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

-191

9

1920

-192

9

1930

-193

9

1940

-194

9

1950

-195

9

1960

-196

9

1970

-197

9

1980

-198

9

1990

-199

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