Making ‘what works’ work: The use of knowledge in UK health and social care decision-making

Decision-makers in UK health and social care are routinely asked to draw on evidence of ‘what works’ when designing services and changing practice. However, this paper argues that too much focus to date has been placed on a narrow definition of what constitutes valid ‘evidence’ (and one that privileges particular approaches and voices over others) and a simplistic conception of the decision-making function. As a result, policy and practice have too often been dominated by medical and quantitative ways of knowing the world, with such research approaches assumed to be more valid than other forms of enquiry. In contrast, the paper calls for a more inclusive notion of ‘knowledge-based practice’, which draws on different types of research, the tacit knowledge of front-line practitioners and the lived experience of people using services. This, the paper argues, will lead to a more nuanced approach to ‘the evidence’ and – ultimately – to better and more integrated decisions. Against this background, the paper outlines a suggested research agenda for those seeking to develop decision-making within these areas.