COMMENTARY & ISSUES ❑ JON GLASBY University of Birmingham ❑ PETER BERESFORD Brunel University Who knows best? Evidence-based practice and the service user contribution Abstract This paper reviews the assumptions underlying traditional medical research and critiques the concept of ‘evidence-based practice’. In particular, it identifies and counters three basic tenets of this approach: the alleged need for objectivity in research, the notion of hierarchies of evidence and the primacy of systematic reviews. Instead, the paper argues for a new emphasis on ‘knowledge-based practice’, recognizing that the practice wisdom of health and social care practitioners and the lived experience of service users can be just as valid a way of knowing the world as formal research. Key words: evidence-based practice, knowledge-based practice, user involvement In recent years, there has been an increasing recognition that policy and practice in health and social care should be ‘evidence-based’. In 1997, the White Paper, The New NHS, was clear that ‘what counts is what works’ (Department of Health, 1997). In particular, New Labour was adamant that ‘services and treatment that patients receive across the NHS should be based on the best evidence of what does and does not work and what provides best value for money’ (para. 75). This was to be achieved through a number of mechanisms including the dissemination of high quality scientific evidence through the national Research and Development programme, the introduction of new evidence-based frameworks for various health and social care services, and a new National Institute for Clinical Excellence (see over). Copyright © 2006 Critical Social Policy Ltd 0261–0183 86 Vol. 26(1): 268–284; 059775 SAGE PUBLICATIONS (London, Thousand Oaks, CA and New Delhi), 10.1177/0261018306059775 268 at SWETS WISE ONLINE CONTENT on July 20, 2010 http://csp.sagepub.com Downloaded from