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  4. BSA Risk Study Group Conference: Risk, Policy and Decision Making

Apr

12

Tuesday

BSA Risk Study Group Conference: Risk, Policy and Decision Making

9.30am

Public

Speakers: Peter Taylor-Gooby, Professor of Social Policy (University of Kent), Peter Ayton, Professor of Judgment and Decision Making (City University London)

Risk, policy and decision making

One day conference at City University London.

Covened by

Jacqueline Davies and Paul Godin at City University London

in conjunction with

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This conference explored how risk thinking and behaviours give rise to organisational and government policies, and how and why people make the decisions they do in response to the risks and risk policies they encounter.

Keynote Speakers

Peter Taylor-Gooby, Professor of Social Policy, University of Kent, Taking government to the People: consumer choice versus decentralised democracy

Less government and greater public participation is currently fashionable. The two main ways of doing this are to constitute individuals as pro-active, rational and well-informed consumers and to transfer democracy downwards, involving people in participation, consultation and greater control over the services they use: open enrolment and the education market versus free schooling.

This paper considers why government is seeking to transfer responsibility for social risks. It is hard to balance the demands for cuts and cost-efficiency with pressures for legitimacy and public acceptability.

It reviews the strengths and weaknesses of various policy developments, paying attention to those aspects of psychological theory that are not commonly included in policy debate.

These addresses both comparing loss and gain (cuts or spending) with a note that people don't worry as much about loss as they get excited about gain.

The addresses were followed by 14 streamed papers. One of the streams continued the the theme of loss and gain in maternity care, cancer treatment and forensic mental health. Another focused on public health education in three different areas: sex workers, new parents and thrombosis.

Speakers and Abstracts from the Streams

Dr Daniel Ashton and Dr Rebecca Feasey, Bath Spa University - The 'Jade Effect', affect, and public understandings of risk and celebrity

The news coverage of Jade Goody's battle with cervical cancer during 2009 was seen to provide valuable visibility of the disease and prompt a number of young women to evaluate their own health. This paper explores how decision-making in relation to health risks is bound up with the complex relationships people have with celebrities. In other words, how might awareness of a disease be inextricably linked to an awareness of a particular celebrity?

Drawing on focus group research with young females in the cervical cancer screening-commencement age range, this paper explores the complexities and tensions in how the 'public' can engage with mediated illness.

Firstly, this paper will signal the role in which 'soft' media (see Henderson and Kitzinger, 1999 on breast cancer) can have on shaping understandings of disease and informing risk decision-making. More specifically, it will outline the focus on magazines and popular media taken in this research project and highlight the currency of this approach.

Secondly, and set against existing accounts of celebrity illness disclosure and awareness (including Magic Johnson and AIDS), this paper highlights the significance of audience research for exploring public understandings. As Couldry and Markham's research (2007) on celebrity and political participation highlights, we should not assume the resonance particular celebrities might. With reference to comments from focus groups, this paper will examine the range of affective meanings and engagements that participants describe in relation to Jade and that form part of their health risk decision-making.

The paper will conclude by examining tensions in health communication literature on awareness and visibility, and highlighting the challenge to policy makers presented by celebrity mediated health disclosures (as complex resources in personal health risk decision-making).

Professor Peter Ayton, Professor of Judgment and Decision Making, City University London - Risky decisions: thoughts and feelings

In recent years evidence has been accumulating for the idea that risk perceptions and risky decisions are informed by affect - emotional feelings - rather than being the result of purely cognitive processes.

Here I present evidence from both experimental studies and field studies of the influence of emotions on risky decision making and vice versa. These effects could not be anticipated from a rational consequentialist perspective on human decision making.

Lucy Brown, University of Strathclyde - Governance, Planning and Risk: an analysis of industrial and community change in Grangemouth

Based on original empirical research, this paper examines the effects of community liaison and governance on perceptions of environmental risk. The research assesses the impact of commercial and political changes on perceptions of risk and regimes of accountability; taking the town of Grangemouth as a case study in risk communication and risk management.  Dominated by the presence of a major petrochemicals complex, the town of Grangemouth in central Scotland is a suitable site for a micro-level study into the dynamics of planning governance and community liaison. The complex is now owned by INEOS and accommodates eight further 'top tier' hazard sites. These transnational corporations run various community liaison groups and are active participants in partnership activities with local authority Falkirk Council.

