Between policy and practice: a qualitative case study exploring the enactment of healthy public policy in primary school settings

Contemporary public health practice for school-aged children in primary schools is a complex system with several different government, public sector, and private sector agencies, organisations, and individuals responsible for developing and enacting healthy public policy. The role and responsibilities of professionals such as school nurses and teachers have adapted and broadened, policy and practice have evolved, approaches and priorities have been re-evaluated, and multi-agency working is challenged. Additionally, policy documents do not clearly link the two sectors of health and education together practically to enable joined-up multi-agency working, creating a separation between policy and practice.

Situated within an interpretivist paradigm, a qualitative case study methodology has been taken to explore the system of public health in primary schools in England, and the theoretical lens of policy enactment is used to interpret the perceptions of professionals in the disciplines of school nursing and teaching. Set across two stages of research, individual and group interviews have been used as the data collection method, and reflexive thematic analysis has been used for analysis.

Despite having a prominent role in health and education policies, it was found that professionals often work in silos and are not effectively enacting multi-agency working in the way they would like, citing conflicting priorities, overlapping policies, ever-changing expectations, and overstretched services as contributing factors.

The development of a conceptual and a theoretical framework in this thesis provides a nuanced understanding of how systems thinking, and policy enactment theory can be combined to understand the enactment practices of professionals in the spheres of health and education. Importantly, the frameworks serve as a tool and an opportunity to facilitate conversations between professionals in and across disciplinary groups and therefore provide important contributions to policy and practice.