Phased out? On to-ing and fro-ing in a realist study of the use of NICE guidance in local government

NICE has expanded its work and issues guidance to be implemented by local government. This is a different policy context where health research hierarchies of evidence are not privileged. NICE has worked to develop its... [ view full abstract ]

NICE has expanded its work and issues guidance to be implemented by local government. This is a different policy context where health research hierarchies of evidence are not privileged. NICE has worked to develop its approach but as yet there is little evidence of widespread implementation. There is also a more embryonic approach to evidence access and use within local authorities and what counts, as evidence is itself conceptualised differently. Indeed, it has been argued that local government as a system is characterised by ambiguity, complexity and messiness.

This PhD study sets out to explore how NICE guidance is received and used (if it is) in local government. Examining the use of NICE guidance by Local Government Officers (LGOs) requires a lens which examines the context of the culture within which decisions to use or not use are taken; develops theory about how knowledge to support decision making is valued, sought and introduced; recognises complexity and places value on human volition within this process. The study then uses a realist approach to uncover what works, for whom in what circumstances and provide insights to better target NICE guidance and facilitate its implementation

The study was originally conceived in (intertwined) phases beginning with a realist synthesis to uncover and categorise generative mechanisms which support the implementation of NICE guidance into policy by LGOs. The resulting Context Mechanism Outcome Configurations will be prioritised by stakeholders. Finally, a realist evaluation, using comparative case studies, will be conducted to test the prioritised theories. However, in beginning to operationalise the work and develop a means of describing the approach for scientific review as part of PhD milestones the semi-permeability of the named phases was identified and challenged. This poster will describe these challenges; explore why clarity in naming phases is important, in practice, recognising that there will be to ing and fro -ing between phases and set our suggested way forward for this study i.e. substituting ‘validation’ for evaluation.