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Framing in policy processes: A case study from hospital planning in the National Health Service in England


  • Jones, Lorelei
  • Exworthy, Mark


This paper reports from an ethnographic study of hospital planning in England undertaken between 2006 and 2009. We explored how a policy to centralise hospital services was espoused in national policy documents, how this shifted over time and how it was translated in practice. We found that policy texts defined hospital planning as a clinical issue and framed decisions to close hospitals or hospital departments as based on the evidence and necessary to ensure safety. We interpreted this framing as a rhetorical strategy for implementing organisational change in the context of community resistance to service closure and a concomitant policy emphasising the importance of public and patient involvement in planning. Although the persuasive power of the framing was limited, a more insidious form of power was identified in the way the framing disguised the political nature of the issue by defining it as a clinical problem. We conclude by discussing how the clinical rationale constrains public participation in decisions about the delivery and organisation of healthcare and restricts the extent to which alternative courses of action can be considered.

Suggested Citation

  • Jones, Lorelei & Exworthy, Mark, 2015. "Framing in policy processes: A case study from hospital planning in the National Health Service in England," Social Science & Medicine, Elsevier, vol. 124(C), pages 196-204.
  • Handle: RePEc:eee:socmed:v:124:y:2015:i:c:p:196-204
    DOI: 10.1016/j.socscimed.2014.11.046

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    References listed on IDEAS

    1. Martin, Graham P. & Learmonth, Mark, 2012. "A critical account of the rise and spread of ‘leadership’: The case of UK healthcare," Social Science & Medicine, Elsevier, vol. 74(3), pages 281-288.
    2. Salter, Brian, 2003. "Patients and doctors: reformulating the UK health policy community?," Social Science & Medicine, Elsevier, vol. 57(5), pages 927-936, September.
    3. Jones, Lorelei & Exworthy, Mark & Frosini, Francesca, 2013. "Implementing market-based reforms in the English NHS: Bureaucratic coping strategies and social embeddedness," Health Policy, Elsevier, vol. 111(1), pages 52-59.
    4. Kearns, Robin A. & Joseph, Alun E., 1993. "Space in its place: Developing the link in medical geography," Social Science & Medicine, Elsevier, vol. 37(6), pages 711-717, September.
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