Description
Background: The goal of Health for All requires health services to change and develop in line with emerging evidence of models of healthcare that prove effective and equitable. In practice, major changes to health services, such as the closure of hospitals, can be deeply unpopular and challenging for health systems to achieve. In 1999, political devolution in the UK created the potential for significant policy divergence between England, Scotland, Wales and Northern Ireland. Despite evidence that this ‘natural experiment’ has seen meaningful changes in policy approach, surprisingly little research has compared policy in the four countries. We compare and contrast the countries’ approaches to achieving meaningful public involvement within difficult and sometimes unpopular decisions on major service change.Methods: This comparative qualitative study – consisting of a desk-based review of policy documents from the four health systems, plus qualitative interviews with key policy actors and stakeholders in all four countries – explores perceptions of how policy can best support health services to involve the public and patients in service change.
Results: We demonstrate that, despite some commonalities of process, the increasingly divergent health systems in each of the four nations take distinctive approaches to involving the public, particularly when it comes to who is permitted to speak for citizens within the decision-making process.
Conclusions: We present key lessons learned in each health system, and draw out more general recommendations for the enduring health policy dilemma of conducting constructive conversations on unpopular frontline service changes.
Key messages: The devolved national health systems of England, Scotland, Wales and Northern Ireland engage the public on service changes differentlyThe study enabled the identification of strength and weaknesses of each nation’s NHS engagement with the public
| Period | 2016 |
|---|---|
| Event title | European Public Health Conference 2016 |
| Event type | Conference |
| Location | Vienna, AustriaShow on map |