Translating policy into practice: A case study in the secondary prevention of coronary heart disease

Background: This paper focuses on the relationships between health ‘policy’ as it is embodied in official documentation, and health ‘practice’ as reported and reflected on in the talk of policy makers, health professionals and patients. The specific context for the study involves a comparison of policies relating to the secondary prevention of coronary heart disease (CHD) in the two jurisdictions of Ireland – involving as they do a predominantly state funded (National Health Service) system in the north and a mixed healthcare economy in the south. The key question is to determine how the rhetoric of health policy as contained in policy documents connects to, and gets translated into practice and action.

Methods: The data sources for the study include relevant healthcare policy documents (N=5) and progress reports (N=6) in the two Irish jurisdictions, and semi-structured interviews with a range of policy-makers (N=28), practice nurses (14), general practitioners (12) and patients (13) to explore their awareness of the documents’ contents and how they saw the impact of ‘policy’ on primary care practice.

Results: The findings suggest that although strategic policy documents can be useful for highlighting and channelling attention to health issues that require concerted action, they have little impact on what either professionals or lay people do.

Conclusion: To influence the latter and to encourage a systematic approach to the delivery of health care it seems likely that contractual arrangements – specifying tasks to be undertaken and methods for monitoring and reporting on activity - are required.

Regenerative Medicine and New Labour Life Science Policy: Rhetorics of Success, Narratives of Sustainability and Survival

Advances in stem cell science and tissue engineering are being turned into applications and products through a novel medical paradigm known as regenerative medicine. This paper begins by examining the vulnerabilities and risks encountered by the regenerative medicine industry during a pivotal moment in its scientific infancy: the 2000s. Under the auspices of New Labour, British medical scientists and life science innovation firms associated with regenerative medicine, received demonstrative rhetorical pledges of support, aligned with the publication of a number of government initiated reports presaged by Bioscience 2015: Improving National Health, Increasing National Wealth. The Department of Health and the Department of Trade and Industry (and its successors) held industry consultations to determine the best means by which innovative bioscience cultures might be promoted and sustained in Britain. Bioscience 2015 encapsulates the first chapter of this sustainability narrative. By 2009, the tone of this storyline had changed to one of survivability. In the second part of the paper, we explore the ministerial interpretation of the ‘bioscience discussion cycle’ that embodies this narrative of expectation, using a computer-aided content analysis programme. Our analysis notes that the ministerial interpretation of these reports has continued to place key emphasis upon the distinctive and exceptional characteristics of the life science industries, such as their ability to perpetuate innovations in regenerative medicine and the optimism this portends – even though many of the economic expectations associated with this industry have remained unfulfilled.

Qualifications, examinations and assessment: views and perspectives of students in the 14–19 phase on policy and practice

This paper brings to the forefront students’ views on one of the most significant aspects of education in the 14-19 phase, specifically the qualifications, examinations and assessment they experience. In this respect the paper foregrounds students as ‘policy actors’, they are significant players in the mediation of national qualification systems rather than just subjects in their implementation. Data from a national dataset of focus groups with 243 students from the 14-19 phase is presented. Key themes are highlighted relating to young people’s experiences of qualifications, examinations and assessment at this stage of education in a context of continuous initiatives and change as well as the impact of students being on the receiving end of qualification reform in situ which can be confusing, unsettling and ultimately detrimental to future success.

Justice as Fairness in Planning Policy-Making

This paper considers a moral basis for planning theory and endeavours to establish principles of justice which might be relevant to the regulation of development. Whilst the investigation recognises that there is a need for a deeper understanding of the dynamics of governance, it suggests that many of the inefficiencies, inequities and public disquiet concerns relating to planning centre on a drift from a perception that the system is both fair and just, and that practice needs to be anchored on founding values concerned with redistribution and equality. In this context, John Rawls’ theory of justice is employed as a vehicle to capture moral ideas of equality and liberty within a constitutional democracy and as a basis for scrutinising emerging justice based issues which impact upon planning. Using National Policy Statements as a case study, the paper concludes that, whilst there are serious concerns over current policymaking practices, the principles of justice offer a foundation for practical critique which can help overcome problems of mistrust.