Transcript presentation - Society for the Study of Addiction

Getting Evidence into Drug Policy:
How can structures and processes help
Nicola Singleton
Director of Policy & Research, UK Drug Policy Commission
SSA Symposium 2012
The UK Drug Policy Commission
• Who are we?
– A charitable, independent body.
– Set up in 2007 to provide objective analysis of
evidence related to UK drug policy.
– Not a campaigning/lobbying body as such.
– 12 commissioners with expertise in drug
treatment, research, policing, media etc.
• Work programme across drug policy
spectrum – both what & recently how
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Why look at policy governance?
UK Independent Commission on Good Governance in the Public
Services (2004)
“Good governance leads to good management, good performance,
good stewardship of public money, good public engagement and,
ultimately, good outcomes.” In contrast “… bad governance fosters
the low morale and adversarial relationships that lead to poor
performance or even, ultimately, to dysfunctional organisations”.
Edgar et al (2006)
“Governance is important since it determines who has a voice in
decision making, the balance of power, how decisions are made and
how account is rendered.”
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Our research methodology
• Multi-component project
– Delphi expert consultation process (29 international experts)
 key characteristics of good governance
– Desk research + commissioned essays
– Interviews & round-table discussions (> 50 people)
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Current & former politicians (including ex-Home Secs)
Current & former civil servants (inc. ex-perm secs)
Academics & researchers
Service providers & representative organisations
Media & SpAds
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In the ideal policy-making world …
… evidence is an essential tool for:
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describing the problem/issue
understanding the problem
identifying possible solutions
checking if a possible solution is effective
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whether objectives achieved?
is it value for money?
does it work for everyone?
is it better than alternatives?
can it be done better or change practices?
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But in the real world …
• Drug policy is viewed as ‘toxic’ topic
 Totemic toughness
 Post-retirement enlightenment syndrome
• Role of evidence downgraded
– ACMD advice ignored
– Nutt sacking
• Reactive policy making
– Role of ‘interest groups’ and media as drivers of policy
eg mephedrone
• Lack of evaluation & review
– ineffective programmes still used – DARE, crackdowns;
– many programmes not evaluated – particularly in CJS.
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But also need to recognise…
• Evidence
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Is not static / set in stone;
Can be complex and hard to access;
Is often equivocal; and
Takes time to obtain.
• Policy-making
– Cannot ignore values/morals;
– Needs to evolve and try new things; and
– Is impacted on by other wider contextual factors
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Some challenges to better use of evidence
1. Polarisation and contested interpretations of the evidence
on both the problems & solutions
“… there's no shortage of alleged experts in this field and they all disagree with
each other … and they all believe whatever they're doing is working. So that's
one constraint that is the lack of a one true path.” [Former minister]
2. What counts as evidence? Struggle against the ‘killer anecdote’.
“… we often think about scientific evidence or research evidence but that in policy
process, what we call research evidence is only one of the forms of the
information or evidence the policymakers consider. [Researcher]
3. People issues
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Personalities
Expertise
Turn-over – civil servants & ministers
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Challenges to better use of evidence
4. Different expectations - a disconnect (& disrespect?)
between policy and science/research
“when you talk to people in the academic world about this they are massively
frustrated about the failure to influence the way government thinks about their
area of work. By the same token many, many politicians are very frustrated by
the academic world. So what the politicians are looking for is some sense of
certainty and the academics, quite rightly of course, can’t offer that sense of
certainty because there isn’t a sense of certainty.” [Ex-minister]
“It's information but it's pointless. It does not tell me anything I can do with, It's
very interesting but it isn't important. So there's a whole bunch of things that are
interesting but not important. Evidence has to be action orientated or otherwise
it's just interesting.” [Civil servant]
Time frames: “The problem was that the research is all long term. … it’s very
difficult for policy makers. They have to be very lucky to find there is actually
evidence that can … be applied to the construction of their policies. It’s normally
… give us money and in three or four years’ time we’ll have conducted this
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longitudinal study and we may … have some evidence to give you. [Civil servant]
Challenges to better use of evidence
5. Evidence base fragmented, uncoordinated and patchy
•Drug policy cross-cutting & multi-disciplinary - may cause tensions.
