In access policy shaping, the status quo is remarkably resilient
Research shows that six in ten policy shaping campaigns fail, largely because defenders of existing policy usually win. But when change does happen, the impact can be huge. Especially in access policy, where a single reform can determine whether patients receive life-saving treatments in time.
Access policy shaping success: the Cancer Drugs Fund
A well-known example is the UK’s Cancer Drugs Fund (CDF). For years, the system denied patients access to breakthrough oncology medicines because evidence was still emerging. The CDF flipped that script. By pooling resources and creating a managed access scheme, it gave patients faster access while real-world evidence was still being collected. Thousands of patients benefitted, and the model went on to inspire broader thinking about managed entry agreements and conditional access, both in the UK and abroad.
Five truths to build into your access policy strategies.
So how to increase the odds of success in access policy shaping? Based on a comprehensive analysis of ninety-eight US policy issues, Baumgartner et al. (2009) highlight five truths that must be understood to design successful campaigns:
- Defenders of the status quo usually win: efforts to change an existing policy orientation usually fail, as it tends to already reflect a balance of power.
- Attention is the scarcest commodity: a lack of information is rarely the problem; an overwhelming flow of facts and perspectives from diverse stakeholders, each with different priorities, usually is.
- The status quo needs to be seriously flawed: attention can only be attracted if policymakers are convinced that the status quo is seriously, not marginally, flawed.
- When change happens, it’s rarely incremental: significant change is more common than marginal adjustments.
- It’s the gatekeepers that need to change: change often requires either convincing the original architects of policy or finding alternative decision-making channels.
Five success factors in access policy shaping: lessons from the CDF.
The CDF example highlights how these truths translated into five factors that increase the odds of success.
A broad coalition to overcome the inertia of the status quo.
The establishment of the CDF required overcoming the existing framework in which the National Institute for Health and Care Excellence (NICE) evaluated cost-effectiveness of cancer drugs. The framework often led to rejections of expensive cancer drugs with limited survival benefits. Patient groups and charities like Macmillan Cancer Support and Cancer Research UK actively lobbied for faster access to new drugs. The initiative was supported by clinicians and oncologists, who highlighted the human cost of delayed drug access. Political figures, notably Prime Minister David Cameron and Health Secretary Andrew Lansley, aligned with these groups.
Stakeholder alignment on the facts.
Fresh evidence alone rarely convinces gatekeepers to change the status quo. Diverse stakeholders converged around a clear, evidence-based understanding of the facts about the current policy and its flaws. Research and reports highlighted the lengthy delays and restrictive cost-effectiveness thresholds that blocked access to new treatments. Patient stories, media coverage, and academic studies aligned to emphasize that while NICE was effective in cost control, it was failing cancer patients.
A reframed status quo.
The coalition reframed the status quo from ‘rational cost-effectiveness’ to ‘bureaucrats denying dying patients treatment’ and ‘heartless rationing denying hope’, which galvanized public and political support.
Substantial change over marginal adjustments.
The reframing made small tweaks to the existing framework insufficient, generating support for major structural innovation. The CDF represented a new policy instrument rather than marginal reform of the NICE framework. Preceded by an interim fund of £50 million, a dedicated cancer drugs fund of £200 million per year, for a total of three years, addressed the flaws in the status quo.
A change of venue.
By shifting decision-making away from NICE to a politically controlled fund, the Conservative Party introduced a parallel policy instrument, while leaving the established NICE framework intact. This move reduced bureaucratic constraints and allowed politicians to claim credit for life-saving access.
From dialogue to action.
The CDF shows that success in access policy shaping is about more than evidence and dialogue. It requires coalition building, courageous conversations, clarity, strategic framing, and engaging the right stakeholders.
At The Access Embassy, we help leaders turn these le into action. By connecting perspectives, aligning stakeholders, and building momentum, we help you move the needle and break the 60% failure cycle.
