Experience and Evidence - Where the Twain Meet

Marion MacLeod and Mark Smith - 17th March 2022

Over recent decades there has, quite rightly, been a stronger emphasis on ‘evidence-based’ practice in service planning, resource allocation and professional practice, in social care services and more broadly. While the application of evidence to practice is rarely straightforward, it is reasonable to expect that politicians and policy makers are aware of a range of different sources of evidence when introducing new policies and are able to weigh up the comparative significance of these.  

Evidence can come from a range of sources. Traditionally, it might have been associated with peer reviewed academic research but, rightly, it has been extended to incorporate practitioner and user perspectives. Whatever its source, research ought to involve systematic inquiry to come to a well-founded view on a scientific or social problem. Broadly, it falls within two main types, quantitative and qualitative (or perhaps a mix of the two). 

Both quantitative and qualitative research are important. The data obtained from a properly constructed sample describes the collective views and experiences of a group and can be accepted as applying more broadly across populations. It provides a robust base for effective professional practice, public policy, service planning and resource allocation. It does not, however, convey the whole picture. 

Human behaviour and experience are also important when developing policy and associated structures and services. A hospital that achieves excellent clinical outcomes may not be able to be accessed by people who could benefit from the treatment offered, because real life challenges such as transport complications and caring responsibilities were not identified or acknowledged. For this reason, reliable quantitative data can, in appropriate circumstances, be valuably complemented by individual personal experience. 

What is not valuable is the trend among Scottish policy makers towards reliance on the subjective information supplied by individuals to the exclusion of more accurate, robust and representative data. The Scottish Government seems to have given up on considering meaningful research and has turned instead to the idea of ‘lived experience’ as its predominant policy driver. Even more concerningly, the expertise of those articulating their lived experiences has been deemed to extend to service design and resource allocation. 

While it is important to understand personal experiences and to ensure that they are reflected in policy, planning and practice, they should be interpreted as what they are – the subjective experience of individuals which may not be representative of wider concerns or well-informed in relation to solutions. Recent ‘flagship’ policies and plans, such as the Independent Care Review, the National Care Service proposal, the National Trauma Training Programme and the evaluation of the ‘free childcare’ policy are based on the ‘voices’ of those who have used or may use services. Substantial and credible bodies of research have been ignored and no new objective studies commissioned.

The recent turn in government towards ‘lived experience’ is a legitimate philosophical position, what is called phenomenology. It also has an understandable appeal in political terms, bringing a human element to overly rational policies that might otherwise push this aside. But policy based primarily on ‘lived experience’ is a worrying trend for a number of reasons:

• Lived experience is constructed in social contexts. It changes with one’s personal circumstances and/or the audience it is intended to appeal to. As a result, it is rarely ‘pure’ but picks up on dominant cultural scripts, which determine what is encouraged or discouraged from being said on a particular topic. It is thus malleable and open to co-option by interest groups. It certainly cannot be considered typical or representative.
• Lived experience can be employed for different purposes but it is generally used to create a coherent story that will help us make sense of our lives; it can be used to explain, justify, mitigate, or blame. We all do this, although we probably fight shy of doing so publicly.
• The idea of lived experience fits with a contemporary therapeutic zeitgeist. Those whose voices find their way into policy discourse are often involved in what might be termed the ‘troubled persons’ industries - they have their particular stories to tell.   And, while we would wish to listen to such stories, they are not necessarily reflective of any wider ‘truth’ and certainly should not be assumed to offer any special insights into policy.

While, within a therapeutic culture, but also as a basic human response, we might wish to ‘honour’ lived experience, in any intellectual sense it needs to be interpreted. It should not be allowed to speak for itself; to assume otherwise is an indefensible position for serious scholarship or policy making.

One might wonder, then, how lived experience has become such a major feature of the contemporary policy landscape. At one level it fits with wider and laudable trends towards greater local and participative democracy, as encapsulated in Scotland by the Christie Commission on the future delivery of public services. Perhaps some politicians and civil servants imagine that in turning to lived experience they are following the direction set by Christie.

But one might, just as easily advance a more cynical position. There is little evidence that The Scottish Government is interested in local democracy – everything it has done in recent years has sought to curtail the power of local authorities. In that context, claims to draw on lived experience provide a veneer of participation to an increasingly centralized policy agenda. And, even more cynically, one might ask where the Scottish Government’s voices of lived experience come from. Very often, we might suggest, they come from the very charities and public bodies that depend on The Scottish Government for their continued funding. This is not a progressive policy development but a deeply worrying one that sees a government, devoid of any big ideas itself, co-opt the voices of ‘lived experience’ to shore up what few, and generally contentious, ideas it does have.