Employing semi-structured interviews, documentary analysis and some observational work, the research with local governance actors investigated the efficacy of risk communication strategies in mediating community concerns and considered how local decision-makers perceive community concerns regarding risk and hazard.  The change in ownership of the main Grangemouth refinery was found to have had some impact on governance actors' perceptions of the petrochemicals complex; however, the withdrawal of BP and the different approach of INEOS have resulted in a changed relationship between industry and community in Grangemouth. The growing insecurity about the future of the refinery has resulted in the community being less keen to challenge the refinery owners, though local politicians and officials are not similarly immune from criticism and calls for accountability. In terms of partnerships, corporate involvement in local initiatives is regarded as having 'triggered' development, although the extent to which this benefits Grangemouth itself is unclear.

Olive N Y Cheung, Royal Holloway, University of London - An exploration of the influence of interactional factors on sexual risk taking behaviour in the commercial sexual encounter

The selling and the purchase of sexual services have long been conceptualised as risky behaviour. Since the mid-1980s, female sex workers have been identified as key vectors of the spread of HIV/AIDS. Nevertheless, it is evident in research on sex work that there has been a misplaced fear that sex workers posed a threat to public health (Scambler & Scambler 1999; Scambler & Paoli 2008) and sex workers has been scapegoated (Day 2007).

In recent years sexual risk behaviour among male clients of sex workers has attracted increasing interest from academics and policy makers. It is reported that clients are apparently not keen on using protection when they purchases sexual services, in particular in Asian countries (Choi et al. 2005; Lau et al. 2002; Wong & Wun 2003). While sex workers are considered to be likely to be motivated by economic reward and offer unprotected sex, clients' behaviour has been attributed to having poor STD knowledge and their unfavourable attitudes toward condom use (Wee et al. 2004). It is suggested that condom policies and behavioural interventions are likely to have a positive impact on minimising risk-taking behaviour (Lau et al. 2008).

By presenting findings from an empirical study, in this paper I argue that risk-taking behaviour among clients has to be understood in the context of social and cultural relations. The interaction between sex workers and their clients, in particular, affects significantly on risky decision.

Gill Cluckie, Health and Social Care Research, King's College London (Dr C. McKevitt, & Professor A Rudd) - The Lazarus effect: communicating risks of thrombolysis in the emergency room

Long described as the disease for which 'nothing can be done', stroke has recently been re-imagined as something for which much can be done. Licensing of thrombolysis ('clot busting' treatment) for acute ischaemic stroke within 4.5 hours has added impetus for responding to stroke as an emergency condition and the treatment is more effective the earlier it is administered. Media reports of the new treatment as producing a 'Lazarus effect' have down played or disregarded known consequences of the treatment including  having no benefit (in 40% of those treated, brain haemorrhage (6%) and death (3%).

Health care professionals assessing the suitability of people admitted to the emergency room with suspected stroke are required to discuss with them and/or their family member the risks and benefits of thrombolysis before its administration. However, this may be affected by the patient's health status and by the critical temporal requirement of treatment. Sociological accounts of risk communication tend to have been generated from empirical work where this critical time factor is not present. Sociological themes on risk report potential influences such as increased technology or the fear of risk on how risk is socially constructed.

This paper will report findings from an on-going ethnographic study that included observations in London hospital emergency departments and hyper-acute stroke units. It will report on factors that may influence clinicians' choices and actions in relation to risk communication including environmental factors; emotional factors such as distress and anxiety; time; regulatory factors such as protocols; and clinicians' knowledge and beliefs about the safety and efficacy of the treatment, notions of risk and willingness to take risks in their own practice.

Paolo Corvo, Researcher in Sociology and Methodology of social research, University of Gastronomic Sciences Bra-Pollenzo (Cuneo), Italy Catholic University of Milan, Italy - New policies in times of crisis: promoting a qualitative lifestyle

The current global financial and economic crisis is causing profound transformations in consumption patterns and lifestyles; of many Europeans. Even sociologists who study the concept of risk they are trying to understand those changes and to provide plausible interpretations. In this perspective, play a significant role the theories that propose as a possible solution to systemic problems an alternative model of development and growth in relation to the environment, energy, transport, food, pointing to a qualitative and not quantitative dimension of social life.

