Citizen participation in health systems: bringing uninvited action in Dr Ellen Stewart.

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Presentation transcript:

Citizen participation in health systems: bringing uninvited action in Dr Ellen Stewart

When publics won’t ‘behave'!

Invited public participation “when public engagement should be sought, how it should be obtained, or how it might be incorporated” (Mitton et al 2009) newspaper ad | public hearing | public meeting | drop in centre | internet information | hotline | opinion poll | survey | referendum | consultation document | interactive website | focus group | study circle | open space | standing citizens’ advisory panel | citizens’ jury | consensus conference | task force | deliberative poll | town hall meeting with voting | service user forum | round table | open house | patient groups | lay representatives | consumer council

What about public action that isn’t ‘sought’?

Opposition to hospital closure: why? Opposition Patient concerns neglected Visibility of change Symbolic: of community Symbolic: of the NHS

Public protest tactics: from the literature Procedural Legal challenges Forming campaign group Petitions Confrontational Standing for political office Bypassing local decisionmakers Marches and protests Commissioning expert review Disruptive Sit ins and occupations Boycotts of alternative providers

From contestation… to coproduction? Understanding contestation as something that happens within both uninvited and invited participation An orientation/ behaviour not a structure Examples of attempted community buy-outs of threatened hospitals Possible? Future-proof? Desirable?

Two current research projects CSO Postdoctoral Fellowship Project runs til 2018 Analysis of all Scottish hospital closures Case studies of 3-4 proposals to close hospitals: consultation process; evidence base; public experiences and perspectives Health Foundation Rapid Policy Analysis Project runs through 2016 Comparison of recent policy on public involvement in major service change: England; Scotland: Wales: Northern Ireland

Thankyou for listening. Comments, thoughts and ideas very welcome: