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

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

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.

Suggested Citation

  • Stewart, Ellen & Greer, Scott L. & Ercia, Angelo & Donnelly, Peter D., 2020. "Transforming health care: the policy and politics of service reconfiguration in the UK's four health systems," Health Economics, Policy and Law, Cambridge University Press, vol. 15(3), pages 289-307, July.
  • Handle: RePEc:cup:hecopl:v:15:y:2020:i:3:p:289-307_1
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    Blog mentions

    As found by EconAcademics.org, the blog aggregator for Economics research:
    1. Chris Sampson’s journal round-up for 6th July 2020
      by Chris Sampson in The Academic Health Economists' Blog on 2020-07-06 11:00:00

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