Innovations in services and the appliance of science

Managers and doctors should both seek evidence of effectiveness

Everyone now accepts that new drugs should be tested extensively before their introduction. A similar consensus is developing over health technology.1 2 Broadly defined, health technology includes methods of organising care,3 but currently innovations in how health services are organised and delivered often seem to be unregulated and unevaluated. Several factors drive innovation in services. These include perceptions of improved cost effectiveness on the part of policymakers or local purchasers and providers, perceptions of demand from the public and patients for changes in the delivery of care, and enthusiastic promotion of new technologies by commercial interests. Perceptions of usefulness are, however, all too often based on subjective impressions rather than established facts.

Many current innovations are concerned with the interface between primary and secondary care because of the (largely untested) belief that shifting care to the community will be more cost effective and more acceptable to the public than current patterns of provision of hospital services. Such innovations include hospitals at home, specialist outreach schemes, primary care emergency centres, and the development of discharge planning. Other innovations include changes in skill mix and professional roles, such as the introduction of practice counsellors, nurse practitioners, and health advocates for ethnic minority groups. Research on several of these topics is now being commissioned4 as part of the …