EVIDENCE BASED THINKING IN THE PUBLIC SERVICES Jonathan Shepherd Professor of Oral and Maxillofacial...
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Transcript of EVIDENCE BASED THINKING IN THE PUBLIC SERVICES Jonathan Shepherd Professor of Oral and Maxillofacial...
EVIDENCE BASED THINKING IN THE PUBLIC SERVICES
Jonathan ShepherdProfessor of Oral and Maxillofacial Surgery
UNIVERSITY PRACTITIONER TRAINING
Structures
Training arrangements
Public policy context
Research funding
Only 85 RCTs of any size in Crime and Justice 1982-2004
20th Century RCTs in Medical Science and in Social Sciences, Psychology, Education and
Criminology
0
40000
80000
120000
160000
200000
1900
-190
9
1910
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1920
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1930
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1940
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1950
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9
1960
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1970
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1980
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9
Decade
Num
ber o
f RC
Ts
Medicine - Cochrane Library
Campbell Collaboration
20th Century randomised experiments in medicine and in social sciences, education and criminology
According to National OffenderManagement Service researcher, Jonathan Allen (2008): Dearth of studies Implementation is poor Lack of high quality UK research Many studies are not sound
WHAT WORKS: TACKLING RE-OFFENDING AND SUPPORTING OFFENDER MANAGEMENT
Cognitive behavioural therapy, therapeutic communities and drug courts
Augmentation of educational, vocational and job skills and anger management are “promising”
Boot camps and “Scared Straight” don’t work
Overall lack of engagement of policing and offender management with research intensive universities, either for evidence production or for practitioner training
Compared with most other public services, over-dependence ongovernment to produce evidence of effectiveness
GOVERNMENT PUBLIC SERVICE RESEARCH FUNDERS
No trials unit (Medical Research Council MRC) No emphasis on translational research (MRC) No contact point for education, police or
offender management practitioners (MRC)
No public service R&D schemes
(National Health Service R&D scheme)
Economic and Social Research Council (ESRC)
PUBLIC POLICY CONTEXTFramework for science-based innovation to drive public service reform (HM Treasury 2004)
BUTNo formal links between Research Councils and most public services
ANDNo recognition that public service evaluation is a fundamental societal need
Emphasis on science infrastructure, not on applied research (Haldane would not approve)
Evidence producersUniversitiesGovernment departmentsResearch Councils and charitiesPrivate sector
Evidence interpretersGovernment departmentsUniversitiesCochrane/Campbell CollaborationsExcellence InstitutesPrivate sectorMedia
Evidence implementersService practitioners and managers
Evidence distributorsGovernment departmentsUniversitiesExcellence InstitutesProfessional bodiesPrivate sectorMedia
THE EVIDENCE CHAIN
Public services depend on the production, distribution and implementation of evidence of effectiveness
Systematic reviews of evidence depend on field experiments
Few connections between the national science and social science bases and public services
Services are vulnerable to political fashion Many criminologists and other social
scientists lack credibility in public services In teaching and nursing, practitioners stop
practicing when they are appointed as academics
THE MEDICAL SCHOOL MODEL
Practitioner-scientists (formal training pathways)
Practitioner-scientist partnerships Integrated research, services, education and
training ‘Communities (social capital) which produce,
distribute and apply evidence’
The discovery and development of penicillin
NOBEL PRIZE WINNERS 1945
PRINCIPLES
‘The knowing-doing gap’Pfeffer and Sutton 2000
‘Universities must invade the Hospitals’Sir William OslerProfessor of Medicine, Universities of Pennsylvania and Oxford 19th Century
SCIENCE-BASED DISINVESTMENT
Hospital admission Day surgery
Prophylactic surgery:wisdom teeth/tonsils Targeted removal
Coronary artery bypass surgery Angioplasty
Police and Offender management?
SUMMARY
Compared with medicine, applied social sciences are seriously under-developed and far less productive (IEE)
In medicine, there is both fundamental science (e.g., stem cell research) and applied sciences (e.g. public health, general practice and surgery) – in medical schools
By comparison, crime and justice and education research is poorly organised
Proposals for reform
Ensure that research-intensive universities develop service-specific schools/institutes in which new knowledge about service effectiveness and efficiency is generated and disseminated to students preparing for careers as public service professionals.
Establish and maintain formal R&D schemes in all major public services – akin to NIHR in the NHS.
Ensure that research council structure and function reflect and meet public service research needs as well as the needs of research communities
Establish a Public Service Research Board to ensure that research arrangements and expertise, including about the training of practitioner-academics, are shared between services, research councils and government departments.
Establish and maintain crime and justice and education excellence institutes to publish authoritative guidelines and to promote guideline implementation in services and with service regulators.
PROPOSAL
To develop a prototype offender management institute in a research-intensive university which, through strong research, training and service collaborations, generates and delivers more effective and efficient interventions
A multidisciplinary approach, incorporating psychology, health, education, economics and statistics
To develop a cadre of practitioner-academics committed to the production and implementation of reliable evidence for offender management services
WHAT MIGHT A NEW OFFENDER MANAGEMENT INSTITUTE LOOK LIKE?
International standard research hub Interface with OM Trusts and Boards Strong links with government and professional
training Offender rather than discipline focussed Prototype for national adoption
UNIVERSITY POLICE SCHOOLS – THE WALES MODEL
Signal Crime Hotspots
UPSI ACHIEVEMENTS IN FIRST TWO YEARS
Cohort of officer – graduates Signal crime mapping Economic benefits
TrainingRetail trade£1.5 million in external grants
Integration of high grade police research, training and services
REFERENCE:
The production and management of evidence for public service reform. Evidence and Policy 2007;3:231-51
RELEVANCE OF NICE MODEL TO POLICING
NICE provides a model for guiding professional practice Remit similar to NPIA (service quality, innovation, fairness, value etc) Both citizen and population orientated Quality of life orientated Guideline implementation likely in command and control culture Promotes scientific foundations of services Is relevant to generic solutions Provides basis for prioritisation and disinvestment
But: Takes account of few justice issues Depends on primary evidence (e.g. controlled trials) Depends on reliable benefit, harm and cost measures