Commentary: Fixing the policy may not sort out the politics
BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d2093 (Published 04 April 2011) Cite this as: BMJ 2011;342:d2093
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Political science is an oxymoron. Since politics often involves
secret alliances, hidden agendas, broken promises, equivocation, and
misrepresentation, it's hard to imagine that politics is scientific. And
it's not hard to imagine that politics is, in fact, inimical to science.
So I propose that science free itself from politics, and that politics
stop masquerading as science. Sadly, politics is mostly abstraction and
distraction without traction or action.
Competing interests: No competing interests
It is time to simultaneously fix the policies and the politics before
another bouncing bomb called 'reform' hits the NHS.
We badly need cousin of NICE to enter the scene, one called NIPHE -
the National Institute of Policies in Healthcare Excellence. Its remit
would be to evaluate healthcare policy using available evidence, or to
recommend further research, in order to inform national healthcare
providers and government about the policies which result in the most
desirable health outcomes and are cost-effective.
Competing interests: No competing interests
Re:What are we waiting for?
On politics as a science, don't think anyone thinks the practise of
politics is a science - much more an art (black!). But the study of
politics could be scientific.
On the role of NICE to evaluate costs and benefits of policy as well
as clinical interventions, there is already a requirement across
government departments to provide what are called 'impact assessments' of
new (major) policy initiatives. For health, these are published on the
Department of Health website. Unfortunately they tend to be rushed pieces
of cost benefit work, often missing the crucial last step of presenting
costs and benefits in monetary terms. Oh yes, and they are put together by
civil servants within the Department and often clearly designed to support
what ministers have already decided they want to do anyway.
Organisations such as the King's Fund, the NHS Confederation and
others try to provide independent assessments of policy, but it would be
good if there were also a requirement to estimate, at a minimum, what new
policy/legislation is likely to cost - such as provided by the
Congressional Budget Office in the US. Maybe a role for the Office for
Budget Responsibility here?
At the moment, impact assessments do not seem to be taken too
seriously by departments and I suspect are seen more as an irritating
chore rather than an essential piece of policy evaluation.
Competing interests: No competing interests