academic unit and service departments of the NHS locally has made this possible. Recently we have addressed diverse questions, such as the health risks from household waste incinerators, the cost effectiveness of photodynamic treatment for macular degeneration, and the organisation of antenatal screening programmes.
Our experience suggests that facilitation of evidence based policymaking should be underpinned by an acknowledgement of the complexity of policy. We have to accept that we may sometimes need to compromise the technical quality of the answers: if a decision is needed quickly it may be appropriate to base it on easily accessible authoritative guidance rather than on a comprehensive review of all available evidence including appraisal of primary research. We believe that the adoption of a pragmatic approach can achieve a more systematic use of evidence than is usual in the NHS.5
The question of whether our approach, which focuses on the service dimension, produces good policy decisions needs evaluating. We believe that the two dimensions of a health informatics service, as described by Greenhalgh et al, will prove to be an important component of the methodology. We also agree that such an evaluation requires a developmental rather than a conventional approach to research.
References
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