Fit for the Future: Developing and using an 'evidence file'

NHS South East Coast serves 4.2 million people in southern England. A recent management review identified serious inefficiencies in local health services and proposed a radical restructuring involving shifting care from hospitals into out-of-hospital settings, centralisation of specialist care in fewer hospitals and fewer 24/7 full-service emergency departments. Local people and politicians perceived these changes as a downgrading, rather than improvement, of local services and widespread public protests followed. In response to the controversy health planners asked the Director of Public Health for help. She identified two key weaknesses in the process to-date: a lack of appraised evidence and rigorous non-financial/operational management data, and insufficient clinical engagement. It was agreed that an ‘evidence file' should be produced (by the author) in collaboration with key clinical interests. The objective was to provide managers, clinicians and others, with an evidence-based information resource, to support local discussions about service change. The file included information on: demography, health status, health inequalities, case for change (managerial and clinical), and urgent and emergency care. An appendix included supplementary charts on these and other topics, including actual and avoidable admissions. Challenges faced while developing the file included disagreements on what was important (and therefore worth including), limitations in the available evidence and differences in interpreting evidence and data. However, the file proved to be a powerful catalyst for clinical debate and provided a useful framework to guide local discussions. At this time the file is being used to inform local consultations on new proposals for service change.