Monthly Archives: December 2015

Why do governments promote but fail to deliver their radically new ‘preventive’ policy agendas?

Prevention represents the most important social policy agenda in modern history, but governments do not know how to take it forward. In the name of prevention, the UK and Scottish Governments propose to radically change policy and policymaking across the whole of government. Their simple description of ‘prevention policy’ is: a major shift in resources, from the delivery of reactive public services to solve acute problems, to the prevention of those problems before they occur. The results they promise are transformative, to address three crises in politics: a major reduction in socioeconomic equalities by focusing on their ‘root causes’; a solution to unsustainable public spending which is pushing public services to breaking point; and, new forms of localised policymaking, built on community and service user engagement, to restore trust in politics.

Yet, they may never fulfil their aims. We do not identify the usual implementation or expectations gap, in which policymakers only fulfil some of their objectives. Rather, there is great potential for governments to pursue contradictory policies at the complete expense of their prevention agendas. Their most important domestic policy agenda may never get off the ground.

Why do governments fail to deliver on such a massive scale?

We go beyond the usual cynical answer at the heart of low trust in politics and politicians: ‘politicians always make promises they know they won’t keep’. This assertion can only take us so far, partly because governments tend to articulate pledges to allow them to demonstrate success in government, and most governments fulfil a high proportion of pre-election pledges (Bara, 2005). They rarely propose specific policies that they know are too difficult to achieve. This is what makes the pursuit of prevention policies puzzling: why would they make a specific and enthusiastic commitment to an almost impossible policy agenda?

Our simple answer is that, when they make a sincere commitment to prevention, they do not know what it means or appreciate scale of their task. They soon find a set of policymaking constraints that will always be present. When they ‘operationalise prevention, they face several fundamental problems in policymaking, including: the identification of ‘wicked’ problems which are difficult to define and seem impossible to solve; inescapable choices on how far they should go to redistribute resources and intervene in people’s lives; major competition from more salient policy aims regarding the maintenance of existing public services; and, a democratic system which limits their ability to reform the ways in which they make policy. These problems may never be overcome. Or, more importantly, policymakers may soon think that their task is impossible.  Therefore, there is high potential for an initial period of enthusiasm and activity to be replaced by disenchantment and inactivity, and for this cycle to be repeated without resolution.

To follow this work, please see:

https://paulcairney.wordpress.com/prevention/

 

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Filed under agenda setting, ESRC Scottish Centre for Constitutional Change, Prevention policy, public policy, Scottish politics, UK politics and policy

What is Policy?

Source: What is Policy?

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Up to 80% of suicide victims weren’t seen for a year before they died

My undergraduate module POLU9SP has four coursework requirements: (1) a policy paper, to raise a problem and feasible solution in 1000 words; (2) a blog post to summarise the issues to a lay audience; (3) an oral presentation/ Q&A based on the post; and (4) an essay to explain the policymaking context. I recommend this format, since it gives students the chance to be creative and research an issue that interests them. Our discussions then help them work out how feasible are their plans, and a round of presentations should show us the competing demands on policymaker attention and resources.

I have reproduced, below, a blog post from 4th year student Christopher Gilday, as an example of an excellent attempt to fulfil this task:

“A Study by the ISD suggests that up to 80% of suicide victims in Scotland did not have a psychiatric outpatient appointment for up to 12 months before their death. The study showed that suicide is now a major contributor of death for 15-34 year olds and highlighted a significant correlation between suicide and deprivation in Scotland. It also confirmed that the suicide rate for men is three times that of women, a point that Jane Powell, of the Campaign Against Living Miserably (CALM), has been making vehemently recently.

The ScotSID, which is observed and calculated annually, has consistently found a reoccurring number of deaths by suicide in recent years (around 790) which is concerning as there have been incremental increases in funding for mental health by the Scottish Government. Most concerning was a clear pattern which related the number of suicides to the time that patients had waited for a psychiatric appointment. 184 suicide victims were seen in 30 days of their death whereas 604 suicide victims weren’t seen for twelve months before their deaths. The study also claimed that as many as 80% of suicide victims weren’t seen by therapist in a year before they died.

