Knowledge and knowing in policy work: a case study of civil servants in England’s Department of Health
Contemporary English health policy is saturated with claims about what the world is like and how it might be otherwise. These claims span the wide range of subject matters covered by health policy, from hospital waiting times to our preparedness for major disease outbreaks; from structures for the planning and purchasing of healthcare to requirements around the sharing of patient records. Despite this, empirical studies of health policymakers working at the national level in the UK suggest that research evidence plays only a very limited role in policy development (Lavis et al. 2005; Dash 2003; Dash et al. 2003; Innvær et al. 2002; Petticrew et al. 2008). This apparent contradiction was the starting-‐point for this project. If civil servants are not drawing on research knowledge in their work, how is it that they are able to devise policy about such complex and technical policy issues? Policy-‐making requires knowing the world in some way in order to act upon it. My research asks, what kinds of knowledge are civil servants in England’s Department of Health using in their work, and what forms does this use take? This thesis is situated in an emerging field of interpretive policy analysis which treats policymaking as realised in the daily work practices of communities of individuals (Wagenaar & Cook 2003; Wagenaar 2004; Colebatch 2006; Colebatch et al. 2010; Freeman et al. 2011). I have adopted an ethnographic approach, conducting 60 hours of original data collection in the form of interviews and meeting observations among mostly mid-‐ranking civil servants working on various high-‐profile health policies in 2010-‐11. By analysing my fieldwork experiences and the resulting data, and by relating these to insights from theoretical resources in sociology, psychology and philosophy, I offer an account of the different forms of knowing and knowledge entailed in the practice of policy-‐making. I identify three forms of knowledge and knowing that were integral to the work of the civil servants I studied: the ‘practices of knowing’ by which they came to understand the objects of their policies and think through the possibilities for their reform; the ‘pragmatic use of knowledge claims’ in which facts, figures and stories were invoked to generate support for policies and to defend decisions taken; and the ‘know-‐how of policymaking’, which was the most important form of knowledge for the civil servants’ professional identities. In the conclusion, I reflect on the aspects of knowledge and knowing which are shared by the civil servants’ practices and my own work in producing this thesis.