Historians, Policy and Institutional Memory
Jenny Crane, Research Fellow on a Wellcome Trust Senior Investigator Award ‘The Cultural History of the NHS’, Warwick University
For the last three months of 2015, I undertook a Fellowship at the Parliamentary Office for Science and Technology (POST), sponsored by the Wellcome Trust. Thus, I was a historian thrown in to the world of policy, albeit for a short while. What I learnt is that high quality research is used throughout Parliament at every level. However, I also found that research is often conducted in-house, and that long-term historical evidence, in particular, is not regularly consulted. With this in mind, this is why I think that schemes such as the POST Fellowship or Historians in Residence are so exciting – because they give us historians a chance to offer a new, fresh, and outsider perspective on current political debates.
Various types of evidence are used across and throughout Parliament, Research is often conducted internally, through bodies such as the Scrutiny Unit, the Libraries, and POST, as well as by Parliamentary staff, including those who have published research (such as Paul Evans, Paul Fawcett, and Oonagh Gay) and those who work for select committees, MPs, and Peers. This research will tend to be answering specific questions set by the political agenda. At POST, for example, the topics of POSTnotes are chosen by a panel of MPs and Peers who determine which topics are ‘timely’ (a difficult task!) Parliament also has some mechanisms through which to seek out external research and researchers. The research bodies mentioned above often interview academics for specific briefings; select committees can commission research from academia or the third sector; and Parliament has a couple of ‘resident’ academics, such as Professor Sarah Childs, who was commissioned by the Speaker to examine gender in Parliament.
At an event I attended whilst in Parliament, about Research, Impact and Parliament, some delegates explained that many in Parliament prefer internally-conducted research. Paul Evans, the Clerk of Journals at the House of Commons, argued that many see academics and Parliamentarians are existing in entirely separate ‘epistemic universes’, with fundamentally different assumptions, priorities, and communication styles. Adam Alfriyie MP, the Chair of POST’s Board, relatedly argued that many MPs tend to automatically regard any external parties, including academics, with suspicion, as lobbyists out to promote their own agendas, because of the number of people who MPs are approached by and the limitations on their time.
Adding to the problems for historians at Universities trying to influence Parliament, historical evidence specifically is not always sought out by policy-makers. Certainly, when advised on where to seek out the evidence for my briefing, I was told by POST staff to look at science, technology, and medicine journals, blogs, and websites. I was expected to use the skills which I had gained as a historian – research, analysis, and data collection – but not to use historical evidence itself. This trend, of not seeking out historical evidence, itself has a history: indeed Pat Thane has argued that in the early twentieth century ‘the making of innovative and enduring social policies such as the introduction of pensions and national insurance was preceded by in-depth historical studies’. By contrast, she contends that: ‘Since the 1950s and even more since the 1980s, policy and legislation have been produced ever faster, with less and less attention to historical evidence’.
When history is cited in political debate, it tends to be recent history, and, at times, utilised selectively to forward a party’s preferred course of action. Whilst at POST, this was very clear as I prepared a briefing about electronic health records, outlining the potential benefits of an entirely paperless NHS, and the (vast) challenges to implementing it. The very recent history of the National Programme for IT in the NHS (2002-2011) is regularly called upon in Parliamentary discussions of electronic health. In 2013, the Public Accounts Committee argued that: ‘After the sorry history of the National Programme, we are sceptical that the government can deliver its vision of a paperless NHS by 2018.’ (Indeed, a target which has subsequently been revised to 2020.) The Committee also stated that ‘If the Department [of Health] is to deliver a paperless NHS, it needs to draw on the lessons of the National Programme’, particularly in terms of being transparent about their commissioning process, engaging clinicians with new IT systems, and enabling local areas flexibility and choice about the shape of their record systems. The Health Secretary, Jeremy Hunt, has also called upon this recent history whilst describing his paperless NHS, stating that whilst ‘previous attempts’ have been ‘top down project[s]’, he will ‘avoid the pitfalls of a hugely complex, centrally specified approach‘.
A longer history of patient records, or even one before 2002, was not called upon in these debates. When longer histories are used in policy documents, they are often for illustrative and rhetorical purposes, to add flourish or grandeur. The NHS England report the Five Year Forward View (2014), for example, when discussing electronic health states that: ‘There have been three major economic transitions in human history – the agricultural revolution, the industrial revolution, and now the information revolution.’ Yet a longer history of patient records, and a more detailed one, could be of use for informing current debates. Patient records have only been written and stored in a standardised format since 1911, when David Lloyd George introduced national health insurance for low paid male workers. More standardisation was introduced from the early 1950s, after the establishment of the Royal College of General Practitioners, who were seeking to unify, and increase the respect for, their profession. In the 1970s and 1980s, debates around whether the A5 Lloyd George envelopes should be made A4, found in contemporary medical journals, were not merely debates about size, but about the professionalism of family doctors (who felt ’embarrassed and inefficient’ as they ‘tried to disentangle jumbled sheafs of hospital letters and reports’ from small files) and also about the amount of patient information which should be stored and shared.
Since the 1970s and 1980s, doctors have made moves towards storing patient records electronically. At first records were stored on large floppy disks, which could only fit a patient’s name, address, date of birth, and key medical conditions. Computers have since developed far more capacity, and today 99% of GPs store their records electronically, which include masses of patient data, emails from hospitals, and images from new medical technologies such CT and ECG scans. As early as the 1970s, debates raged around the safety and privacy of patient information stored electronically, and about whether the act of putting information online somehow depersonalised the patient, and changed the doctor-patient relationship. These debates were expressed in newspapers, through art, and in homes, and continue today, also publicised by campaign groups such as Big Brother Watch and MedConfidential.
‘Depersonalisation in medicine (“(Mis)recognition”) by Emma Barnard and Mike Papesch(2013).
This artwork was produced in the 1980s, and collects the powder produced from the decay of Guy’s Hospital medical records. The image suggests the vulnerability of paper records
This is a broader history, and a longer history, than Parliamentary research tends to access. Nonetheless, it can be useful for informing current debate. This longer history reminds us, for example, that whilst the above privacy campaign groups are relatively new, the concerns which they represent are not. The long and repetitive history of failed attempts to introduce IT into the NHS (starting with the computer-aided despatch system purchased by the London Ambulance Service in 1974) helps explain why many clinicians and think-tanks remain suspicious of government claims to make the NHS paperless, even with lessons learnt from 2002. The broader history, and art produced around this topic, helps us to understand a little better how electronic records – something which sounds so stale and dry – profoundly affect the lives and feelings of patients and clinicians, given the personal, sensitive, and essential nature of people’s medical histories. These feelings and meanings are important to access if policy-makers want to include and involve patients and clinicians in installing and utilising an electronic health record system.
Thus, research is used in Parliament, and it is used well, but it is not usually research conducted by historians based at Universities. Nonetheless, we can offer a useful perspective for political debate: we can be outsiders, and can provide a broad and a long understanding of social, political, and cultural change, unencumbered by the specificities or contexts of Parliament and its short institutional memory. Policy-makers may not automatically seek out our insights (for now), but there are many avenues through which we can explain, concisely and carefully, how our research can inform policy. Historians can, and should, submit evidence to select committee inquiries, join All-Party Parliamentary Groups, contribute to relevant inquiries at the Libraries or POST, and write comment pieces for History & Policy. We can also, excitingly, apply for residencies with Historians in Residence, which give us the opportunity to see Parliament and other institutions from the inside, and to promote and demonstrate the value of historical research and evidence.