Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-14T22:38:09.321Z Has data issue: false hasContentIssue false
  • English
  • Français

Involving citizens in disinvestment decisions: what do health professionals think? Findings from a multi-method study in the English NHS

Published online by Cambridge University Press:  29 December 2017

Tom Daniels Open the ORCID record for Tom Daniels [Opens in a new window] ,
Iestyn Williams ,
Stirling Bryan ,
Craig Mitton  and
Suzanne Robinson
Tom Daniels*
Affiliation:
Health Services Management Centre, University of Birmingham, Birmingham, UK
Iestyn Williams
Affiliation:
Health Services Management Centre, University of Birmingham, Birmingham, UK
Stirling Bryan
Affiliation:
Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
Craig Mitton
Affiliation:
School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
Suzanne Robinson
Affiliation:
Department of Social Sciences and Security Studies, School of Public Health, Curtin University, Perth, WA, Australia
*
*Correspondence to: Tom Daniels, Health Services Management Centre, University of Birmingham, Park House, 40 Edgbaston Park Road, Birmingham, B15 2RT, UK. Email: tomdaniels1984@yahoo.co.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Public involvement in disinvestment decision making in health care is widely advocated, and in some cases legally mandated. However, attempts to involve the public in other areas of health policy have been accused of tokenism and manipulation. This paper presents research into the views of local health care leaders in the English National Health Service (NHS) with regards to the involvement of citizens and local communities in disinvestment decision making. The research includes a Q study and follow-up interviews with a sample of health care clinicians and managers in senior roles in the English NHS. It finds that whilst initial responses suggest high levels of support for public involvement, further probing of attitudes and experiences shows higher levels of ambivalence and risk aversion and a far more cautious overall stance. This study has implications for the future of disinvestment activities and public involvement in health care systems faced with increased resource constraint. Recommendations are made for future research and practice.

Type
Articles
Information
Health Economics, Policy and Law , Volume 13 , Issue 2 , April 2018 , pp. 162 - 188
Check for updates
Copyright
© Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Amalberti, R., Nicklin, W. and Braithwaite, J. (2016), ‘Preparing national health systems to cope with the impending tsunami of ageing and its associated complexities: towards more sustainable health care’, International Journal for Quality in Health Care, 28(3): 412–414.CrossRefGoogle ScholarPubMed
Anderson, W. and Florin, D. (2000), ‘Consulting the public about the NHS’, British Medical Journal, 320(7249): 1553–1554.Google Scholar
Baker, R., Thompson, C. and Mannion, R. (2006), ‘Q methodology in health economics’, Journal of Health Services Research & Policy, 11(1): 38–45.Google Scholar
Baker, R., Wildman, J., Mason, H. and Donaldson, C. (2014), ‘Q-ing for health – a new approach to eliciting the public’s views on health care resource allocation’, Health Economics, 23(3): 283–297.Google Scholar
Bodkin, H. (2016), ‘Street protests could halt hospital closures’ NHS Boss. http://www.telegraph.co.uk/news/2016/11/16/street-protests-could-halt-hospital-closures---nhs-boss/[14 December 2017].Google Scholar
Brown, S. R. (1980), Political Subjectivity: Applications of Q Methodology in Political Science, New Haven, CT: Yale University Press.Google Scholar
Brown, S. R. (1993), ‘A primer on Q methodology’, Operant Subjectivity, 16(3/4): 91–138.Google Scholar
Bruni, R. A., Laupacis, A. and Martin, D. K., The University of Toronto Priority Setting in Health Care Research Group (2008), ‘Public engagement in setting priorities in health care’, Canadian Medical Association Journal, 179(1): 15–18.Google Scholar
Bryant, L. D., Green, J. M. and Hewison, J. (2006), ‘Understandings of Down’s syndrome: a Q methodological investigation’, Social Science & Medicine, 63(5): 1188–1200.Google Scholar
Charles, C. and DeMaio, S. (1993), ‘Lay participation in health care decision making: A conceptual framework’, Journal of Health Politics, Policy and Law, 18(4): 881–904.Google Scholar
Church, J., Saunders, D., Wanke, M., Pong, R., Spooner, C. and Dorgan, M. (2002), ‘Citizen participation in health decision-making: past experience and future prospects’, Journal of Public Health Policy, 23(1): 12–32.Google Scholar
Cross, R. M. (2004), ‘Exploring attitudes: the case for Q methodology’, Health Education Research, 20(2): 206–213.Google Scholar
