A sociology of public responses to hospital change and closure

Abstract

The “problem” of public resistance to hospital closure is a recurring trope in health policy debates around the world. Recent papers have argued that when it comes to major change to hospitals, “the public” cannot be persuaded by clinical evidence, and that mechanisms of public involvement are ill‐equipped to reconcile opposition with management desire for radical change. This paper presents data from in‐depth qualitative case studies of three hospital change processes in Scotland's National Health Service, including interviews with 44 members of the public. Informed by sociological accounts of both hospitals and publics as heterogeneous, shifting entities, I explore how hospitals play meaningful roles within their communities. I identify community responses to change proposals which go beyond simple opposition, including evading, engaging with and acquiescing to changes. Explicating both hospitals and the publics they serve as complex social phenomena strengthens the case for policy and practice to prioritise dialogic processes of engagement. It also demonstrates the continuing value of careful, empirical research into public perspectives on contentious healthcare issues in the context of everyday life.

The role of professional elites in healthcare governance: Exploring the work of the medical director

“…The following is from an interview with Stephen and illustrates the activities of Medical Directors on the ‘back stage’ of healthcare planning. In the UK hospital closures are a politically contested issue, often the focus of ‘save our hospital’ campaigns from local community groups ( Stewart 2019 ). In this case plans to close hospital facilities had been prepared by the organisation as part of financial assurance processes requested by a national regulator.…”

Legitimating complementary therapies in the NHS: Campaigning, care and epistemic labour

“…Interview data are supplemented with analysis of official board documents, CIC empirical studies (published and unpublished), emails and written correspondence. These data were collected between February 2018 and July 2019, as part of a broader 4 year interpretive study of four 'change projects' in the Scottish NHS (Stewart, 2019). Ethical approval for the study was received from the University of Edinburgh's Usher Institute Research Ethics G. The CIC case was added 'asymmetrically': first as an atypical example where patients come from all over Scotland but which is not designated a national service and, second, because our reading of the sociology of CAM indicated that the case might yield a clash of 'knowledges' at the fringes of mainstream healthcare.…”

“…Second, we survey existing work on the legitimacy/legitimation of CAM, which focuses on the actions of practitioners. We bring the CAM 'consumer' into the frame, actively shaping the trajectory of their NHS (Stewart, 2016(Stewart, , 2019. The third empirical section examines campaigners' work in legitimating CAM, drawing on both experiential knowledge and that credentialed by experts.…”

The problems of smaller, rural and remote hospitals: Separating facts from fiction

“…81 The Targeted Enhanced Recruitment Scheme has been highly successful in increasing the number of general practitioner trainees moving to under-doctored locations in return for a one-off 'golden handshake'. 82 This suggests that closing hospitals on the pretext of inadequate staffing is a short-term, nihilistic solution to a problem that, although urgent, is not without alternative solutions.…”