At the same time have spread worldwide movements and associations that seek to change the approach to the consumption of natural resources according to a vision of economic, social and environmental sustainability. It's possible to prevent the risk of environmental disaster, exhaustion of energy sources, global food crisis, with the dematerialization of economy and a lower use of energy and resources, based on a changed view of the relationship with nature and society.

Public policy could take the opportunity of the crisis to determine and implement new strategies, involving citizens more directly, promoting a qualitative lifestyle, with attention to territorial development, exploitation of local natural resources, in food, transport, energy sources. It's important to dedicate more time to social relations and community life, consolidating the roots of sociability and participation of the Welfare State. It 's a delicate and complex challenge, which could lead to a positive and renewed equilibrium of ecosystem.

Mauro Dilullo, University of Strathclyde - Risk Society: Can we escape from it?

In the last thirty years crime control and social regulation (Foucault 1991; Wacquant 2008) have increasingly become central features of social and political agendas for western societies, particularly in relation to crime prevention and the management of offenders.

We are living in a society where penal severity is now presented almost unanimously as an essential reaction of self-defence by a society threatened by criminality and dangerous terrorists. We are continuously at risk! As Wacquant puts it, those who dare to question the self-evident commonplaces of the pensée unique (Wacquant, 2003) about "insecurity" that now rules uncontested is irrevocably categorized as a dreamer or a terrorist ideologue.

This is to some extent due to the recognition of the cost-effective and efficient way in which 'risk societies' (see Beck 1992) and populations at risk can be managed and; governed: therefore as it has been argued (Ibid) the importance and relevance of risk has emerged over the past three decades for policy makers, researchers and professional practitioners.

For Beck, risk society, "designates a developmental phase of modern society in which social, political, economic and individual risks tend to escape the institutions for monitoring and protection in society" (Beck 1992 p. 5) .The author claims that late modernity, as a reflexive social order, creates new risks and uncertainties in different ways to previous times:

Risks become global, rather than territorially specific; risks are contrasted to dangers and natural hazards as they are made by society; and risks cannot be limited (e.g. terrorism) and therefore cannot be insured against or compensated for.

In this post-modernist political framework (Foucault, 1978), it has also been argued that a new language of penology is emerging (Feeley, Simon, 1992). This new language, shifts focus away from the traditional concerns of the criminal law and criminology, which have focused on the individual, and redirects it to actuarial consideration of aggregates and the risk they are able to bring to society. (Society must be defended, Foucault, 1977).

This shift has a number of important implications: It facilitates development of a vision or model of a new type of criminal process that embraces increased reliance on imprisonment and that merges concerns for surveillance and custody, that shifts away from a concern with punishing individuals to managing aggregates of dangerous groups, and that affects the training and practice of criminologists and sociologists, limiting themselves to varying recognitions of a society at risk (Beck 1992) and the concept of governmentality (Foucault 1991) with an increased emphasis on the relationship between risk, postmodernity and penal reform (see Feeley and Simon 1992, 1994).

This leads us to the question of how current sociocultural perspectives of risk are understood and translated within policy-based notions of risk and how this is embedded within risk-analysis. Furthermore, do current concepts and practices of understanding and implementing risk that are rooted within risk-analysis undermine the rehabilitative potential of offenders when addressing their offending behaviour?

Therefore the main purpose of my research will be:

1) To challenge current theoretical understandings of risk and current concepts associated with risk-analysis underlying social structural underpinnings of crime such as socio-economic disadvantages (O'Malley 1992)

2) To highlight how these practices and understandings of risk differ from individual offenders' perspectives of their risk-taking behaviour.

Hazel Kemshall, Professor of Community and Criminal Justice, De Montfort University - Public Disclosure about Sex Offenders: But does the public really want to know? An example of mis-placed assumptions in government responses to risk

In 2009-2010 the English Home Office launched a scheme allowing members of the public to apply to police for information about persons who have contact with their children. The scheme allows limited disclosure to parents and carers about sex offenders who may present a risk to their children. Interestingly, and despite both media coverage and campaigns arguing for a 'Sarah's Law', the actual take-up of the scheme was very low, and fell far short of the expectations set by both policy makers and politicians. Despite this and a cautious evaluation of the pilot (conducted by the author), a national roll-out of the scheme was announced prior to the completion of the pilot.