Dalton, J., Chambers, D., Harden, M., Street, A., Parker, G. and Eastwood, A. (2015), ‘Service user engagement and health service reconfiguration: a rapid evidence synthesis’, Southampton, UK: Health Services and Delivery Research. NIHR Journals Library. http://www.ncbi.nlm.nih.gov/books/NBK285944/ [23 November 2016].Google Scholar
Daniels, T. (2016), To what extent should the public be involved in health disinvestment decision making: a mixed methods investigation into the views of health professionals in the English NHS. https://doi.org/10.14288/1.0223694 [23 November 2016].Google Scholar
Daniels, T., Williams, I., Robinson, S. and Spence, K. (2013), ‘Tackling disinvestment in health care services: the views of resource allocators in the English NHS’, Journal of Health Organization and Management, 27(6): 762–780.CrossRefGoogle ScholarPubMed
Day, R. T., Norman, R. and Robinson, S. (2016), ‘Challenges and opportunities for disinvestment in Australia: a need to evaluate the implementation and impact of choosing Wisely in Australia’, Journal of Health Organization and Management, 30(8): 1301–1307.Google Scholar
Department of Health (2012), Health and social care act, Norwich: TSO.Google Scholar
Dunn, P., McKenna, H. and Murray, R. (2016), Deficits in the NHS 2016, London: The King’s Fund.Google Scholar
Florin, D. and Dixon, J. (2004), ‘Public involvement in health care’, British Medical Journal, 328(7432): 159–161.Google Scholar
Gallagher, K. and Porock, D. (2010), ‘The use of interviews in Q methodology’, Nursing Research, 59(4): 295–300.Google Scholar
Gilson, L. (2003), ‘Trust and the development of health care as a social institution’, Social Science & Medicine (1982), 56(7): 1453–1468.Google Scholar
Goddard, M., Hauck, K. and Smith, P. C. (2005), ‘Priority setting in health – a political economy perspective’, Health Economics, Policy and Law, 1(1): 79.Google Scholar
Greer, S. L., Stewart, E. A., Wilson, I. and Donnelly, P. D. (2014), ‘Victory for volunteerism? Scottish health board elections and participation in the welfare state’, Social Science & Medicine, 106: 221–228.Google Scholar
Guttman, L. (1954), ‘Some necessary conditions for common-factor analysis’, Psychometrika, 19(2): 149–161.Google Scholar
Hands, D. W. (2012), ‘The Positive-Normative Dichotomy and Economics’, in U. Mäki (ed.), Philosophy of Economics. Handbook of the Philosophy of Science, Amsterdam: Elsevier, 219–241.Google Scholar
Harrison, S. and Mort, M. (1998), ‘Which champions, which people? Public and user involvement in health care as a technology of legitimation’, Social Policy and Administration, 32(1): 60–70.Google Scholar
Health Foundation (2016), Changing Together: Brokering Constructive Conversations, London: The Health Foundation.Google Scholar
Hunter, D. J., Kieslich, K., Littlejohns, P., Staniszewska, S., Tumilty, E., Weale, A. and Williams, I. (2016), ‘Public involvement in health priority setting: future challenges for policy, research and society’, Journal of Health Organization and Management, 30(5): 796–808.CrossRefGoogle ScholarPubMed
Ipsos-Mori (2017), ‘Engaging the public in STPs: lessons from the past’. https://www.ipsos.com/ipsos-mori/en-uk/engaging-public-stps-lessons-past [16 August 2017].Google Scholar
Jeffares, S., Dickinson, H. and Hughes, G. (2012), ‘iPOETQ (version 1.1)’. http://poetqblog.blogspot.co.uk/ [10 November 2016].Google Scholar
Kaiser, H. F. (1960), ‘The application of electronic computers to factor analysis’, Educational and Psychological Measurement, 20(1): 141–151.Google Scholar
Kline, P. (1994), An Easy Guide to Factor Analysis, London; New York: Routledge.Google Scholar
Knox, C. and McAlister, D. (1995), ‘Policy evaluation: incorporating users views’, Public Administration, 73(3): 413–436.Google Scholar
Lenaghan, J. (1999), ‘Involving the public in rationing decisions. The experience of citizens juries’, Health Policy, 49(1–2): 45–61.Google Scholar
Litva, A., Coast, J., Donovan, J., Eyles, J., Shepherd, M., Tacchi, J., Abelson, J. and Morgan, K. (2002), ‘The public is too subjective: public involvement at different levels of health-care decision making’, Social Science & Medicine, 54(12): 1825–1837.CrossRefGoogle ScholarPubMed
Marinker, M. (2006), Constructive Conversations About Health: Policy and Values, Oxford: Radcliffe Publishing.Google Scholar
Martin, G. P. (2008), ‘Representativeness, legitimacy and power in public involvement in health-service management’, Social Science & Medicine, 67(11): 1757–1765.Google Scholar
Mayer, J. and Nachtnebel, A. (2015), ‘Disinvesting from INeffective Technologies: Lessons Learned from Current Programs’, International Journal of Technology Assessment in Health Care, 31(06): 355–362.Google Scholar
McKeown, B. and Thomas, D. (1988), Q Methodology, Newbury Park: Sage Publications.CrossRefGoogle Scholar
