4 Policy or practice focus, or a mixture?
The case studies in the previous section offer contrasting professional disciplines and subject matter: social work with older people, promoting public health through smoking cessation and mental health in later life. Each of the literature reviews we featured have been published or presented at different times for different purposes. A fundamental distinction in purpose is whether a review is concerned with policy or practice. In this section, you’ll look at reviews that focus on policy or practice or a mixture of both, using Jean’s, Julie’s and Adele’s cases.
Activity 2 Bottom-up policy?
Watch this interview with Jean and Julie about their literature reviews.
Download this video clip.Video player: Video 2
Transcript: Video 2
SANDY FRASER:
Hello and welcome. I’m Sandy Fraser, one of the authors on this module. Today, we want to talk through how literature reviews can be used to support evidence-based changes to policy and practice. I have with me, two experienced social work and public health practitioners who’ve used literature reviews in their work, Jean Gordon and Julie Hirst.
JEAN GORDON:
Hello.
JULIE HIRST:
Hello.
SANDY FRASER:
Jean, one of the things I wanted to talk through was how did you get involved in the literature review you did concerned with the 21st Century Review?
JEAN GORDON:
The 21st Century Review brought together a whole range of literature review and other sources of evidence. And the particular literature review that I was asked to be involved in is about effective social work with older people. And I got involved, I suppose partly because of my – well, certainly my interest in research and some experience, but not a great deal at that time of literature review. But also my experience working as a practitioner in social work. So I was able to bring that practice-based knowledge to the task.
SANDY FRASER:
Julie, your literature review was about smoking cessation with pregnant women.
JULIE HIRST:
That’s right.
SANDY FRASER:
Was that always an interest, or were you – did you have to do it?
JULIE HIRST:
I had to do it. It is an interest to me because it’s a very important public health issue, obviously, maternal smoking. But it was actually handed to me as a piece of work. I was given the task in Derbyshire of reducing the prevalence of pregnant women who smoke. And therefore, I decided to do a literature review to help me to understand how best I could do that.
SANDY FRASER:
Turning back to Jean, it’s been quite a long time since the 21st Century Review of Social Work in Scotland took place and also therefore, your literature review within it about older people. Do you think that the 21st Century Review had an impact in policy terms about the way in which local authorities worked with older people?
JEAN GORDON
I think in broad terms, what it did was to raise the profile of social work, including social work with older people, and to pay more attention to the voices of practitioners, service users, and carers. And in relation to practitioners, one of the things that happened was that practitioner forums were set up, which gave social workers with experience in lots of fields, including working with older people, to actually get together and influence policy and practice in their local authorities and in other organisations, too. One of the messages that I suppose came from 21st Century Review was about distinctive role of social work and how that fits into multidisciplinary working and integrated teams, which is particularly relevant in Scotland today with the integration of health and social care. So some of the themes, although 2006 is a long time ago, some of those themes are still running on and still important for social workers to be thinking about.
SANDY FRASER:
And were definitely part of the evidence from your literature review.
JEAN GORDON:
The evidence from our literature review, but also all this evidence that came together from a number of different literature reviews and other sources.
SANDY FRASER:
How about you, Julie? I mean, where did we get with impact of the work that you did?
JULIE HIRST:
Well, in terms of impact, we helped 48 women to quit smoking through pregnancy. It was a small pilot, so the numbers were small. And 25 of those women were still quit six months later. We went back, and we validated the tests, so we know that that happened. So 48 women managed to stop smoking throughout their pregnancies, helping to improve the lives of the babies and also for the mums, of course. And yes, 25 were quit six months later, so hopefully, they would remain smoke-free for the rest of their lives.
SANDY FRASER:
So that was true of the pilot, but did the policy outlast the pilot? What happened with the policy? Did it carry on?
JULIE HIRST:
It did. I mean, the original literature review showed that financial incentives, which is what we piloted were four times more effective than any other intervention that we know about to help pregnant women quit smoking. We piloted it at a small scale, and because of the literature review itself, the findings and the outcomes of our pilot, then yes, a decision was made to fund because obviously, it cost more money than the usual treatments that we were giving. But a decision was made. It was important enough to be able to fund that, to roll it out across the whole county of Derbyshire.
SANDY FRASER:
And is it still running today, or is it –?
JULIE HIRST:
It’s not still running today. It ran for about three years, and then things changed at different levels in the – I mean, we started out in the NHS, actually, and we kind of straddled the changes in terms of the Health and Social Care Act 2012, when that got implemented. And like a lot of policies and practice actually, organisations change. And we’ve got to flex with it.
So it started in the NHS. It got sustained for some time in the local authority. And then things changed at the local authority, and a decision was made to stop it and do different things.
SANDY FRASER:
One of the things that strikes me about both of your literature reviews and the policies that you were involved in is they’re quite big policies. One covers the whole of Scotland for quite a long time, long lasting. Another one covers the whole of Derbyshire. Again, the impact of what you were about lasted for quite a long time. But they were, if you like, big policies, but our students are in a slightly different situation. They either are on the Open Programme, or they’re embedded in their social work degree or their health and social care degree. So they are not going to be in a situation to influence big policy. Should that daunt them in any way? Is there a way that they can deal with small, more localised policy?
