Barratt Helen, Harrison David A, Raine Rosalind, Fulop Naomi J
Department of Applied Health Research, University College London, 1-19 Torrington Place, London WC1E 7HB, UK.
Intensive Care National Audit and Research Centre, 24 High Holborn, London WC1V 6AZ, UK.
Health Policy. 2015 Sep;119(9):1210-7. doi: 10.1016/j.healthpol.2015.04.015. Epub 2015 May 1.
In England, proposed service changes such as Emergency Department closures typically face local opposition. Consequently, public consultation exercises often involve protracted, hostile debates. This study examined a process aimed at engaging a community in decision-making about service reconfiguration, and the public response to this process.
A documentary analysis was conducted to map consultation methods used in an urban area of England where plans to consolidate hospital services on fewer sites were under discussion. In-depth interviews (n=20) were conducted with parents, older people, and patient representatives. The analysis combined inductive and deductive approaches, informed by risk communication theories.
The commissioners provided a large volume of information about the changes, alongside a programme of public events. However, the complexity of the process, together with what members of the public perceived to be the commissioners' dismissal of their concerns, led the community to question their motivation. This was compounded by a widespread perception that the proposals were financially driven.
Government policy emphasises the importance of clinical leadership and 'evidence' in public consultation. However, an engagement process based on this approach fuelled hostility to the proposals. Policymakers should not assume communities can be persuaded to accommodate service change which may result in reduced access to care.
在英格兰，诸如急诊科关闭等拟议中的服务变更通常会面临当地的反对。因此，公众咨询活动往往会引发旷日持久的激烈辩论。本研究考察了一个旨在让社区参与服务重新配置决策的过程，以及公众对该过程的反应。
进行了一项文献分析，以梳理在英格兰一个市区所采用的咨询方法，该市区正在讨论将医院服务整合到更少地点的计划。对家长、老年人和患者代表进行了20次深入访谈。分析结合了归纳法和演绎法，并以风险沟通理论为依据。
专员们提供了大量有关变更的信息，同时还安排了一系列公众活动。然而，过程的复杂性，以及公众认为专员们对他们的担忧不予理会，导致社区对他们的动机产生质疑。普遍认为这些提议是受经济利益驱动，这使情况更加复杂。
政府政策强调临床领导力和“证据”在公众咨询中的重要性。然而，基于这种方法的参与过程加剧了对这些提议的敌意。政策制定者不应假定可以说服社区接受可能导致医疗服务可及性降低的服务变更。
