Intended for healthcare professionals


Troubled families, troubled policy making

BMJ 2016; 355 doi: (Published 04 November 2016) Cite this as: BMJ 2016;355:i5879
  1. Chris Bonell, professor of public health sociology1,
  2. Martin McKee, professor of European public health1,
  3. Adam Fletcher, academic director2
  1. 1Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
  2. 2Y Lab, Cardiff University, Cardiff, UK
  1. Correspondence to: C Bonell chris.bonell{at}

Families were let down by government’s ignorance of evidence based policy making

Last month, an independent evaluation of the first four years of the coalition government’s flagship Troubled Families Programme reported no discernible benefits for participating families, a failure that was both predictable and predicted.1 2 Sadly, it represents a massive and expensive waste of effort but at least provides a new case study to add to the extensive list of examples of how not to make policy.3 We note four lessons, each showing how ideas now commonplace in healthcare and public health might, had they been applied, have mitigated this monumental failure.

The first lesson is not to make policy as a rapid and ill considered response to high profile events. The Troubled Families Programme was conceived by the then prime minister in reaction to the 2011 riots across UK cities.4 The programme was not clearly formulated, and there was no logic model (a framework commonly used …

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