Is it nice to have a NICE?

 

Eibhlin Ni Ogain

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Eibhlin Ní Ogáin

What would happen if we decided which social interventions to fund based purely on the evidence of their efficacy? If we are to believe the current rhetoric, a lot more effective interventions would get funded, public and private funds would not go to waste, and a lot more lives would be changed as a result.

This is the idea that has been behind many debates and a flurry of articles in the world of social good. Some have dubbed it the ‘NICE for social policy’ as NICE (the UK’s National institute for Health and Clinical Excellence) already provides evidence-based guidance on the most effective ways to prevent, diagnose and treat disease and ill health.

All sounds great, doesn’t it? But could this really work for the social sector and what would such a body look like?

There was lively debate when this idea was discussed at a recent roundtable hosted by NPC. There was genuine passion for the ability of research and stringent evaluation to tell us what works for different social problems and the need to use this information to ensure that funds do not go to waste. We heard stories of badly done evaluations and large, expensive public programmes being funded despite the lack of evidence of change. These problems, coupled with the current economic climate (where we need to achieve a lot more with a lot less), led some to support the idea of having an institute that produces guidance on which social interventions to fund.

The consensus in the room was that it’s an idea worth trialling but there are difficulties, especially when it comes to translating from the ‘forest of health to the arid sands of social policy’, as one attendee put it. Some of these ‘transplanting concerns’ focussed on the complexity of evaluating social interventions. The causes and consequences of today’s social issues are a lot harder to pin down and test than drug trials for x, y and z diseases. The results of social intervention evaluations may also differ depending on the context, the local economy and indeed the country.

One attendee, who coincidently had a background in the pharmaceutical industry and was involved in many of the early discussions that led to the creation of NICE, told us these concerns echoed the conversations that preceded NICE. Interestingly, NICE now produces guidance for a plethora of interventions – not just strictly drug treatments. Log onto the NICE website and you will find recommendations on a range of approaches, from promoting social, emotional and mental well-being to a number of conditions that have a substantial behavioural component. These are issues that are not easy to pin down, not easy to research empirically and certainly not easy to find effective interventions for: yet significant progress has been made in researching the core issues and core ways of intervening.

Yes, human welfare can be a lot more complicated and as a consequence the interventions themselves may be complex – but pinning down and systematically reviewing what works and making sure this gets funded could make a real difference. The danger is that potentially innovative and untested interventions may not get funding if we are too prescriptive in this approach and set the standard for evidence unachievably high. We need a dual system where we fund what works at the same time as encouraging and testing new approaches. A NICE could help us to do this but we need to be wary of the gap it might leave.

Eibhlin Ní Ogáin is is a research analyst in the measurement team at New Philanthropy Capital

Tagged in: Effectiveness NICE Social policy UK


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