As writer on law and policy, David Green, has described, good policy makes the best use of available resources to achieve a public benefit through a ‘considered course of action’. Good policy-making is, invariably, complex and usually difficult to do – but vital, nonetheless
The work of policy-makers behind the scenes underpins and sustains the efforts of many more visible public servants – not least in the application of science and technology for health.
The accelerating pace of scientific advances is great news for healthcare, but makes the challenge of understanding, evaluating and preparing the way for innovations to improve clinical practice ever greater. Whilst the need for solutions offered by new knowledge and tools is acute, it is no simple matter to introduce them efficiently, responsibly and effectively to hard-pressed healthcare systems. Indeed, it is usually only through the considerable, and combined, efforts of many stakeholders from the research, health and policy communities that it is achieved at all – and, whilst the results may be obvious, the policy development behind them, generally, is not.
Nevertheless, policy does continue to provide that essential bridge from research to practice and, in recent years, there has been growing recognition of the value of efforts to inform and influence policy based on evidence, ideas and needs. But where to begin? The obvious choice is to hear directly from those who know.
Lessons from the experts
A recent PHG event in Cambridge brought together two people with remarkable records in influencing national and international policy to share their unique insights. Dame Sally Davies, former chief medical officer for England and now, apparently effortlessly, combining roles as UK envoy on antimicrobial resistance with being master of Trinity College, Cambridge, was joined by Professor Eric Meslin, president and CEO of the prestigious Council of Canadian Academies, and a distinguished bioethicist. Between them they have advised a whole range of governments, and other important bodies, including the World Health Organisation, the Human Genome Project, UK Biobank and Centres for Disease Control and Prevention.
Give them what they want
It is vital to really listen to what is being asked or sought. Sometimes, decision-makers just want an expert assessment of evidence, or the current situation; take the opportunity to give them what they need, promptly and succinctly. This will go down much better than answering alternative questions that may be more in line with your own agenda.
At other times, there may well be interest in recommendations – whether for immediate action, or for more focused questions – perhaps highlighting gaps in evidence or issues that warrant scrutiny.
You may not always be the right person to answer the question posed and, in this case, you should be prepared to admit that someone else would be better placed to offer advice.
Accentuate the positive
A common mistake is to focus too much on problems; policy-makers already have plenty of problems – they are looking to you to help find solutions! Clear advice and answers to specific questions are more likely to be appreciated – and used. Consulting with other stakeholders can also help understanding of the real problems and whether or not a proposed action will address them effectively.
It’s worth considering which individuals, or organisations, influence the decision-makers you want to access. Can they be persuaded to lend their voices to yours? Bringing together other stakeholders to develop policy not only improves the utility of plans or proposals, it can also help to gain traction with decision-makers. A united front from multiple sources is more compelling than a lone voice.
Achieving consensus and engagement necessitates building rapport and diplomacy, such as allowing others (for example, politicians) to take the credit for ideas and proposals. If this is what it takes to achieve the impact you need, why not?
Have you been framing?
Both speakers emphasised the importance of successful ‘framing’. How are you packaging your information and presenting it to recipients? For example, the issue of antimicrobial resistance, an area of long-term concern, only achieved appropriate levels of political attention when it was presented as a wide-reaching economic issue, rather than a purely medical one.
Polling data has reportedly shown that people think governments should act to protect children. Meanwhile, galvanising public and political action on obesity has proved difficult. Framing childhood obesity as an issue where action is needed to protect children from unhealthy food choices being forced on them by circumstances – described as a violation of children’s fundamental human rights – has, apparently, met with more success.
The pathways to influence
There are many ways to have impact; while hard evidence is one element of good policy-making, judgement matters too – so contributing expertise can be just as valuable. Moreover, evidence can mean different things to different people, and in different contexts; something admissible in a court of law for a lawyer, a robust, randomised controlled trial for an epidemiologist and a compelling anecdote for a politician. When you have spent years producing your evidence this is a difficult fact to accept, but recognising it may be key to ensuring that your information plays a part.
Is it worth it?
Often there will be no immediate or obvious impact from even the best efforts to inform policy. However, to paraphrase Gandhi, ‘If you don’t contribute, you don’t get to influence – so make the most of any opportunities you have to contribute’.