The finest strategies must be backed up with the best science

The main task of NHS purchasers should be to reshape services to achieve the greatest possible improvements in their population's health. The obstacles to that endeavour are many. They include the scientific problems of measuring the effectiveness of, and hence need for, clinical interventions*RF 1-3* and the political problems of bringing about changes in the teeth of fiercely held interests. As relatively small organisations, purchasersneed all the help they can get with the sheer complexity of altering so many interlockingaspects of provision of the health services while meeting the many other demands of theirnew role.

Coming to their rescue is the Welsh Health Planning Forum's recently completed series of protocols for investment in health gain,*RF 4-17* which summarises the science and mobilises the political will. The series highlights both the advantages and the pitfalls of such an initiative being taken centrally in the NHS. The advantages are obvious: the initiative has led to a lucid set of syntheses that identify many points where change is needed and to a Welsh health service deeply imbued with the proclaimed values of “health gain” (a much used term attributed to this group), “people centredness,” and “resource effectiveness”--the three pillars on which the whole Welsh enterprise was built. But the pitfalls are also evident: …