As the seven day NHS row shows, you can't dress up ideology as evidence-based policy

The seven-day NHS ought to be an exemplar of evidence-based policymaking: a problem is exposed by evidence, and solved by responding to it. But that requires good evidence – and good advice on how to interpret it

A junior doctor strikes outside King's College hospital A&E on April 27 2016 (Getty)

Among the many controversial justifications for the Government’s ambition to create a “seven day NHS” is the so-called ‘weekend effect’ on hospital death rates. Studies cited by the Government as evidence behind their policies for a modernised health service suggested that patients admitted to hospital over the weekend were more likely to die, which ministers claimed might be down to lower staffing rates and lack of routine care. A fully-staffed service all week long would be able to overcome this risk, it was suggested.

The figures have long been contested by doctors, who state that the original studies misinterpreted data on hospital deaths. In the last week, two new reports have emerged which appear to vindicate the doctors. The first, from Oxford University, reported that discrepancies in death rates were down to how they were recorded, or “coded”, by doctors – a process that is not sufficiently specific, and leads to inaccuracies. When these inaccuracies are removed, the weekend death spike similarly disappears.

A study from the University of Manchester found that only the most sick patients were admitted at the weekend, meaning admissions were more likely to lead to mortality due to the severity of the illness suffered by the admitted patient. So where does this leave the Government’s promise to create a safe, seven day service?

Political policies, when they are designed, are based on one of two things: evidence, or ideology. Ideological policy is based on ideas of how the world should be; what is right, just and most cost effective for the country according to one’s political beliefs. Evidence-based policy is something else. It centres not on how the world ought to be but how it already is, and how and where it can effectively be changed. It is concerned with the end result, rather than the means.

The seven day NHS ought to be an exemplar of evidence-based policymaking: a problem is exposed by evidence, and solved by responding to it. But, as this case shows, good policymaking requires good evidence, and good advice on how to interpret it. It is not enough to create an ideological policy and dress it up as evidence-based simply because a study or two appears, at first glance, to support it. Blankets are rarely pulled over the collective eyes of the electorate for long.

If the Government is truly committed to making policy that is based on evidence and research – and that would be a welcome move – it needs to invest the time and resources into properly understanding that evidence first.