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  • Author or Editor: Stefanie Ettelt x
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Background

Current debates on e-cigarette policy in the UK are highly acrimonious and are framed in terms of evidence-based policymaking.

Aims and objectives

The article aims to understand the use of evidence in policymaking in the context of both political controversy and limited policy-relevant evidence via a case study of UK e-cigarette debates.

Methods

The study draws on a series of semi-structured interviews with policy actors to examine their positions on e-cigarette policy process and their use of evidence to support this.

Findings

Policy actors articulate a strong commitment to evidence-based policymaking and claim that their positions are evidence-based. Some actors also claim emerging consensus around their positon as a rhetorical tool in the debate. Respondents argued that actors adopting opposing policy positions fail to follow the evidence base. This is attributed to a lack of understanding or disregard for the relevant evidence for political or ideological reasons.

Discussion

Respondents adhere to a rationalist understanding of policymaking in which policy disputes can be settled by recourse to ‘the evidence’. Interpretative policy analysis suggests that multiple legitimate framings of policy issues, supported by different bodies of evidence, are possible. Policy differences are thus not due to bad faith but to policy actors framing the issue at stake in different terms and thus advocating different policy responses.

Conclusions

Process of ‘frame reflection’ may help to overcome the acrimony of current policy leading to more effective engagement by public health actors in the e-cigarettes policy debates.

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This article explores the process of policy learning from abroad from a knowledge utilisation perspective, using examples of health policy making in the Department of Health in England. It argues that information about policy abroad is often heterogeneous and difficult to obtain systematically and therefore does not fit easily with notions of evidence-based policy making. While some officials interviewed for this study did regard policy examples from other countries as a substitute for evidence, especially in areas in which research evidence was insufficient, others appeared to be less confident about its validity and generalisability. Department of Health officials reported a great variability in strategies to obtain such information, with processes often constrained by pressures on time and resources. They were also highly selective in exploring policy examples from abroad, with most respondents stating that they were largely interested in generating ideas to address domestic policy problems, often relating to details of policy. The iterative process of using this information thus raises questions about the extent to which looking abroad contributed to genuine policy learning.

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In this paper we reflect on our experience of providing a rapid response facility for international healthcare policy comparisons to the English Department of Health. We examine the challenges of developing sustained relationships with policy officials while providing an ‘on-demand’ service in an environment with high turnover of policies and staff. It may be easier for policy makers to draw on researchers in such a setting than for researchers to foster ‘linkage and exchange’ relationships with policy makers. Under the facility, knowledge transfer has mostly been from researchers to policy officials, affording us little insight into the policy process or the impact of our work.

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The personalisation of residential care services is based on three broad principles of valuing personal identity, empowering resident decision-making and fostering care relationships. We analysed 50 Care Quality Commission care home inspection reports to identify factors that the reports indicate facilitate or hinder the delivery of personalised residential care in England. Findings suggest that the provision of personalised services is affected by staff skills, attitudes and availability, as well as the quality of care home leadership. Future care policy should consider addressing external pressures facing the care home sector, including inadequate funding and too few staff, to mitigate barriers to delivering high-quality, personalised care.

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This article reports findings from the evaluation of the Direct Payments in Residential Care Trailblazers in England (2014–16). It focuses on the perspective of residential care providers on implementing direct payments, which aimed to improve the level of choice and control over care available to their residents. The article explores the views of providers, using interviews and survey responses of care home managers and owners. Concerns expressed by providers include issues that have arisen in domiciliary care but also issues specific to residential care, especially challenges in facilitating greater choice and control in settings that provide care collectively for substantial numbers of residents.

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