JULIE HIRST:
Well, yes, I would say so because all frontline practitioners see and observe things and notice things that could be done better. And if they feel that something could be done better at the frontline, they’ve got a fantastic opportunity to help to develop bottom-up policy, as it were. And in that way, change practice as well. So it’s kind of a cycle, isn’t it? It’s a loop, and just as an example, if people see things that they think could be done better, the first thing that I would suggest they do is look for the evidence, as students are learning to do on this module. If you are convinced, then as a student, as a practitioner, then maybe you want to convince your peers and certainly your line manager that a change is important and could make a big difference. And in that way, a bottom-up policy could be developed.
SANDY FRASER:
But even if it’s a bottom-up policy, with policy, there’s usually some kind of key decision maker who can say yes or no who, for example, if I’m wanting to tackle practice, that might be my own practice. So I have to find it, and I am the decision maker. I’m going to do a literature review. I’m going to search for the evidence. I’m going to change what I do next. But policy is a bit different, isn’t it?
JULIE HIRST:
It is, and it requires more of an organisational buy-in, if you like, and therefore, the people you’ve got to persuade are wider than say just changing your own practice. But I think that’s why it’s important to be convinced yourself. If you’re convinced enough that things should change, then you should be able to convince others. And if you can’t, then probably you don’t have the evidence to do so.
SANDY FRASER:
And Jean, how does that work in social work?
JEAN GORDON:
I’m just thinking of an example of going back to that, I was talking earlier about multidisciplinary working and integrated teams and so on. And a lot of social workers work in integrated teams these days. So, from for a practitioner’s point of view, there are lots of questions to be asked really about how members of an integrated team work together and what the particular role of social work is within that and how social workers can best work with their colleagues. And that’s something that a practitioner could be.
SANDY FRASER:
You mean policies to support integrated care in that particular workplace?
JEAN GORDON:
Yes. Yeah, so how integrated working is part of a big policy move, how does that actually work on the ground? And that’s something that a practitioner could really get involved in in terms of looking at the evidence base for effective integrated working and in relation to social work specifically. How can social work best contribute to that whole effort?
SANDY FRASER:
One of the things we’ve just been talking about, though, is how that works, policy change with respect to health and social care practitioners, but the way that this module sort of sees that is it also can include service users and carers as part of a way that they could gather evidence. How would gathering evidence for policy change work for them?
JEAN GORDON:
I think for service users and carers, having that evidence base, being able to gather the evidence they need to present a case for change, for example, in relation to health and social care being offered in a more individualised kind of way, more person-centred kind of way than it is at the moment, or can be, then actually be able to draw on the evidence out there is one way really to make your case and to challenge I suppose established thinking about how services may be offered at the moment and look at alternatives.
SANDY FRASER:
And Julie, how does that work in a public health context?
JULIE HIRST:
Well, I think it’s a really important principle of public health actually. It’s empowerment and seeing everybody as equals. Now, we all know, don’t we in health and social care that quite often people feel a massive power differential because professionals have a lot of knowledge that they’ve trained over the years to acquire. They’ve got all the resources, and they can determine where those resources go to some extent. So I think if service users and their carers understand and can conduct literature reviews, find out what the evidence is, find out what they should be receiving, find out how to get it. Look at the choices as well. Then I think it’s a very, very empowering thing for them to do in and of itself as well as potentially leading to better care.
SANDY FRASER:
Jean, Julie, you’ve provided a lot of food for thought today. Thank you very much.
JEAN GORDON:
Thank you.
JULIE HIRST:
Thank you.
Video 2
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In the video, there was a discussion of ‘bottom-up’ policy. What do you think ‘bottom-up’ policy might mean?
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Discussion
Hopefully you agree that this interview raised various issues and not just the answer to the activity question.
We can contrast two approaches to evidence-based policy inherent in the discussion with Jean and Julie. You should consider both in framing any investigation. Both Jean’s and Julie’s literature reviews were ‘top-down’ in the sense that they were commissioned by other people to take part in literature reviews. In Jean’s case, it was because the people leading the 21st Century Review were part of her network of shared professional contacts. The 21st Century Review Group needed the evidence about social work with older people. In Julie’s case, her managers asked her to review the evidence for ‘what works’ relating to smoking cessation in pregnancy. A matter of public health. Her employers, first the NHS and then, following the 2012 Care Act, local authorities, (Northern Ireland, Scotland and Wales arrange public health services differently) wanted an effective policy to help pregnant women stop smoking.
This can be contrasted with ‘bottom-up’ evidence-based policy, in which a practitioner might take note of a broad policy that affects their workplace and ask questions about it. For example, Jean noted that integrated health and social care is favoured in different jurisdictions, although she knew more about it in Scotland. Jean suggested that a practitioner might be interested in the evidence of effectiveness of integration, and what factors made it successful, to inform the local implementation of integrated care. Can you identify a broad policy of interest that fits your investigations?
You will now look at what our contributors said about each of their literature reviews.