The scheme provides an interesting example of political and policy maker mis-perceptions about public perceptions and demands for information about a traditionally taboo risk (sexual offending of children). In addition, it also illustrates the fraught context of media and politics within which critical decision making on risk occurs, including the competing views and interests of various stakeholders - in this case criminal justice professionals, children's charities, and the victims champion Sara Payne.

In the context of this study, it is interesting to pose the question: does the public really want to know about child sex offenders, and what are they expected to do with such knowledge if and when provided? Central policy makers and politicians may presume that the public want to know, and wish to be actively engaged in the community management of sex offenders, but both the low take- up and the views of those participating indicates that the public may be resistant to such 'responsibilisation', and that far from engaging and enabling the public to manage this risk, such schemes may only serve to heighten anxieties. Such schemes may respond to media pressure or demands by particular pressure groups such as victim groups, but may actually mis-calculate wider public concerns and risk perceptions.

Dr Tatyana MICIC, School of Engineering and Mathematical Sciences, City University London - Built Infrastructure, Acceptable Risk Levels?

Built infrastructure such as bridges, roads, railways, etc. are often taken for granted by the wider public. It is only when faced with consequences of major disruption such as that caused by the 2009 Cumbria flooding that questions arise how are we accounting for risks associated with built infrastructure and what are acceptable levels of risk for the public.

At present, infrastructure owners, in most cases pursue a predetermined sequence of well defined, inspection, maintenance and repair activities. Such processes are costly, for example, the Highways Agency has spent approximately £800m only on maintenance for its road network in 2007/8. With the pressure for cost efficiencies there could be an, inevitable, effect on increasing risk to public from built infrastructure.

We explore methods to classify and quantify risk to public from the built infrastructure and possible methodology to establish acceptable levels. When the government is seeking to transfer responsibility who will take it on and how?

Jo Moriarty & Jill Manthorpe, Social Care Workforce Research Unit, King's College London - Risk and Dementia: safety first or rights-based decision making?

The effects of dementia on people's ability to make decisions mean that risk plays an important part in the everyday lives of people with dementia, family carers, and practitioners yet there is little research evidence on how all these groups negotiate decisions about risk.

This paper discusses some of the reasons why people with dementia appear to have been excluded from wider debates about risk and society and what we know about how practitioners, people with dementia, and family carers negotiate decisions about risk. It is based on work undertaken for the Department of Health's Risk Guidance for people with dementia Nothing Ventured, nothing gained.

Nathaniel O'Grady, Department of Geography, Durham University - Assemblages and the negotiation of risk: insights from public service co-ordination

Prevalent in both the academic world and that of governmental policy is the notion that, to deal with emergencies of the future, more co-ordination and better relations are needed across blue-light public services such as the Police, Ambulance and Fire and Rescue Services. The surge towards forging a network of relations across governing elites in academia is occasioned in various work (Deleuze (2003), Foucault (2004), Latour (2005)) under the nomenclature of assemblage theory. In governmental literature, pushes towards construction of this 'assemblage' is found in major legislature such as the Civil Contingencies Act (2004).

From my on-going research with the Fire and Rescue Service, this paper considers the multiple difficulties, opportunities and processes implicit in the construction of public emergency assemblages. Lines of inquiry will relate to how new techniques for both the analysis of risk such as risk profiling devices and building resilience to risks of the future require the forging of new relations across blue-light services. Moreover, this paper will show how, to enact the public emergency assemblage, the actual conception we have of risks in terms of the likelihood of a risk's occurrence, the likely victims of particular risks and the possible consequences a risk may have is the product of negotiation at a public emergency assemblage level.

Lisa Reynolds, Senior lecturer in forensic mental health, City University London, and Bob Heyman, Professor of health care risk management, University of Huddersfield - The impact of homicide inquiry reports on risk assessment and decision making in forensic mental health care

This presentation will examine the impact of homicide inquiry reports on local and national policy development and care delivery. Their impact will be discussed in relation to the findings of a participant observational study of a UK medium secure forensic mental health service which had been the subject of several such reports. The responses of local and national bodies to a recent homicide inquiry report and its subsequent media coverage will be explored.

