I’ve recently had an article published where I suggest that recent changes in the supply of intoxicating substances and treatment for their misuse mean that local decisions are more important than there were in the New Labour years, when policy in the field was pretty strongly centrally controlled. Now, where we had the NTA setting very clear requirements for local treatment systems, public health and local authority officials have a fair amount of autonomy about what they commission, and the local supply of alcohol and particularly new psychoactive substances is heavily dependent on operational decisions by police, licensing and trading standards.
As a result of this claim, I have suggested that some locally-based policy research would be useful. That is, while we have pretty good stuff on national policymaking through the likes of James Nicholls, Vital Katikireddi and Paul Cairney, we’re less strong on how similar processes operate at a local level.
I’m not talking about how ‘street level bureaucrats’ like frontline treatment staff or job centre employees turn national policy into reality. What I’m interested is that you could actually have a situation where rather than the government defining what the priorities and aims for drug treatment are (reducing acquisitive crime and HIV and Hepatitis transmission), these are set by local politicians and officials, and vary from one county to the next. Maybe Cornwall decides it’s concerned about ‘binge’ drinking while Devon thinks it’s all about ‘legal highs’ and steroid use.
There might be nothing wrong with that, but it seems unlikely that the decision will have been taken on anything like a scientific ‘evidence-based’ rationale – and in fact it’s not possible to set prioirities simply on the basis of evidence. You could get some analysis that shows the relative costs and benefits of different priorities and interventions, but you wouldn’t be able to action them all, and so the decision about which to invest in will be necessarily political, or subjective. (I know, this isn’t a new point for me to make.)
So what I’m interested in is how these decisions are taken.
There was also, not so long ago, a call put out for applications to the NIHR for researchers to engage in ‘knowledge mobilisation’ activities. This project aims to get research findings out to the coal face to make a difference to practice. For example, there’s a pilot trying to make commissioners of care more aware of research, which will then be evaluated to find out what ‘works’ in making their decisions more research (or evidence) based.
And, (without forcing it to happen just so I had something to blog about) I started to wonder whether these two things could be linked.
I started to wonder: doesn’t policy research have implications for policymakers too? I’m not just interested in finding out how people make those increasingly important local decisions I was talking about; I want to know if we can improve the policymaking process.
This isn’t just about making it more closely approximate some idealised technocratic evidence-based process. I don’t think policy can ever be anything other than political, and there’s nothing wrong with that. In fact, we should embrace it.
National policymakers are well aware of this, and academics producing research are perhaps catching on too – there are certainly enough people writing about this and the way ‘knowledge exchange’ should happen.
But in attending various conferences over the past few years, and particularly since my job moved over to a public health department earlier this year, I wonder whether this has translated to all (local) policymakers, given those changes outlined in my article, whereby there’s something of a double whammy for the sphere of substance misuse: there’s increased local autonomy that means people who were previously technocrats are more like policymakers; and at the same time that autonomy comes with increasing political oversight, as funds have been consolidated into local authority budgets when they used to sit within the NHS, with its very different ‘commissioning’ and budgeting processes.
So if there’s an opportunity for knowledge mobilisation in this area, I’d say it wasn’t to increase commissioners’ awareness of the evidence base for treatment or prevention, so much as to sensitise people who have now become local policymakers to the latest research on the policymaking process, so this can be as good as possible. As I wrote in a previous post, I don’t think public health officials do themselves any favours when they ignore the political nature of policymaking and imagine it is simply about listening to the evidence and taking either a ‘good’ or ‘bad’ decision.
Now that would be an interesting bid for NIHR funding: educating new local policymakers in the art of policymaking.