Informal governance can be defined as a means of decision-making that is un-codified, non-institutional and where social relationships play crucial roles. Research evidence suggests that an analysis of informal governance is essential if we are to fully understand how political innovation occurs.
The issue of informality in policy-making is particularly timely as public managers seek to manage multifaceted policy problems within contested and uncertain environments. One view is that political decision-making has increasingly moved away from the national level of government to a more spatially diverse, temporal and fluid set of arrangements. From this perspective, policy-making is increasingly taking place in arenas where there is no generally accepted rules and norms according to which politics is to be conducted. Some argue that it is the surge of ‘wicked problems’ that have prompted this type of leadership, as multiple actors come together to solve complex policy problems. These developments raise important questions about how informal governance operates in this transforming policy landscape and the impact it has on political innovation. Yet, there is comparatively little research on the role of informality in policy-making, partly because of the complexity of studying it.
As soon as women find out they’re pregnant, they are overwhelmed with information about what they can – or more likely can’t – eat and drink. Off the menu go soft cheeses, partially cooked eggs, raw meat, pâté, liver, caffeine, alcohol. It’s a lot to remember.
But the advice on eating fish when pregnant is the by far the most complex. Does it need to be so complicated? What is the actual evidence of the risks and benefits of eating fish for a mother-to-be? Continue reading
The 9th-15th October is Baby Loss Awareness Week, which provides a chance to raise awareness about the issues surrounding pregnancy and baby loss in the UK. Our team has over 10 years of research experience in what makes effective training for staff involved in care for bereaved parents, and seven years working to end preventable harm related to stillbirth.
Author: Dr Dimitrios Siassakos, Consultant Senior Lecturer in Obstetrics, Department of Obstetrics and Gynaecology, The Chilterns, Southmead Hospital and Bristol Medical School
We welcome the House of Commons debate on Tuesday 10th October 2017 as part of Baby Loss Awareness Week, and have drawn on our recent research at the University of Bristol to contribute to this debate.
Our research has found that bereavement care is inconsistent across UK hospitals, and variable in quality. Bereaved parents are not always involved in decision-making, and parents may not be aware of the process when hospitals review their baby’s death. Healthcare staff may not be supported in caring for parents.
Our research on what makes training effective highlights that not all training is equal.
How we would like our MPs to help:
In a systematic review published this month, we identified 153 communication skills training interventions for generalists in end of life care. In randomised controlled trials, training improved showing empathy and discussing emotions in simulated interactions (i.e. with actor patients) but evidence of effect on clinician behaviours during real patient interactions, and on patient-reported outcomes, was inconclusive.
The global increase in the proportion of older people and length of life means providing end of life care is now increasingly the responsibility of generalist as well as specialist palliative care providers. But many clinicians find communicating about end of life issues challenging: how do you best discuss imminent mortality, limited treatment options, what to expect when you’re dying, or a patient’s preferences for end of life care?
When this communication is done poorly, or not done at all, patients are confused and less satisfied with their care, experience inadequate symptom relief, and have worse quality of life. Staff who feel insufficiently trained in communication skills are more likely to provide depersonalised care and suffer from burnout.
While research in clinical communication has grown in recent years, there is little consensus on optimal training strategies and the most effective teaching methods. Continue reading
One of the central planks of the British government’s legislative agenda ahead of Brexit, the European Union (Withdrawal) Bill, will begin its second reading on September 7 as MPs return from their summer recess.
The government’s aim for the bill, originally known as the “Great Repeal Bill”, was to “convert the body of existing EU law into domestic law”, so that parliament can decide what to keep or repeal once the UK leaves the bloc. This was to ensure that, “as a general rule, the same rules and laws will apply after we leave the EU as they did before”, so as to reassure citizens and businesses.
But the bill falls far short of providing citizens and businesses with clarity and certainty. Instead, it paves the way for the modification and removal of rights that currently exist under EU law. Continue reading
Administrative data: it’s one of those phrases that can generate much excitement among economists and some other social scientists, but will never make for scintillating party conversation in any other setting.
However, the possibilities and limits on the use of administrative data for research can have a big impact on the policymaking process and raise tricky ethical questions, so it is important that the conversation is as broad as it can possibly be.
What is administrative data?
Administrative data is collected by the government for a non-research purpose.
For example, as part of my doctoral research I analyse national insurance data on jobs, wages and commuting distances in Germany.
Whenever someone starts or leaves a job, starts to claim unemployment benefits, is assigned to a jobseekers’ training programme or goes on parental or sick leave, this leaves a paper trail.
Economists in particular are very interested in this information: Many of us still subscribe to the traditional credo “Believe what people do, not what they say”. Continue reading
Unfairly dismissed from your job? Seeking unpaid wages? For the last few years, if you wanted your case heard at an employment tribunal in the UK, you had to pay up front. For unfair dismissal, the fees amounted to £1,200, and for unpaid wages £390.
Introduced in 2013, the fees were designed to ensure that “users” of the system were the ones who funded it. The other justifications were to incentivise early settlements, and to deter weak or vexatious claims.
Underlying all these motivations was a concern that too many cases were being brought. And in that sense, the fees sort of worked.
That was mainly because the high level of fees (for workers who hadn’t been paid or had lost their job) compared unfavourably with the low level of sums awarded. A survey in 2013 found the median award for claims for unpaid wages was only £900. Put simply, it just wasn’t worth it. Continue reading
Multimorbidity is one of the biggest challenges facing healthcare. In recent years, a succession of research studies have shown that people with multiple health problems are more likely to have a worse quality of life, worse mental health and reduced life expectancy. The more health problems someone has, the more drugs they are likely to be prescribed and the more frequently they are likely to consult a GP or be admitted to hospital.
You might think this is all rather self-evident – it’s hardly a surprise that sick people get ill, take medicines and go to doctors more often than healthy people.
So why has multimorbidity become so prominent in discussions about healthcare over the last decade?
Statins are well known and established for their role in the prevention of cardiovascular disease (heart attack, strokes, or angina) and this is based on their ability to lower levels of cholesterol in the blood.
However, there is evidence to suggest that statins have multiple effects and these include potential beneficial impacts on other disease conditions.
Venous thromboembolism is a condition involving the formation of blood clots in the veins of the lungs and lower limbs. It affects millions of people globally and is a preventable cause of hospital-related deaths.
Standard techniques for the prevention of venous thromboembolism include the use of elastic stockings, compression devices, patient mobility and rehabilitation, and anticoagulant therapy (blood thinning medications).
Evidence now suggests that statins also have the ability to reduce inflammation in the body and prevent the formation of blood clots. Based on these properties, there have been suggestions that statins may prevent venous thromboembolism.
Several studies have investigated this, however the evidence has not been conclusive until now.
We decided it was time to bring all the evidence together and evaluate if statins really did have a protective effect on the risk of developing venous thromboembolism.
Altogether we analysed 36 studies (13 observational cohort designs and 23 randomised controlled trials) with data on more than 3.2 million participants.
Our results showed a clear link between the use of statins and a reduced risk of developing venous thromboembolism. Continue reading
The impact of academic research, particularly on policy and the private sector, is an increasingly important component of research assessment exercises and funding distribution. However, Duncan Green argues that the way many researchers think about their impact continues to be pretty rudimentary. A lack of understanding of who key decision-makers are, a less-than-agile response to real-world events, and difficulties in attributing credit are all hampering progress in this area. Looking at how impact is measured by aid agencies, there is much academics could learn from their monitoring, evaluation and learning teams.