Reconfiguring Local Health Economies

Reconfiguring local health economies: Evidence, policy, practice, and participation.
With David Byrne and Andrew Fletcher

Evidence from social science studies plays an increasing role in consultation in governance processes and in justifying recommended change. An example of such justifications can be seen in health service reconfigurations that concentrate services in large units and in the use of population projections in extending plans for local services. Often this evidence is given a status that ignores its uncertainties and qualifications. This study builds on lessons from research on the deeply contested structural changes in Manchester UK that overlapped Accident and Emergency with Maternity services, where both public consultation and evidence-based on opinions of clinicians played a major role. It focuses on the nature of social science evidence in such processes, on the way in which evidence is understood and deployed by policymakers and on what evidence means in relation to consultation and participation in democratic societies. 

Case Study Update - January 2019

Health policy decisions are informed by a range of evidence types. How these are prioritised, balanced and deployed varies in relation to NHS organisational structures and drivers such as austerity. We have analysed publicly available data on reconfigurations and devo health and interviewed key relevant informants to explore the ways evidence is used to make and justify decisions around health service reconfigurations. Of particular interest was how evidence changes in relation to changing organisational structures and the growing trend for unpopular reconfiguration decisions to be challenged through judicial review. This allows us to speculate on wider treatments and understandings of evidence. Our findings were presented at the Health Policy and Politics Network annual conference in Oxford.