Policy as Palimpsest: a case study of micro and macro policy and politics intersecting in local implementation resulting in unintended consequences

A palimpsest is a multi-layered text that is reinscribed over time. This article presents policy as analogous to a palimpsest to highlight implementation processes and the complexity of judging progress. Findings from an ethnographic study of the UK Sure Start Children's Centres policy demonstrate how implementation is experienced locally. Here religious beliefs and traditional cultures influence implementation and persistent social structures are in tension with rapid policy shifts or 'initiativitis'. Perceptions of progress depend on how history is interpreted, how policy is framed and how the future is imagined. Unintended consequences are produced as a local policy-palimpsest is enacted

Sustaining patient and public involvement in research: a case study of a research centre.

The literature on patient and public involvement (PPI) in research covers a wide range of topics. However, one area of investigation that appears under developed is the sustainability and impact of PPI beyond involvement in time-limited research projects. This paper presents a case study of PPI development in one primary care research centre in England, and its approach to making this sustainable using documentary sources and material from a formal evaluation. We provide narrative accounts of the set-up, operation and main processes of PPI, and its perceived impact. PPI requires a long-term perspective with participation and trust growing over time, and both users and researchers learning what approaches work best. PPI is a complex interplay of clarity of purpose, defined roles and relationships, organised support (paid PPI staff) and a well-funded infrastructure. ‘Soft systems’ are equally important such as flexible and informal approaches to meetings, adapting timetables and environments to meet the needs of lay members and to create spaces for relationships to develop between researchers and lay members that are based on mutual trust and respect. This case study highlights that the right combination of ethos, flexible working practices, leadership, and secure funding goes a long way to embedding PPI beyond ad hoc involvement. This allows PPI in research to be integrated in the infrastructure and sustainable