Major health service transformation and the public voice: conflict, challenge or complicity?

Objectives Calls for major reconfigurations of health services have been accompanied by recommendations that wide ranging stakeholders be involved. In particular, patients and the wider public are seen as critical contributors as both funders and beneficiaries of public health care. But public invol...

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Bibliographic Details
Published in:Journal of health services research & policy 2018-01, Vol.23 (1), p.28-35
Main Authors: Martin, Graham P, Carter, Pam, Dent, Mike
Format: Article
Language:English
Subjects:
Beneficiaries
Citizen participation
Complicity
Decision making
Health initiatives
Health services
Original Research
Public health
Transformation
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Summary:Objectives Calls for major reconfigurations of health services have been accompanied by recommendations that wide ranging stakeholders be involved. In particular, patients and the wider public are seen as critical contributors as both funders and beneficiaries of public health care. But public involvement is fraught with challenges, and little research has focused on involvement in the health service transformation initiatives. This paper examines the design and function of public involvement in reconfiguration of health services within the English NHS. Methods Qualitative data including interviews, observation and documents were collected in two health service ‘transformation’ programmes; interviews include involved public and professional participants. Data were analysed using parallel deductive and inductive approaches. Results Public involvement in the programmes was extensive but its terms of reference, and the individuals involved, were restricted by policy pressures and programme objectives. The degree to which participants descriptively or substantively represented the wider public was limited; participants sought to ‘speak for’ this public but their views on what was ‘acceptable’ and likely to influence decision-making led them to constrain their contributions. Conclusions Public involvement in two major service reconfiguration programmes in England was seen as important and functional, and could not be characterized as tokenistic. Yet involvement in these programmes fell short of normative ideals, and could inadvertently reduce, rather than enlarge, public influence on health service reconfiguration decisions.
ISSN:1355-8196
1758-1060
DOI:10.1177/1355819617728530