Mitton, C., Dionne, F., Damji, R., Campbell, D. and Bryan, S. (2011), ‘Difficult decisions in times of constraint: criteria based resource allocation in the Vancouver Coastal Health Authority’, BMC Health Services Research, 11(1): 169.Google Scholar
NHS England (2015), Planning, Assuring and Delivering Service Change for Patients, Leeds: NHS England.Google Scholar
Niven, D. J., Mrklas, K. J., Holodinsky, J. K., Straus, S. E., Hemmelgarn, B. R., Jeffs, L. P. and Stelfox, H. T. (2015), ‘Towards understanding the de-adoption of low-value clinical practices: a scoping review’, BMC Medicine, 13(1): 255. http://www.biomedcentral.com/1741-7015/13/255 [23 November 2016].CrossRefGoogle Scholar
Prasad, V., Cifu, A. and Ioannidis, J. (2012), ‘Reversals of established medical practices: evidence to abandon ship’, JAMA: The Journal of the American Medical Association, 307(1): 37–38.CrossRefGoogle ScholarPubMed
Previte, J., Pini, B. and Haslam-McKenzie, F. (2007), ‘Q methodology and rural research’, Sociologia Ruralis, 47(2): 135–147.Google Scholar
Robert, R., Harlock, J. and Williams, I. (2014), ‘Disentangling rhetoric and reality: an international Delphi study of factors and processes that facilitate the successful implementation of decisions to decommission healthcare services’, Implementation Science, 9(1): 123. http://implementationscience.biomedcentral.com/articles/10.1186/s13012-014-0123-y [23 November 2016].Google Scholar
Robinson, S., Glasby, J. and Allen, K. (2013), ‘‘It ain’t what you do it’s the way that you do it’: lessons for health care from decommissioning of older people’s services’, Health & Social Care in the Community, 21(6): 614–622.Google Scholar
Robson, C. (2011), Real World Research: A Resource for Users of Social Research Methods in Applied Settings, Chichester, West Sussex: Wiley.Google Scholar
Seymour, W. S. (2001), ‘In the flesh or online? Exploring qualitative research methodologies’, Qualitative Research, 1: 147–168.Google Scholar
Steelman, T. A. and Maguire, L. A. (1999), ‘Understanding participant perspectives: Q-methodology in national forest management’, Journal of Policy Analysis and Management, 18(3): 361–388.3.0.CO;2-K>CrossRefGoogle Scholar
Stenner, P., Cooper, D. and Skevington, S. M. (2003), ‘Putting the Q into quality of life; the identification of subjective constructions of health-related quality of life using Q methodology’, Social Science & Medicine, 57(11): 2161–2172.Google Scholar
Stenner, P., Dancey, C. and Watts, S. (2000), ‘The understanding of their illness amongst people with irritable bowel syndrome: a Q methodological study’, Social Science & Medicine, 51(3): 439–452.Google Scholar
Stewart, E. and Aitken, M. (2015), ‘Beyond NIMBYs and NOOMBYs: what can wind farm controversies teach us about public involvement in hospital closures?’, BMC Health Services Research, 15(1): 530. http://www.biomedcentral.com/1472-6963/15/530 [14 March 2017].Google Scholar
Taylor, J. (2017), ‘Why are local campaigns fighting to save the NHS from transformation?’. http://www.nhsconfed.org/blog/2017/06/why-are-local-campaigns-fighting-to-save-the-nhs-from-transformation [16 August 2017].Google Scholar
VanExel, J. and DeGraaf, G. (2005), ‘Q methodology: a sneak preview’. http://qmethod.org/articles/vanExel.pdf [8 November 2012].Google Scholar
VanExel, J., Baker, R., Mason, H., Donaldson, C. and Brouwer, W. (2015), ‘Public views on principles for health care priority setting: findings of a European cross-country study using Q methodology’, Social Science & Medicine, 126: 128–137.Google Scholar
Wait, S. and Nolte, E. (2006), ‘Public involvement policies in health: exploring their conceptual basis’, Health Economics, Policy and Law, 1(2): 149.Google Scholar
Watts, S. and Stenner, P. (2005), ‘Doing Q methodology: theory, method and interpretation’, Qualitative Research in Psychology, 2(1): 67–91.Google Scholar
Watts, S. and Stenner, P. (2012), Doing Q Methodological Research: Theory, Method and Interpretation, Los Angeles: Sage.Google Scholar
Webler, T., Danielson, S. and Tuler, S. (2009), Using Q Method to Reveal Social Perspectives in Environmental Research, Greenfield, MA: Social and Environmental Research Institute.Google Scholar
Webler, T., Tuler, S. and Krueger, R. (2001), ‘What is a good public participation process? Five perspectives from the public’, Environmental Management, 27(3): 435–450.Google Scholar
Williams, I., Robinson, S. and Dickinson, H. (2012), Rationing in Health Care: The Theory and Practice of Priority Setting, Bristol: Policy.Google Scholar
Woods, C. E. (2011), ‘Using Q methodology to explore leadership: the role of the school business manager’, International Journal of Leadership in Education, 14(3): 317–335.Google Scholar