Towards a knowledge based health service

Few decisions made in health services are made with good evidence.1 This applies particularly to decisions on how health services are structured and managed but is also true of decisions made every day by doctors and nurses.2 The failure stems from those who work in health services being unaware of evidence that is available, from the evidence being disorganised and inaccessible,3 and from the evidence simply not existing. The ambitious mission of the NHS research and development programme is to create a national health service in which decisions are based on evidence,4 and the publication last week of the report of standing group on health technology was an important step in that direction.5 The failure of research to feed through into practice is currently a hot topic,6,7 and the old model of how doctors were supposed to incorporate the latest research into their practice has had only limited success. The model might be summarised thus: doctors are trained at medical school in the latest scientific thinking; their scientific training continues in their postgraduate years; and they pick up on the latest science by reading journals, attending meetings, and talking to colleagues and then incorporate it into their practice. In fact, training at medical school in scientific methods and critical …