Beyond NIMBYs and NOOMBYs: what can wind farm controversies teach us about public involvement in hospital closures?

Abstract

BackgroundMany policymakers, researchers and commentators argue that hospital closures are necessary as health systems adapt to new technological and financial contexts, and as population health needs in developed countries shift. However closures are often unpopular with local communities. Previous research has characterised public opposition as an obstacle to change. Public opposition to the siting of wind farms, often described as NIMBYism (Not In My Back Yard), is a useful comparator issue to the perceived NOOMBYism (Not Out Of My Back Yard) of hospital closure protestors.DiscussionThe analysis of public attitudes to wind farms has moved from a fairly crude characterisation of the ‘attitude-behaviour gap’ between publics who support the idea of wind energy, but oppose local wind farms, to empirical, often qualitative, studies of public perspectives. These have emphasised the complexity of public attitudes, and revealed some of the ‘rational’ concerns which lie beneath protests. Research has also explored processes of community engagement within the wind farm decision-making process, and the crucial role of trust between communities, authorities, and developers.SummaryDrawing on what has been learnt from studies of opposition to wind farms, we suggest a range of questions and approaches to explore public perspectives on hospital closure more thoroughly. Understanding the range of public responses to service change is an important first step in resolving the practical dilemma of effecting health system transformation in a democratic fashion.

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

“…However, realising the potential gains from transforming health systems is, at least in democratic systems, properly dependent on wider public support for the changes that are required. As in other examples where expert-led developments encounter widespread public opposition, the particular character of attempts at public engagement are crucial in finding acceptable ways forward (Aitken, 2010;Chilvers and Kearnes, 2015;Stewart and Aitken, 2015;Allen et al, 2017). It is frequently argued that organisations simply need to conduct 'meaningful' engagement in order to change services effectively (Dalton et al, 2016;Foley et al, 2017).…”

Exploring the neglected and hidden dimensions of large‐scale healthcare change

“…While some scholars have viewed these policies and programmes as a manifestation of managerialism, legitimated as originating in the private sector (Kitchener and Gask 2003), others have traced a longer history, surfacing an instrumental rationality that has attracted a confluence of clinical, economic, and techno-managerial interests (Jones and Exworthy 2015). For policy elites, large-scale change serves a performative function, showing, clearly, that 'something is being done' (Coid and Davies 2008), and yet that same visibility can generate opposition on the ground (Barnett andBarnett 2003, Stewart andAitken 2015).…”

Perspectives on the underlying drivers of urgent and emergency care reconfiguration in Ireland

“…8,16 It has been suggested that policymakers have tended to prioritise efficiency and effectiveness criteria when configuring health care, rather than seeking to balance the priorities of different stakeholders and fitting a solution to incorporate these priorities. 15,17 This implies that implementing "out of the box" reconfiguration based on international evidence on centralisation alone is not likely to be accepted by stakeholders in different contexts.…”

“…Public sector health care bodies have been characterised as “pluralistic” in the organisational literatureand should, ideally, satisfy the requirements of actors within and outside of the organisation in order to garner their support . It has been suggested that policymakers have tended to prioritise efficiency and effectiveness criteria when configuring health care, rather than seeking to balance the priorities of different stakeholders and fitting a solution to incorporate these priorities . This implies that implementing “out of the box” reconfiguration based on international evidence on centralisation alone is not likely to be accepted by stakeholders in different contexts.…”