A Career in Health Policy
If you missed Dr David Neal’s webinar this summer or don’t have time to watch it in full then read on for a summary of the key points…
To watch the full webinar click here.
Dr Neal is on the Board of Polygeia, a student run think tank focusing on global health and policy, as well as a practicing foundation Doctor in London. He has also interned at the World Health Organisation (WHO), has a degree in Experimental Psychology and Biological Anthropology and is an editor for online mental health magazine This Space.
Follow this link to find out more about Polygeia (from the Greek phrase ‘a wish for good health’) https://www.polygeia.com/who-we-are
I found the webinar to be inspiring and provided a clear overview of how we can all use our medical audits, which everyone does as part of training, to help shape future health policies and to change and improve healthcare. Audits can provide evidence to support the need to make a new policy or to change an existing policy.
The key learning points from the webinar were:
- What policies are
- Understanding the policy cycle & where audits fit in
- Understanding the difference between academic writing and policy writing
- The importance of understanding your target audience
- Policy vs Politics
A policy tells us in practical terms what to do in a specific situation to solve a problem and gives us a specific plan. They can be local, national, regional or global and exist within a political context, which sets and prioritises principles and goals. An example would be a policy to reduce maternal mortality globally.
In contrast to this politics is the debate around competing ideologies and beliefs, covers a broad view and compromises will be made between competing interests- for example there is limited funding to go to different areas of the population and decisions must be made about which problems to solve as a priority.
Current policies on a national level include the 4 hour A&E targets, the Junior Doctor contract and Sustainability and Transformation partnerships.
Local policies are overseen by local authorities run by local politicians and also hospital managers, department heads and commissioners and will be affected by each of these individual’s personal ideologies.
There are also regional policies for example those from the EU and global policies for example those developed by WHO.
- Policy Cycle
The policy cycle is as follows: Problem identification -> Option identification and analysis -> Policy selection ->Policy implementation -> Evaluation and monitoring (this includes audit) -> Back to the start
Policy selection includes considering proven effectiveness, value for money, affordability and sustainability. For audits to have an impact on policy the results must be fed back to policymakers.
Challenges faced when developing policy include defining the scope of problem including research, inherent uncertainty of new problems eg Ebola, timing– is it urgent and how long do we have to research this? Also the context of the problem can change over time and there will always be barriers to implementing policy for example cost.
- Academic writing vs policy writing:
When writing policies communication is key, and as medics we should all be well versed in communicating with clarity and efficiency. Key skills needed with policy writing are a flexible approach and persuasion– which we will have developed through getting those urgent scans done or explaining to a patient why self-discharge isn’t in their best interest.
Scientific writing: needs to be written clearly, accurately and objectively to outline the method & results, so that others can replicate it and it is a way of sharing knowledge.
Policy writing: also clear, accurate and objective writing but the aim is to get an individual, organization or group to change what they do in a given situation and is about persuading people to act.
What to write: letters or emails to hospital managers, the CCG, local or national politicians, present posters at conferences, journal writing: blogs, newspaper, policy briefs (these should be a short, summary of work & recommendations).
Who to write to: for national guidelines write to the head of department in the first instance, for trust guidelines it should say on the policy who to contact, or you could contact the clinical/medical director or audit office.
A key message is that a policy is one specific area and an audit will look at one specific policy or part of a policy but you need to take into account the context of the policy and this includes the political climate so therefore you will need to persuade the relevant people to prioritise this policy in particular.
- Target audience
Think about who you are trying to persuade, their guiding principles and the wider context in which they’re working. Also try to find out about the way they like to communicate eg by phone/email and do they prefer a brief overview or lots of detail? What is the purpose of your communication and consider how much they are likely to support it and how much influence they have to implement or block the policy.
All parties involved in implementing policy will have to agree or compromise on a solution to the problem and they will all have different priorities. You will need to explain the importance of the proposed policy, highlight shared values and goals and show enthusiasm whilst maintaining some realism as no change is easy or obvious. It can be useful to bring in an independent expert to help persuade people to implement the policy.
To find the national health priorities they should be fairly obvious and featured in health news stories however local priorities may differ and it can be helpful to read the health strategy of the local authority which is linked to the CCG and also your local trust’s ‘key values’.
Thinking about a career in health policy?
Try to make connections, build networks and get internships where you can, although these tend to be competitive.
Another idea is to try to influence health policy locally through your current work and if you are successful opportunities may arise from there.
Someone who managed to do this and has had an impressive career to date is Lorenzo Savioli, who trained in Italy and moved to Tanzania in the 1970s where for over a decade he implemented public health programmes and transformed the public health on Zanzibar. He then joined the WHO for a decade and put neglected tropical diseases on the map which has helped millions.
Areas which you might be able to make a difference to health policy: look for ones that are at a tipping point, which are most likely to change if they were given a bit more of a ‘push’- these areas will be in the news a lot and there might be big awareness campaigns running.
Also areas which are yet to be sufficiently addressed and may be useful to explore in the future: rota gaps and reliance on locums including the possible effects on patient care, end of life and advance care planning, medical apps and how these might affect doctor-patient relationships.
Thanks to Dr David Neal for a really useful overview of how we can all use our audits to influence the healthcare policies of the future!
Dr Kate Smith