by The King’s Fund (2017)
Central government cuts have forced councils to reduce planned spending on vital public health services such as sexual health clinics and reducing harm from smoking, alcohol and drugs by £85 million, according to new analysis by The King’s Fund.
Wye, L. et al. BMC Health Services Research, 2015; 15: 430
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Abstract
Background
Policymakers such as English healthcare commissioners are encouraged to adopt ‘evidence-based policy-making’, with ‘evidence’ defined by researchers as academic research. To learn how academic research can influence policy, researchers need to know more about commissioning, commissioners’ information seeking behaviour and the role of research in their decisions.
Methods
In case studies of four commissioning organisations, we interviewed 52 people including clinical and managerial commissioners, observed 14 commissioning meetings and collected documentation e.g. meeting minutes and reports. Using constant comparison, data were coded, summarised and analysed to facilitate cross case comparison.
Results
The ‘art of commissioning’ entails juggling competing agendas, priorities, power relationships, demands and personal inclinations to build a persuasive, compelling case. Policymakers sought information to identify options, navigate ways through, justify decisions and convince others to approve and/or follow the suggested course. ‘Evidence-based policy-making’ usually meant pragmatic selection of ‘evidence’ such as best practice guidance, clinicians’ and users’ views of services and innovations from elsewhere. Inconclusive or negative research was unhelpful in developing policymaking plans and did not inform disinvestment decisions. Information was exchanged through conversations and stories, which were fast, flexible and suited the rapidly changing world of policymaking. Local data often trumped national or research-based evidence. Local evaluations were more useful than academic research.
Discussion
Commissioners are highly pragmatic and will only use information that helps them create a compelling case for action.Therefore, researchers need to start producing more useful information.
Conclusions
To influence policymakers’ decisions, researchers need to 1) learn more about local policymakers’ priorities 2) develop relationships of mutual benefit 3) use verbal instead of writtencommunication 4) work with intermediaries such as public health consultants and 5) co-produce local evaluations.
Cairney, P. et al. Health Research Policy & Systems, 2017; 15: 35
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There is extensive health and public health literature on the ‘evidence-policy gap’, exploring the frustrating experiences of scientists trying to secure a response to the problems and solutions they raise and identifying the need for better evidence to reduce policymaker uncertainty. We offer a new perspective by using policy theory to propose research with greater impact, identifying the need to use persuasion to reduce ambiguity, and to adapt to multi-level policymaking systems.
We identify insights from secondary data, namely systematic reviews, critical analysis and policy theories relevant to evidence-based policymaking. The studies are drawn primarily from countries such as the United States, United Kingdom, Canada, Australia and New Zealand. We combine empirical and normative elements to identify the ways in which scientists can, do and could influence policy.
We identify two important dilemmas, for scientists and researchers, that arise from our initial advice. First, effective actors combine evidence with manipulative emotional appeals to influence the policy agenda – should scientists do the same, or would the reputational costs outweigh the policy benefits? Second, when adapting to multi-level policymaking, should scientists prioritise ‘evidence-based’ policymaking above other factors? The latter includes governance principles such the ‘co-production’ of policy between local public bodies, interest groups and service users. This process may be based primarily on values and involve actors with no commitment to a hierarchy of evidence.
We conclude that successful engagement in ‘evidence-based policymaking’ requires pragmatism, combining scientific evidence with governance principles, and persuasion to translate complex evidence into simple stories. To maximise the use of scientific evidence in health and public health policy, researchers should recognise the tendency of policymakers to base judgements on their beliefs, and shortcuts based on their emotions and familiarity with information; learn ‘where the action is’, and be prepared to engage in long-term strategies to be able to influence policy; and, in both cases, decide how far you are willing to go to persuade policymakers to act and secure a hierarchy of evidence underpinning policy. These are value-driven and political, not just ‘evidence-based’, choices.
Masters R, et al. J Epidemiol Community Health 2017;0:1–8. doi:10.1136/jech 2016-208141
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ABSTRACT
Background Public sector austerity measures in many
high-income countries mean that public health budgets
are reducing year on year. To help inform the potential
impact of these proposed disinvestments in public
health, we set out to determine the return on investment
(ROI) from a range of existing public health
interventions.
Methods We conducted systematic searches on all
relevant databases (including MEDLINE; EMBASE;
CINAHL; AMED; PubMed, Cochrane and Scopus) to
identify studies that calculated a ROI or cost-benefit ratio
(CBR) for public health interventions in high-income
countries.
Results We identified 2957 titles, and included 52
studies. The median ROI for public health interventions
was 14.3 to 1, and median CBR was 8.3. The median
ROI for all 29 local public health interventions was 4.1
to 1, and median CBR was 10.3. Even larger benefits
were reported in 28 studies analysing nationwide public
health interventions; the median ROI was 27.2, and
median CBR was 17.5.
Conclusions This systematic review suggests that local
and national public health interventions are highly costsaving.
Cuts to public health budgets in high income
countries therefore represent a false economy, and are
likely to generate billions of pounds of additional costs
to health services and the wider economy.
By National Institute for Health Research (2016)
This briefing summarises the findings of a study that found that practices that offered additional appointments showed a reduction in the number of their patients attending emergency departments for minor conditions but that there was no overall reduction in emergency visits. Costs were reduced for emergency departments but by less than the cost of the additional appointments. These findings suggest additional appointments may help reduce minor A&E visits but may be more costly overall.
By Public Health England (2016)
Health inequalities are systematic and avoidable differences in health and wellbeing between groups of people or communities.
This resource has been prepared by the Public Health England Knowledge and Library Services Team to help people working in public health, identify the best evidence for making decisions around health inequalities.
The conceptual and legal frameworks for considering health inequalities and equality are related but slightly different. Health inequalities are avoidable and unfair differences in health status between groups of people or communities. Equality and diversity in the UK reflects concern with promoting good relations, ensuring equality of opportunity and eliminating discrimination.
By Parliamentary Office of Science and Technology (POST) (2016)
A range of bodies, including government agencies, have promoted the possible physical and mental health benefits of access to green space. This briefing summarises the evidence for physical and mental health benefits from contact with nature, such as reducing rates of non-communicable diseases, and the challenges for urban green spaces.
By Care Quality Commission (2016)
This annual assessment of the quality of health and adult social care in England has found that most health and adult social care services in England are providing people with safe, high quality and compassionate care – but with pressures rising on demand, access and cost, this report raises concerns about how long this can last. The report also highlights the impact of the fragility of the adult social care market on those who rely on these services and on the performance of NHS care.
By Health Services Management Centre (2016)
The report interviews 104 older people exploring their experiences of emergency admissions. It focuses on whether the older people felt it was appropriate to be admitted to hospital and whether they thought anything could have prevented their admission.
By The King’s Fund (2016)
This report looks at the evidence on new roles and ways of spanning organisational workforce boundaries to deliver integrated health and social care. Commissioned by NHS Employers and the Local Government Association, it finds increasing focus on roles which facilitate co-ordination and management of care, development of existing roles to increase the skill-mix and enable the provision of more holistic care, and a limited number of truly innovative roles, the most notable being care navigators and community facilitators, enablers or link workers. Given that many of the skills required for integrated care already exist within the workforce, it suggests the central question is how to use those skills more effectively to support boundary-spanning activities.