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Transforming health care: the policy and politics of service reconfiguration in the UK's four health systems

Research output: Contribution to journalArticlepeer-review

Author(s)

Ellen Stewart, Scott L Greer, Angelo Ercia, Peter D Donnelly

School/Research organisations

Abstract

Public involvement in service change has been identified as a key facilitator of health care transformation (Foley et al., 2017) but little is known about how health policy influences whether and how organisations involve the public in change processes. This qualitative study compares policy and practice for involving the public in major service changes across the UK's four health systems (England, Northern Ireland, Wales and Scotland). We analysed policy documents, and conducted interviews with officials, stakeholders, NHS staff and public campaigners (total number of interviewees = 47). Involving the public in major service change was acknowledged as a policy challenge in all four systems. Despite ostensible similarities, there were some clear differences between the four health systems' processes for involving patients and the public in major changes to health services. The extent of central Government oversight, the prescriptiveness of Government guidance, the role for intermediary bodies and arrangements for independent scrutiny of contentious decisions all vary. We analyse how health policy in the four systems has used 'sticks' and 'sermons' to promote particular approaches, and conclude that both policy and the wider system context within which health care organisations try to effect change are significant, and understudied aspect of contemporary practice.

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Details

Original languageEnglish
Pages (from-to)289-307
Number of pages19
JournalHealth economics, policy, and law
Volume15
Issue number3
Early online date12 Apr 2019
DOIs
Publication statusPublished - Jul 2020

    Research areas

  • Emergency medical services, England, Health policy, Humans, Politics, Scotland, State medicine, United Kingdom, Wales

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