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

Stewart, E. , Greer, S. L., Ercia, A. and Donnelly, P. D. (2020) Transforming health care: the policy and politics of service reconfiguration in the UK's four health systems. Health Economics, Policy and Law, 15(3), pp. 289-307. (doi: 10.1017/S1744133119000148)

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.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Stewart, Professor Ellen
• Authors: Stewart, E., Greer, S. L., Ercia, A., and Donnelly, P. D.
• College/School: College of Social Sciences > School of Social and Political Sciences > Urban Studies
• Journal Name: Health Economics, Policy and Law
• Publisher: Cambridge University Press
• ISSN: 1744-1331
• ISSN (Online): 1744-134X
• Published Online: 12 April 2019
• Copyright Holders: Copyright © 2019 Cambridge University Press
• First Published: First published in Health Economics, Policy and Law 15(3):289-307
• Publisher Policy: Reproduced under a Creative Commons License

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