Policy making, adult safeguarding and public health: a formula for change?
| DOI | https://doi.org/10.1108/JAP-04-2013-0015 |
| Published date | 08 April 2014 |
| Pages | 68-86 |
| Date | 08 April 2014 |
| Author | Leo Quigley |
| Subject Matter | Health & social care,Vulnerable groups,Adult protection |
Policy making, adult safeguarding and
public health: a formula for change?
Leo Quigley
Leo Quigley is a Policy Analyst
with the Maryland State
Innovation Models team and is
based at the Trachtenberg
School of Public Policy and
Public Administration, George
Washington University,
Washington, DC, USA.
Abstract
Purpose – The purpose of this paper is to review the reasons underlying the slow rate of progress towards
developing a comprehensive policy underpinning for adult safeguarding in England and proposes long-term
solutions.
Design/methodology/approach – This paper uses a model of policy change to argue that adult
safeguarding has been over-reliant on case histories to define its policy problems and influence its politics,
while making insufficient progress on data collection and analysis. It uses examples from the parallel
discipline of public health to explore four challenges, or “problems”, relevant to the further development of
the knowledge base underpinning adult safeguarding policy.
Findings – Four recommendations emerge for closing the adult safeguarding “knowledge gap”, including
the development of a national research strategy for adult safeguarding. In a fifth recommendationthe paper
also proposes a clearer recognition of the contribution that local public health professionals can make to
local adult safeguarding policy making and programme development.
Practical implications – The first four recommendations of this paper would serve as the basis for
developing a national research strategy for adult safeguarding. The fifth would strengthen the contribution of
local public health departments to safeguarding adults boards.
Originality/value – The author is unaware of the existence of any other reviewof the limitations of the adult
safeguarding knowledge base as a foundation for policy making, or which proposes strategic solutions.
The work is valuable for its practical proposals.
Keywords Public health, Policy, Prevention, Safeguarding, Data collection, Cost-effectiveness analysis
Paper type Conceptual paper
I. Introduction
The slow pace of development of national policy on safeguarding adults has been a source of
frustration to those professionally involved in the field. The question of what drives policy change
is one widely debated in academic circles, and the way in which scientific, professional or expert
“knowledge” develops alongside and influences policy is arguably of particular relevance to a
complex policy field like adult safeguarding.
Using a policy change model that describes policy problems, policy solutions and politics,
I argue in Sections II and III of this paper that adult safeguarding has been over-reliant on case
histories to define its policy problems and influence its politics, while making insufficient
progress on data collection and analysis that might both suggest innovative policy solutions and
help choose between them.
Next, believing that cross-fertilisation between disciplines can stimulate and illuminate
conceptualisation and analysis of policy issues, I suggest in Section IV that efforts to secure
policy change in adult safeguarding could benefit from consideration of a discipline which
presents similar policy challenges but has a longer policy history than adult safeguarding,
subject of course to careful attention to the differences as well as the similarities of the scientific,
The author is grateful to Jill
Manthorpe for valuable comments
on an early draft of the manuscript.
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VOL. 16 NO. 2 2014, pp. 68-86, CEmerald Group Publishing Limited, ISSN 1466-8203 DOI 10.1108/JAP-04-2013-0015
professional and policy challenges attending each discipline. On this basis I explore four
challenges, or “problems”, from the field of public health which may be of particular relevance to
the further development of the knowledge base underpinning adult safeguarding policy: the data
problem, the causation problem, the prevention problem and the problem of human behaviour
as an object of policy.
In the course of this analysis I draw up recommendations (emboldened within the text for each
problem area) which, taken together,begin the formulation of a national strategy for accelerating
the future development of the adult safeguarding knowledge base.
The paper closes with a recommendation for achieving closer alignment between adult
safeguarding and public health policy making and practice.
II. Catastrophic events and models of policy change
On a stormy March night in 1864, the huge dam at Dale Dyke above the booming English
industrial town of Sheffield collapsed. A gigantic wall of water, laden with trees and other debris,
thundered down the Loxley and Don valleys levelling bridges, houses and anything else in its
path. In total, 244 people lost their lives (Charles et al., 2011). The inquest jury drew up a strongly
worded recommendation on dam safety:
In our opinion the Legislature ought to take such action as will result in governmental inspection of all
works of this character, and that such inspections should be frequent, and sufficient, and regular
(Harrison, 1999).
Surprisingly, given the enormous death toll, a Waterworks Bill presented in Parliament in 1865
never reached the statute books. It took a further 65 years, two more dam failures and 21 more
lives lost before the Reservoirs (Safety Provisions) Act of 1930 introduced regular inspection of
dams (Charles et al., 2011), since when not a single life has been lost in the UK from dam failure.
This is an example of policy change driven by catastrophic events. “Catastrophic”, “disastrous”
or “high-profile” events, or, more generally, “case histories” offer valuable opportunities for
improving policy (Charles et al., 2011). However, the linkage between triggering events and
policy change does not seem to be straightforward. Some events lead to rapid change, as with
the introduction of all-seated stadiums after the 1988 Hillsborough disaster (Thompson et al.,
1998), while others, like the Dale Dyke dam tragedy described above, do not, with policy change
occurring only after further disasters, or not at all. The question “why?” naturally arises.
In the 1980s John Kingdon introduced a model into political science (see e.g. Mucciaroni, 1992)
which aimed to capture the process of policy change and explain when and why policy change
occurs (or does not). Kingdon defined “policy problems” as the seemingly limitless set of issues
legislation might potentially address, “policy solutions” as alternative measures for responding to
the policy problems, and “politics” as the constantly shifting interaction between legislators,
interest groups, economic circumstances and public concern that determines what gets onto
the legislative agenda and when. Using these three conceptual categorisations, Kingdon’s
insight was that legislative change becomes possible only when “problems”, “solutions” and
“politics” align in just the right way (Mucciaroni, 1992).
At first glance, this model neatly maps the process of policy change driven by high-profile
events, starting with the observation that any event meriting the description “high profile” must
be regarded, almost tautologically,as “a policy problem”. The model sees new “policy solutions”
as arising through “the gradual accumulation of knowledge and perspectives among specialists
in any given area” (Mucciaroni, 1992); when a solution emerges, and the national mood and
other “political” considerations support it, policy change may result. This sounds straightforward
enough, but Mucciaroni observes that policy change is rarely, if ever, inevitable, even when
problem, solution and politics appear to be favourably aligned. In a critical analysis of Kingdon’s
model Mucciaroni argues that Kingdon’smodel is limited through dealing only with factors which
are subject to change, whereas a better fit with observed policy examples can be obtained
by also taking into account unchanging structural forces – social, economic and political in
nature – which can make it difficult for some ideas to get onto the legislative agenda or determine
which of several alternative policy solutions will be favoured (Mucciaroni, 1992).
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