It should be self-evident…

All sectors involved in health and social care must begin to respect the evidence produced by one another for self management to flourish.

“Third sector organisations provide quite a lot of the support available to help people with their self management.”  Not particularly controversial.

“Good evidence helps service commissioners make good decisions.”  Again, probably not much to quibble with.

“Self-evaluation evidence from third sector organisations is at least as valuable as that gathered via formal research.  It should therefore be used to inform investment decisions.”  Hmmm…?

“Self-evaluation can produce even better evidence when it’s led by service users.”  Errrr…? Why bother involving people in evaluation? Beyond feedback (this link will take you away from our website) – this is a free resource which can help you try this out.

My guess is that some of you are feeling less sure about nodding along now.  Or perhaps you agree wholeheartedly but know this doesn’t necessarily reflect the environment you work in.

“Evidence informed policy making.”  A Good Thing, surely?  “Evidence based practice.” Another.

The contexts surrounding self management are changing with the introduction of Self-directed Support and Health & Social Care Integration.  At the same time these phrases have entered the zeitgeist.  It is beyond the scope of this blog to examine whether there’s a causal link.  However, if our society is aiming to use “evidence” to make important decisions, I do want to explore whether there is a shared understanding of what this should include.

Despite my own very definite non-scientific bias, the first image that leaps to my mind is of people in lab coats poring over microscopes and creating complicated graphs I don’t understand. I suspect I’m not alone.  Then I remember that this is only one type of evidence.

The Collins English Dictionary defines “evidence” as: “…anything that you see, experience, read, or are told that causes you to believe that something is true or has really happened.”  It goes on to say: “Evidence is the information which is used in a court of law to try to prove something. Evidence is obtained from documents, objects, or witnesses.” (HarperCollins Publishers, 2018)

Despite these definitions highlighting that evidence can be gathered from various sources, I think there’s a tendency to view certain types of evidence as having more weight than others.  Perhaps unsurprisingly this varies by sector.

To oversimplify, the medical world is used to carrying out large-scale randomised control trials and basing protocols on the resulting data.  (Evidence from objects?) The third sector is used to working with individuals in the midst of the full complexity of their lives and using self-evaluation to gather these people’s experiences and inform service development.  (Evidence from witnesses?)  My guess is that each sector has intuitively developed systems that produce the types of evidence that make most sense for its own context.

For self management to become the norm, several different cultures and perspectives (including individual, third sector, local authority, health and private enterprise) need to come together and work in partnership.  This includes agreeing on what is accepted as useful evidence for making policy, practice and investment decisions. Evaluation Support Scotland (ESS) recently facilitated a cross sector round table event on this topic.  An event report is available: Evidence for What? Lessons from the third sector (this link will take you away from our website). 

My concern is that health (the biggest, most streamlined culture) may, perhaps unwittingly, dominate.  I have already come across third sector organisations that believe they now need to produce (quasi) scientific evidence in order to be taken seriously in this evolving environment.

This dismays me.  For a start I doubt that the resulting “evidence” will have much genuine validity.  Third sector organisations are not designed, funded or staffed to conduct rigorous research.  More importantly, however, I think it risks erasing individuals’ voices from the bank of available evidence which informs service planning.   For me, these voices are essential.  How can we know what works for people and why if we don’t have a means of hearing their perspective and experiences?

We would, quite rightly, be horrified if all clinical research was abandoned and simply replaced by feedback from patients alone.  There is, of course, no way this would happen.

Similarly I believe it is self-evident that the third sector must continue to provide opportunities for individuals to bear witness to their experiences.  ESS’s Threading the Needle (this link will take you away from our website) programme has shown that effective health and social care commissioning needs a range of different types of evidence and that third sector evidence is a key part of the rich mix needed to inform good decision making. Threading the Needle is a Scottish Government funded programme which focuses on how third sector evidence can be used to commission outcomes for health and social care.

For self management to flourish, therefore, all sectors need to respect each other’s evidence, set aside any notions of better and worse types, and welcome the chance to build a more comprehensive pool of knowledge to draw on.

End of page.