Fletcher Andrew Neil
Department of Philosophy, University of Durham, 50 Old Elvet, Durham, DH1 3HN UK.
Soc Theory Health. 2022;20(3):291-305. doi: 10.1057/s41285-021-00170-4. Epub 2021 Nov 16.
How 'evidence' is conceptualised, generated and deployed in meso-level policy implementation on the ground is critical to health delivery. Using the case of a large-scale health service reconfiguration in northwest England, this study began as a narrative investigation into how different data types and sources are prioritised as NHS administrative structures change over time. During the research, one unpopular reconfiguration decision, the downgrading of a hospital, was challenged using judicial review. Suddenly, a key decision was being based not upon 'facts and data' type evidence but upon evidence of adherence to administrative procedure. This transferred focus away from the ever-shifting categories and hierarchies of data 'types' towards an emphasis on process. By comparing two deliberative contexts-committee and judicial review-this article proposes that evidence can be understood as simultaneously entity and process. As health service reconfigurations continue in response to austerity, integration agendas, evolving organisational landscapes, and demographic and political change, it is increasingly important to recognise the different meanings and uses of evidence.
在实地的中观层面政策实施中，“证据”如何被概念化、生成和运用对于卫生服务的提供至关重要。以英格兰西北部一项大规模卫生服务重新配置为例，本研究最初是一项叙事性调查，探究随着国民保健服务（NHS）行政结构随时间变化，不同数据类型和来源是如何被赋予优先地位的。在研究过程中，一项不受欢迎的重新配置决定，即一家医院的降级，受到了司法审查的挑战。突然间，一项关键决定不是基于“事实和数据”类证据，而是基于对行政程序的遵循证据。这将关注点从不断变化的数据“类型”类别和等级转移到了对过程的强调上。通过比较两种审议背景——委员会和司法审查，本文提出证据可以被理解为既是实体又是过程。随着卫生服务因财政紧缩、整合议程、不断演变的组织格局以及人口和政治变化而持续进行重新配置，认识到证据的不同含义和用途变得越来越重要。
