Analysing devolved health policy in ‘interesting times’

Ellen Stewart
Ellen Stewart

Ellen Stewart (University of Edinburgh, UK) discusses her article “A mutual NHS? The emergence of distinctive public involvement policy in a devolved Scotland

In the last twelve months’ heated debates about the SNP’s evolving role in UK politics, there has been far too little focus on their record North of the border, where they have now been in Government for almost two full terms (first as a minority government from 2007-2011, and then, beating the odds of the electoral system, with an unexpected majority since 2011). The UK media has only occasionally engaged with this record in government, and these efforts have often been haphazard potted histories, shifting between judging Scotland’s policies or its outcomes, and between comparing them to the other countries of the UK, or to the pre-recession past.

The difficulty of discussing devolved policy in a measured fashion is not new, although it is certainly heightened in the current political climate. In 2011, when I sat down to write what was eventually published in Policy & Politics as ‘A mutual NHS: the emergence of distinctive public involvement policy in a devolved Scotland’, I was trying to pin down some substance behind the pervasive rhetoric of ‘mutuality’ in the Scottish NHS. Much academic analysis of the ‘distinctiveness’ of Scottish health policy has relied on data from interviews with politicians, civil servants and other stakeholders. These yield fascinating findings, but can be strongly coloured by some of the myths which make up (all) national identities. As McPherson and Raab remarked on interviewing Scottish education policymakers in the 1980s, Scottish social democracy is, while influential, “a theory supported by data it had helped to create”.

One alternative option, which has been utilised extensively by thinktanks the Nuffield Trust and Health Foundation‘s 4-nation comparative work, is to judge health policy only on its outcomes. Using this approach, “the different policies adopted by each country appear to have made little difference to long-term national trends on most of the indicators that the authors were able to compare”.  As the authors acknowledge, this approach is seriously hampered by the idiosyncrasies of NHS data collection in the four nations. Starting with the available data on outcomes can prevent us engaging with the full complexity of the policy process, and from areas of health policy (like public involvement) which are important but rarely have linear effects on big picture health outcomes.

In my article I analysed health White Papers, picking out actual proposals relevant to public involvement from the (meaningful, but sometimes deceptive) language with which they are presented. This suggested that SNP policy in this area was indeed a break from the prevailing New Labour approach, which tended to emphasise building organizational capacity for public involvement. By contrast, the SNP proposals suggested a more adversarial approach to public involvement, preoccupied with increasing control of the territorial Health Boards. The linguistic shift masked what was a more traditionally command-and-control approach. Analyzing policy documents contributes another useful part of the picture of devolved health policy, offering results which are cognisant of emerging policy approaches but not entirely reliant on the self-understandings of individual policy actors.

Each of these approaches make a valuable contribution to the wider evidence-base on devolved health policy in the UK. While academics have no special claim to neutrality, we have established procedures for claiming and critiquing the validity of our findings. In a fast-paced political environment this can make us slower – a forthcoming special issue of Scottish Affairs on the SNP’s record in government, planned for early 2016, makes for a relatively tight academic deadline – but even-handed, transparently-conducted academic research has a vital role to play when the political context gets heated.

If you enjoyed this blog entry, you may be interested in a similar article such as When collaborative governance scales up: lessons from global public health about compound collaboration by Chris Ansell

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