“The first is you’re on the cusp of health and-, health policy and crime policy
(drugs) and so that’s what’s special about it; that’s what makes it difficult; that’s
why so much of the debate is at cross-purposes…because you’re bringing two
completely different sort of frameworks of what is evidence and what is the
purpose to bear ” [Civil servant]
•Uncoordinated & very limited in some areas eg enforcement.
“It wasn’t co-ordinated across Whitehall. As far as I could see it wasn’t at all.”
[Civil servant]
•Under-resourced
“But we have no budget at all. And I’m not sure we should have a budget but
unfortunately nobody else seems to have a budget either. That’s our problem.”
[Academic/advisory body member]
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Challenges to better use of evidence
6. Issues around review & evaluation
• Inadequate culture of review & evaluation
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Need for monitoring as well as evaluation of both individual
programmes and strategy as a whole – built-in from start.
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Pilots underfunded and not properly evaluated – political rather
than research driven.
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Needs to be recognition of importance of evidence as a tool for
more effective policy & practice and that negative results are
acceptable & important.
• Accountability & scrutiny - independence adds credibility – also
transparency – localism a new dimension
• Needs good sources of data over time - in current drive to
localism may not even know what is being done.
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Some helpful structures & processes…
• New resources for research (eg ESRC & MRC
Addictions clusters; CRI & Manchester Univ
collaboration)
• Supportive systems (eg ACMD/EMCDDA; NIHR &
international networks; Recovery Academy; www &
social media)
• Some ‘translation’ for practitioners (eg Skills
Consortium, Drug & Alcohol Findings; trade press)
• Future PHE spending incentivises scrutiny of impacts &
performance
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UKDPC has demonstrated value of
independent ‘mediating’ body
Identify
issue
• Engage
stakeholders in
defining scope &
identifying gaps.
Review
current
evidence
Collect new
evidence
• Stakeholders – academics, policymakers, practitioners, users &
families - involved in project
advisory group.
Identify
implications
for policy &
practice
• Tested with
stakeholders and
target audiences.
Publication &
dissemination
• Targeted
meetings with key
influencers as
well as
conferences etc.
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And some international examples
worth studying…
• Australian investment in core funding for academic
institutions & use of proceeds of crime to fund research.
• Canadian Centre on Substance Abuse – legislated mandate
to provide national leadership and evidence-informed
analysis and advice
• US research funding and knowledge transfer initiatives +
OMB commitment to requiring RCT evidence of benefit.
And lessons from other policy & cross-policy areas:
• Institute for Government
• Alliance for Useful Evidence
• Sense about Science
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Some possible governance options (1)
Key issue
Possible structures & processes
Need for calm space for discussion,
agreement on the evidence.
Cross-party political forum to progress
discussion about future policy.
Dealing with un-evidenced assertions
in media and by politicians.
Engage with fact-check type organisations.
Role of Chief Scientists/ UK Stats Authority.
Reactive approach to drug control and Introduce independent-decision-making on
classification rather than evidencedrug harms & review classification process.
based
Need for greater leadership & coordination of knowledge development
and transfer
New independent body to take on leadership
& co-ordination of research & policy analysis.
Son of UKDPC?
National interdisciplinary conference?
Improve academic – policy-maker
relationship
Exchanges / shadowing?
Drug strategy research committee?
New role for UK Focal Point?
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Some possible avenues to pursue (2)
Key issue
Localism & devolution an opportunity for
natural experiments but threat of pockets
of poor practice
Proposal for change
Evaluate emerging local approaches and
develop mechanisms for knowledge
transfer to and between areas. Who???
Need for minimum standards set at
centre?
Need to embed credible evaluation and
feedback to ensure policy is effective and
VfM and to prevent unintended
consequences.
??PAC ensure that evaluation is built into
policy from the very beginning?
Require proper impact assessments.
Independent scrutiny – SWaNI examples
Mechanisms for arbitrating between
different evidence sources
A NICE equivalent for social sciences?
Improve parliamentary select committee
functioning
Follow-up on recommendations.
Joint meetings
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Concluding thoughts
• Policy & practice needs to be
evidence - based informed imbued
• Evidence-building needs to be:
– a collaborative process – engaging stakeholders at all
stages
– covering basic &evaluative research – research strategy
– co-ordinated to build knowledge
– interdisciplinary and multi-method
– and reviewed regularly as context changes
• Independence and objectivity is important.
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For more information: [email protected]
Our reports are available for download on the
UKDPC website at: www.ukdpc.org.uk