A framework for understanding policy change

Abstract

A new policy, strategic direction or major programme is announced. How do we begin to understand, interpret and explain it? And how can we start the task of analysing and critiquing it? I see three main approaches: 1: Personal views As an individual, we might ask whether we like or agree with the proposed change. Here, we will draw on some combination of personal experience, position and world view. This is a starting point, but results are limited to expressions of individual opinion. 2: ‘Inside-out’, taking the logic of the suggested change We can ‘climb inside’ the proposal to see what we find. Here we would read about the proposal, doing our best to understand it in its own terms. We can then examine the ways its logic might play out in practice. We can test for internal coherence; we can spot likely challenges in implementation; we can also then compare it to analogous efforts. This is more useful than personal views alone. It allows a systematic assessment of any proposal. But maybe this method accepts too much? Maybe it misses something that an outside-in perspective would give. 3: ‘Outside-in’, using a framework of common features We can also view proposed changes from the outside-in. Equipped with a set of typical features, we can ask what the policy looks like from these different standpoints. This could be very useful in supplementing the ‘inside-out’ perspective. But any such set of ‘common features’ would need to be broader than current established and focused approaches to policy analysis (those contained in the Green and Magenta Books, for example). Are there ‘common features’ of policy change that could form a framework? The framework (below) is my attempt to address this question. I was prompted by running an internal Strategy Unit session on NHSE’s ‘Integrating Care’ paper. This forced me to be explicit about the ways of thinking about policy that I have absorbed and used implicitly over the years. I then developed my early drafts by drawing on different commentators’ pieces on the subsequent NHS White Paper. I read: Nigel Edwards discuss the pros and cons of approaches based on competition or collaboration. Judith Smith and Robin Miller think about whether there was continuity or break in policy direction. Hugh Alderwick looking at tensions between political and bureaucratic control - and short Vs longer term decision making. Nicholas Timmins focusing on shifts in power, concentrating on Local Vs National and Democratic Vs Technocratic tensions. The Kings Fund examining similar themes: competition and collaboration; national and local; and the place of NHS reform alongside that of social care and public health. Tony Hockley using the lenses of Prevention Vs Treatment and Equity Vs Efficiency. Donna Hall thinking about organisational and systems perspectives – and treating people as citizens, rather than as consumers. Jennifer Dixon on central ‘command and control’ and the risks of using politics to decide operational priorities. Obviously, I haven’t reflected the range and subtlety of these perspectives in a single framework (!). Instead, I’ve tried to draw out some of the main ways of looking at policy used by these different analyses. Draft framework V0.1 The resulting draft is below. The nature of the task means that there will be no such thing as ‘the finished article’, but I think there is enough to share now for comment. I don’t have a fully refined sense of audience or use, so I'm testing the waters on this too. But I suspect the framework might be useful to: Leaders and managers. It gives them a quick way to understand the main features of policy change, to help them and their teams think critically around it. We will certainly use this as part of the education and development programme in the Midlands Decision Support Centre. Strategists and analysts. The framework suggests ways that different features of a policy will tend towards success and failure. So it can be used to design local strategies and focus analytical attention; and Students interested in policy analysis. It gives them a set of common policy features and ways of thinking that should apply to multiple situations.