Division of Population Health, Health Services Research, and Primary Care, School of Health Science, The University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL, United Kingdom.
Alliance Manchester Business School, The University of Manchester, United Kingdom.
Soc Sci Med. 2017 Oct;190:217-226. doi: 10.1016/j.socscimed.2017.08.007. Epub 2017 Aug 11.
This paper explores how 'place' is conceptualised and mobilized in health policy and considers the implications of this. Using the on-going spatial reorganizing of the English NHS as an exemplar, we draw upon relational geographies of place for illumination. We focus on the introduction of 'Sustainability and Transformation Plans' (STPs): positioned to support improvements in care and relieve financial pressures within the health and social care system. STP implementation requires collaboration between organizations within 44 bounded territories that must reach 'local' consensus about service redesign under conditions of unprecedented financial constraint. Emphasising the continued influence of previous reorganizations, we argue that such spatialized practices elude neat containment within coherent territorial geographies. Rather than a technical process financially and spatially 'fixing' health and care systems, STPs exemplify post-politics-closing down the political dimensions of policy-making by associating 'place' with 'local' empowerment to undertake highly resource-constrained management of health systems, distancing responsibility from national political processes. Relational understandings of place thus provide value in understanding health policies and systems, and help to identify where and how STPs might experience difficulties.
本文探讨了“场所”在卫生政策中的概念化和调动方式，并考虑了这一概念的影响。我们以正在进行的英国国民保健制度的空间重组为例，借鉴场所的关系地理学来加以说明。我们关注的是“可持续发展和转型计划”（STP）的引入：该计划旨在支持改善医疗保健服务，并缓解卫生和社会保健系统的财政压力。STP 的实施需要在 44 个限定区域内的组织之间进行合作，这些组织必须在前所未有的财政限制条件下就服务重新设计达成“地方”共识。我们强调先前重组的持续影响，认为这种空间化实践难以在连贯的地域地理范围内进行整齐的包容。STP 并没有成为一个在财务和空间上“修复”卫生和保健系统的技术性过程，而是通过将“场所”与“地方”赋权联系起来，以对卫生系统进行高度资源受限的管理，从而将责任从国家政治进程中转移出去，从而体现了后政治——通过将“场所”与“地方”赋权联系起来，以对卫生系统进行高度资源受限的管理，从而将责任从国家政治进程中转移出去，从而体现了后政治——关闭政策制定的政治层面。因此，对场所的关系理解在理解卫生政策和系统方面具有价值，并有助于确定 STP 在何处以及如何可能遇到困难。