The current target waiting time for psychiatric waiting times for outpatients, which was set in December 2014, is 18 weeks. This is in contrast to the policy for general outpatient times across the NHS which is set at 12 weeks.

Mental health is a distressing concern for Scotland above other parts of the UK with more people being affected by mental health and the Scottish Government has already acknowledged this by upgrading the legal status of mental health to that of physical health.

For this reason it seems the government should follow through this change in status by setting the outpatient target time of 18 weeks so it is at least akin to the general level of outpatient waiting times of 12 weeks.

However with the pledged £85 million for mental health in the next five years this should be bettered, as 50% of referred patients are already being seen in 8 weeks. The target however stipulates that 90% of referred outpatients must be seen in the target period and only 4 NHS branches actually have met this standard.Suicide in Scotland is an unresolved problem which needs to properly be addressed through mental health support. Too many suicide victims are not seen in time nor at all, and there is clear evidence showing that reducing waiting times reduces the number of suicides.

Using additional funding to employ additional staff, through telephone inquiries or ushers, or spending on alert systems that prevent excessive waiting is essential in reducing waiting times which must now be urgently addressed. Reducing waiting times for psychiatric outpatient appointments will reduce the annual number of suicides”.

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Q. Should PhD students blog? A. Yes.

I wish I could go back and rewrite everything I have published, including my PhD. If I knew then what I know now: I would get to the point quicker and describe its importance to a far wider audience than my supervisor and a few dedicated journal readers. To do so, I would exhibit the skills you develop when you write frequently for an ‘intelligent lay’ audience.

These are the writing traits that I think you develop when just writing for academics:

  1. You assume a specialist audience, familiar with key terms. So, you use jargon as shorthand without explaining its meaning. The downside is that the jargon often doesn’t have a particularly clear meaning. When you blog, you assume a non-specialist audience. You use less jargon, or you explain its meaning and value.
  2. You treat the exercise as a detective novel with a big reveal: a nice, vague opening discussion (passive tense optional), a main body of text to build up the suspense, and finally the big twist at the end. Ta da! Wow, I didn’t see that coming. When you blog, you assume that people will not read your work unless you front-load the reveal. You have a catchy and tweetable title, you provide a hook in the first sentence, and you only have a few hundred words in which to show your work (and encourage people to read the longer report).
  3. Or, you describe your hypotheses in a way that suggests that even you don’t know what will happen. Wow – I confirmed that hypothesis! Who knew? When you blog, it seems more sensible to use the language of hypotheses (or an equivalent) more simply, to explain what factors are most important to your explanation.

You can develop this skill by using a personal blog to describe your research progress and the value of your findings. However, it is also worth blogging in at least two other venues:

  1. Somewhere like the LSE blog, or Democratic Audit, in which the editors will try to summarise your argument in a short opening statement. This is very handy for you: did they summarise the main argument? If so, good. If not, look again to see if you explained it well.
  2. Somewhere like The Conversation, in which the editors will try to mess around with the title (to encourage more traffic) and wording (to make it punchier and quotable). This is a good exercise in which you can think about how far you want to go. Are you confident enough in your research to make such stark statements? Or, do you want to obfuscate and fill the argument with caveats? If the latter, you can think about the extent to which your argument is clear and defendable (it may well be – sometimes caveats and humility can be good!).

I also encourage advanced undergraduates and taught postgraduates to produce a blog post (albeit unpublished) alongside an essay or policy paper, because it is difficult to be concise, and the exercise helps develop a good life skill. Even without the blog exercise, I’d still encourage dissertation students (at the start of their research) to write up their argument/ plan/ work in a half-page document, so that we can see if it adds up to a coherent argument. You can do the same thing with a blog post, with the added (potential) benefit of some feedback from outside sources.

See also: there are resource sites which go into far more aspects of the writing process, such as medium.com/@Write4Research and patthomson.wordpress.com

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Filed under Academic innovation or navel gazing, PhD