Factors that Influence the Way Communities Respond to Proposals for Major Changes to Local Emergency Services: A Qualitative Study

Abstract

ObjectiveAccording to policy commentators, decisions about how best to organise care involve trade-offs between factors relating to care quality, workforce, cost, and patient access. In England, proposed changes such as Emergency Department closures often face public opposition. This study examined the way communities respond to plans aimed at reorganising emergency services, including the trade-offs inherent in such decisions.DesignCross-sectional study involving in-depth interviews. Participants selected their priorities for emergency care, including aspects they might be prepared to have ‘less’ of (e.g. rapid access) if it meant having ‘more’ of another (e.g. consultant-delivered care). A thematic analysis was carried out, combining inductive and deductive approaches, drawing on theories about risk perception.SettingTwo urban areas of England; one where changes to emergency services were under consideration (‘Greenville’), and one where they were not (‘Hilltown’).Participants28 participants in total. Greenville interviewees included more common emergency service users - parents of young children (n=5) and older people (n=6) - plus patient representatives and individuals campaigning against service closures (n=9). Hilltown interviewees (n=8) received outpatient care for Chronic Obstructive Pulmonary Disease, an important cause of emergency admission.ResultsMost participants, in both areas, were not willing to accommodate the trade-offs involved in consolidating emergency services, principally because of the belief that timely access is associated with better outcomes. Participants did not consider the proposed improvements as gains worth having; interviewees believed care quality would be adversely impact, partly because increased patient numbers would place staff under greater pressure and result in longer waiting times.ConclusionsVisible clinical leadership and detailed explanation of the case for change were insufficient to overcome opposition to the reconfiguration in Greenville, challenging the assumption that communities can be persuaded by evidence. Commissioners should make explicit credible plans to accommodate changes in patient flows, as well as clarifying the roles played by key staff groups.

A sociology of public responses to hospital change and closure

“…This likely reflects the general and community functions of the facilities in the study, and it contrasts with examples such as emergency care and maternity care, where contending definitions of acceptable medical risk have been identified (Barratt et al . , Farmer et al . ).…”

“…The most in‐depth study of wider public perspectives on major change comes from the English NHS (Barratt et al . ). This study includes interviews modelled on “discrete choice experiments” with 20 individuals, and compares perspectives on reconfiguration of emergency care in an area undergoing change with an area which is not.…”

“…Yet their conclusion is blunt: “Our study challenges the assumption that evidence can be used to persuade communities to accommodate service reorganisations which may compromise timely access” (Barratt et al . ). The unrepresentativeness of campaigners against change also arises repeatedly within this literature (Barratt et al .…”

“…This goes beyond the idea that publics interpret information based on their own prior experiences (Barratt et al . ). Rather, publics are themselves shifting collective entities, always “in‐the‐making” (Chilvers and Kearnes ).…”

“…The unrepresentativeness of campaigners against change also arises repeatedly within this literature (Barratt et al . ; Martin et al . , Parkinson ), assuming that there exists some wider known collectivity to be represented.…”