The effects on the communication and management of risk by frontline staff and associated negative consequences for service users such as increased stigmatisation, prolonged detention and restricted freedom will be discussed. The presentation will highlight the conflicting demands placed on forensic services to simultaneously contain risks to the public and promote patient autonomy in the context of clinical decision making. It will be argued that the risk rationality taken for granted in retrospective inquiries breaks down in these conditions, creating an unbridgeable gap between what is expected in policy terms and what can actually be achieved.

Professor Penny Roy & Professor Shula Chiat, Department of Language and Communication Science, City University London - Socio-economic disadvantage and language problems in preschoolers: risks and resolutions

The Bercow Review of Services for Children and Young People with Speech, Language and Communication Needs (SLCN; Bercow, 2008), a recent government report, highlighted the multiple risks associated with early SLCN including poor academic achievement, psychosocial and mental health problems, unemployment and diminished life opportunities. The review also noted that children from socio-economically disadvantaged backgrounds are at disproportionate risk of early language problems.

Our paper will draw on two studies of preschoolers, one looking at language potential in children from an area of socioeconomic disadvantage, the other looking at profiles of children referred to clinical services with concerns about language. Based on results, we will consider the extent to which service provision matches the needs of children with language disadvantage and/or disorder. We will also argue that efficient use of resources requires a full understanding of the nature of SLCN in order that interventions are appropriately targeted.

Jill Russell, Queen Mary University, London, and Trish Greenhalgh QMUL - The rhetorical construction of risk in NHS rationing decisions

...we need to review whether we risk becoming insensitive and thus too quick to decide not to fund something, which also exposes us to the risk of a successful challenge. I believe that we also need to review whether we risk finding some of these decisions too emotionally challenging and thus decide to fund them without sufficient thought, and thereby risk compromising the care of others (especially as setting precedents means that we commit ourselves to spending much more that the individual case being considered).' (extract from a Primary Care Trust discussion paper)

Decision-making about the allocation of NHS resources is a risky business. The above quote, from the chair of an NHS rationing panel (a local primary care trust individual funding treatment panel), highlights the risk that institutional processes become insensitive to human suffering, the ever-present risk of legal challenge, the risk that emotions might get in the way of good judgement, and the risk that in attending to individual needs, the needs of others are neglected. Beyond these risks lie others - the risk of financial overspend for cash-strapped NHS bodies, and the risk that rationing decisions erode further the principle of universal health care on which the NHS is based.

This paper will report on a study we are currently undertaking of deliberations about rationing in the NHS. It will describe how we are using discursive methods and argumentation theory to explore how notions of risk are rhetorically constructed, and the effects that this sort of linguistic work has on a panel's decisions about the allocation of health care resources.

Mandie Scamell, Midwifry, Women and Child Health, King's College London - Risk in midwifery talk and practice

Despite the ubiquitous nature of risk in maternity care and the development of robust risk management schemes within this clinical setting, relatively little empirical work has been done on how midwives, the most senior practitioners present in the majority of births in this country, make sense of risk and how this process of interpretation impacts upon how birth can be performed in the UK. It is the importance of risk in service provision planning which makes this lack of investigation particularly surprising.

Using evidence taken from an ethnographic analysis of midwifery talk and practice, conducted in the South East of England, this paper aims to explore the social construction of risk at the 'street level'. With a professional interest in the normality of birth, midwives are uniquely positioned to risk within the health service. By starting from a position of assumed wellbeing, midwives might be expected to favour a broad interpretation of risk, where risk-taking could be seen as a means of protecting both normality and client autonomy.

The research from which this paper draws coalesced around an interest in how such professional priorities sit within the wider policy context of clinical governance where it is recognised that risk is assumed to be a harm which practitioners have a duty to mitigate in the interests of patient safety. This paper will present evidence to show how midwives deal with the potentially divergent professional interests of risk policy and normality and how this impacts upon how birth is imagined and performed.

