Rhetoric, Evidence and Policymaking: a Case Study of Priority Setting in Primary Care*

Abstract

This chapter describes a study undertaken as part of the UCL Evidence programme to explore how policymakers talk about and reason with evidence. Specifically, researchers were interested in the micro-processes of deliberation and meaning-making practices of a group of people charged with prioritising health care in an NHS Primary Care Trust in the UK. The chapter describes how the research study brought together ideas from rhetorical theory and methods of discourse analysis to develop an innovative approach to exploring how evidence is constituted at the micro-level of social interaction and communication. It presents empirical data to illuminate the representation and meaning of evidence within one particular policymaking forum, and to highlight contrasting constructions of the policymaking process.

Disinvestment policy and the public funding of assisted reproductive technologies: outcomes of deliberative engagements with three key stakeholder groups

“…Deliberative processes are underpinned by the theory that an appropriately informed sample of the population can deliberate productively with a view to offering contributions to policy development that are reflective of broader values. Used productively in other contexts to canvass community and stakeholder perspectives on health-related priority setting [ 15 - 17 ], deliberative methods are held to both improve and legitimate policy directives [ 18 ]. In the context of disinvestment decision-making where, it may be argued, there is a particular imperative for “health services to be accountable to users as taxpayers, voters and consumers” [ 19 ], deliberative methods represent a more transparent means of addressing the complex, ethical nature of resource allocation and policymaking.…”

The ASTUTE Health study protocol: Deliberative stakeholder engagements to inform implementation approaches to healthcare disinvestment

“…Debate around ‘the fair and reasonable allocation of resources has become a prominent one in modern day discourses about healthcare’ [9]. Health funding decisions, particularly those which relate to some level of reimbursement retraction (more effective redistribution notwithstanding) may carry significant moral implications, be highly contested (by a range of stakeholders) and historically have not been made in an explicit and transparent manner.…”

Microsimulation Model for Health Economic Evaluation of Public Health Policies: An Imperfect but Useful Tool

“…A constructive view of policy-making is needed, where evidence and action content lead to constructive negotiation. 8 What is needed to inform policy-making is a better understanding of the mechanisms for change from the perspective of all stakeholders-the government, the industry, and individuals.…”