Incorporation of a health economic modelling tool into public health commissioning: Evidence use in a politicised context

Sanders, Tom, Grove, Amy, Salway, Sarah, Hampshaw, Susan and Goyder, Elizabeth (2017) Incorporation of a health economic modelling tool into public health commissioning: Evidence use in a politicised context. Social Science & Medicine, 186. pp. 122-129. ISSN 0277-9536

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This paper explores how commissioners working in an English local government authority (LA) viewed a health economic decision tool for planning services in relation to diabetes. We conducted 15 interviews and 2 focus groups between July 2015 and February 2016, with commissioners (including public health managers, data analysts and council members). Two overlapping themes were identified explaining the obstacles and enablers of using such a tool in commissioning: a) evidence cultures, and b) system interdependency. The former highlighted the diverse evidence cultures present in the LA with politicians influenced by the 'soft' social care agendas affecting their local population and treating local opinion as evidence, whilst public health managers prioritised the scientific view of evidence informed by research. System interdependency further complicated the decision making process by recognising interlinking with departments and other disease groups. To achieve legitimacy within the commissioning arena health economic modelling needs to function effectively in a highly politicised environment where decisions are made not only on the basis of research evidence, but on grounds of 'soft' data, personal opinion and intelligence. In this context decisions become politicised, with multiple opinions seeking a voice. The way that such decisions are negotiated and which ones establish authority is of importance. We analyse the data using Larson's (1990) discursive field concept to show how the tool becomes an object of research push and pull likely to be used instrumentally by stakeholders to advance specific agendas, not a means of informing complex decisions. In conclusion, LA decision making is underpinned by a transactional business ethic which is a further potential 'pull' mechanism for the incorporation of health economic modelling in local commissioning.

Item Type: Article
Uncontrolled Keywords: UK; Commissioning; Local government; Health economic model; Evidence informed practice; Qualitative study; Implementation; Discursive field
Subjects: B900 Others in Subjects allied to Medicine
L400 Social Policy
Department: Faculties > Health and Life Sciences > Social Work, Education and Community Wellbeing
Depositing User: Paul Burns
Date Deposited: 18 Jan 2019 14:49
Last Modified: 11 Oct 2019 14:30

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