Peter Scourfield, Faculty of Health and social Care, Anglia Ruskin University - Intuition and rationality when social workers assess risk: disentangling the law, folklore and sod's law

How social workers actually talk and decide about risk in everyday settings is shaped by various cognitive and affective factors. It is not limited solely to the objective and systematic deliberation of the 'evidence', nor the logical application of legal and policy principles. Intuition, 'gut feeling' and other subjective heuristic devices come variously into play.

The paper draws on 'risk talk' observed in risk assessment exercises involving social workers to promote further discussion about the complex factors involved in assessing risk in the context of adult social work. Interestingly, the observations also provide illustrations of social workers engaging in 'post-hoc' rationalizations that downplay the role and value of their intuitive judgements and, instead, justify decisions by appeals to stories constructed from legislation, 'universal' rules, 'evidence' and perceived messages from policy. This post hoc rationalising tendency is used to suggest that more research into the psychology of assessing risk in the real world of social work would be beneficial.

It is also proposed that practitioners should be both encouraged and enabled to interrogate critically the different cognitive and affective 'rationalities' that inform their assessment of risk. However, some pessimism is expressed over whether the current political, professional and organisational contexts of social work in the UK are conducive to this taking place satisfactorily.

Peter Taylor-Gooby, Professor of Social Policy, University of Kent - Is the 'risk society' perspective a luxury of affluence?

One way of managing the social risks that people experience in developed countries has been through the welfare state. The welfare state comes in various styles, according to national politico-economic models. At one extreme are countries in which social provision is structured according to the demands of market economics, with extensive use of means-testing, private services and low tax and social contribution systems. At the other are regimes which incline more towards strong citizenship rights and, in a European context, base much of social provision on social insurance contracts.

Changes in production and communication technologies in the context of globalisation impose pressure on welfare states. The recent economic crisis sets the various responses to these challenges in sharp relief. The problem for the liberal market approach is how much of a welfare system can be retained. Citizenship models encounter further tensions in relation to the scope of welfare provision. This may lead to divisions between insiders and outsiders, which are then exploited by the extreme right.

Beck and other commentators have argued that conflicts over risks have tended to displace conflicts over resources. Recent developments suggest, that in relation to social risks, issues of access to resources may be regaining their position on political agenda. Is the 'risk society' perspective a luxury of affluence? Does this suggest that attention may be distracted from fundamental risk issues, most obvious climate change?

Dr Jo Warner, Senior Lecturer in Social Work, University of Kent - Shifting the Paradigm of Risk: Decision-making in Times of Uncertainty

This paper reports on an ongoing action research project that the author has undertaken in partnership with the Adult's and Children's Social Service Directorates of a local authority. The project began in spring 2008 with the long-term goal of addressing issues relating to the decision-making practice of social workers, managers, and others in the organisation. The intention is to address those issues which arise from the wider political and organisational context for social work and social care policies and practice, specifically the dominant culture of risk and blame.

This broad aim encompasses a number of objectives which have been embedded in a range of research activities. The first stage was to deliver a series of workshops for frontline staff on the topic of risk and decision-making. These took place in the autumn of 2009 and were well-received by staff. In parallel, we designed and conducted a short survey among staff across both Directorates to gather basic information about how they manage decision-making about risk. Data from this survey were analysed and the report we produced was presented to staff in feedback sessions in 2010. A more in-depth follow-up study based on a sub-set of the survey data is now planned for next year (2011).

The overall design of the research can be defined as 'action research' with elements of institutional ethnography. The aim is to engage fully with staff across directorates, so that participants feel they have ownership over future developments in the project. This project offers a rare opportunity to compare and contrast the risk practices and issues relating to decision-making that are evident across the client group domains of children's services and services for adults. The project so far has enabled the author to draw some preliminary conclusions about the links between the different policies, risk cultures and risk practices of individual practitioners in each of these domains.

The aims of this paper are threefold: firstly, to reflect on the methodological approach taken and its strengths and weaknesses; secondly, to provide some preliminary feedback on the data collected so far and their relative significance; thirdly, to highlight the implications of this project in terms of creating the conditions for change across a range of levels, from the organisational to individual level.

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When & where

9.30am - 5.00pmTuesday 12th April 2011

University Building University Building City, University of London Northampton Square London EC1V 0HB United Kingdom