As I've mentioned before on this blog, I've been pretty busy over the past few months, as we've been re-procuring almost all of the substance misuse treatment services across Bournemouth, Poole and the rest of Dorset. So I can only apologise that several of the posts I'm writing currently are responses to events held or pieces published some time ago. But as I always say, with a historian's perspective, the fundamental issues related to alcohol and other drugs don't really change - and certainly not in a month or two.
So here goes with some reflections from the Alcohol Research UK conference a month or two ago. Unlike its usual format of what I think of as a kind of 'state of the nation' set of presentations from big names in the field or simply those with significant findings that need communicating to the wider sector, this year it had a very specific focus: public involvement in research. In some ways I missed the standard approach, getting my latest update on the state of research in relation to alcohol harm. But there were clear strengths to this approach.
First, there's no doubt that involving service users and the wider public in research and service provision is too often a token exercise, and this is something we're acutely aware of in Dorset: although we've included service user panels in our recent procurement exercise, and there are service user reps are included contract review meetings and relevant decision-making boards, there's still more we can do, particularly in relation to day-to-day business. And this conference was full of pointers about how to start thinking about this process, from philosophical insights to practical tips.
Second, there's simply something positive about being encouraged to look at an issue from a different perspective. In this case, I started to think about the broader point of how we often divorce research from practice. A key presentation came from Simon Denegri of the NIHR, which funds a considerable amount of health research in the UK. He emphasised the increasing importance placed on service user – or patient – involvement in research in the UK. This should help shape the entire process of research, right from the initial setting of priorities for researchers and funders. One of his insights was that actually, most patients expect there to be research going on in relation to healthcare, and so wouldn't be surprised to be asked to be involved.
This is an important insight in terms of more than the culture around healthcare research. The reason people wouldn't find this strange is that they expect there to be work going on to ascertain what treatments work, and how they can be improved. This is partly because medicine is so closely related to science, and the model of drug trials, and Randomised Control Trials (RCTs) fits so well, but that's no reason why we shouldn't expect people to apply the principle more broadly – to the full range of substance misuse treatment services, for example.
If we think of research at its simplest level, it's just trying to answer questions, which is exactly what we spend a lot of time doing whether at work or home. How can I put up these shelves? What sort of meal can I make from these ingredients in the fridge? How can I swim faster? In each case, we probably have a think using the knowledge we've already got, maybe consult a book or the internet to see what other people have found, and maybe we just give something a go and see how it works out. All of these are part of any 'research' process. And most fundamentally, all those example questions I've given have an implicit purpose: someone wants to be able to store books, or eat some tasty food, or win a swimming competition.
Now think about 'alcohol research'. If we take Alcohol Research UK's overarching mission, the aim is to reduce alcohol-related harm. And research can't do this on its own. In fact, it needs policy and practice to 'do' anything, to make any difference.
Let's return to those 'research questions', such as how to make something for dinner. Those are precisely the kind of questions practitioners should – and do – ask of alcohol treatment. How can we optimise treatment for this client? And they'll be working on all those bits I outlined: knowledge/experience they have, consulting maybe findings.org.uk or similar resources to find out what others have done to achieve success, and maybe just trying something and reflecting on how it goes.
And this is precisely the same model as commissioners are encouraged to follow: analyse, plan, do, review.
|Institute of Public Care, Oxford Brookes University. See http://www.scie.org.uk/publications/guides/guide45/files/Workshop_Handout_1_IP__Commissioning_Framework.pdf?res=true|
And wouldn't people in treatment or out of it find it strange if we weren't doing this? If we weren't reflecting on our current practice to find out who needs support, what we think works for different groups, and how well we're delivering this?
This might seem like a bizarre discussion. Like I've set up some kind of straw man. And perhaps I have, but if so then it's a straw man that I've genuinely believed in – or at least been scared of – and that seems to inform thinking in universities, the NHS, and wider treatment services.
I benefited from a grant to do a PhD at Bournemouth University, and the only reason that grant existed was Vice Chancellor Paul Curran’s idea to transform Bournemouth into a 'research led' university, where it had previously been seen as a teaching and training university, according to the established wisdom: our department in particular trained people to be nurses and social workers. I was part of the grand vision to sweep away old experts in teaching with a new cadre of young researchers.
I won’t reflect on how well that worked out, or whether it was even a good idea in the first place, but I’m very grateful for the opportunity it gave me. My point is simply that the division between teaching and practice on the one hand, and research on the other, was an unavoidable aspect of how this issue was framed, and how it played out. And similarly, at conferences in this field it sometimes feels that academics and practitioners don’t just talk different languages, but are different species.
(I’m assured this wasn’t always the case; that addiction studies and conferences like New Directions in the Study of Alcohol used to be filled with research active clinical psychologists – and I believe it. Flicking through the 2002 New Directions journal (another illustration of the fact that the key issues and dilemmas don’t go away) you can read reflections on practice by Doug Cameron and Richard Velleman, amongst others.)
But in fact, any practitioner worth their salt would have been asking those questions I just outlined, and developing their practice accordingly. And any researcher worth their salt should have been trying to answer them. That is, there is no great divide in philosophy, epistemology or anything else between practice and research. Some of us just choose to get precious about – or frightened of – this word ‘research’. In fact, it really just means finding out, and we shouldn’t be dividing it off from practice; we should be embedding it in practice.
As I say, this may mean nothing to some readers, or seem like a straw man argument, but I would argue that if we embed a culture of being curious, seeking knowledge and looking for innovation into our practice, then we are de facto ‘researchers’ – and this is an approach that isn’t typical of services and commissioners today. And if providers and commissioners are de facto researchers, so should those accessing the service be. Then, as in healthcare more broadly, it wouldn’t seem odd or unusual to ‘involve’ service users – in fact it would be strange not to.