Transforming health care

The policy and politics of service reconfiguration in the UK's four health systems

Funded by

The Health Foundation Logo

12 April 2019

Published journal: Health Economics, Policy and law


Public involvement in service change has been identified as a key facilitator of health care transformation (Foley et al., 2017) but little is known about how health policy influences whether and how organisations involve the public in change processes. This qualitative study compares policy and practice for involving the public in major service changes across the UK's four health systems (England, Northern Ireland, Wales and Scotland).

We analysed policy documents, and conducted interviews with officials, stakeholders, NHS staff and public campaigners (total number of interviewees = 47). Involving the public in major service change was acknowledged as a policy challenge in all four systems. Despite ostensible similarities, there were some clear differences between the four health systems' processes for involving patients and the public in major changes to health services.

The extent of central Government oversight, the prescriptiveness of Government guidance, the role for intermediary bodies and arrangements for independent scrutiny of contentious decisions all vary. We analyse how health policy in the four systems has used ‘sticks’ and ‘sermons’ to promote particular approaches, and conclude that both policy and the wider system context within which health care organisations try to effect change are significant, and understudied aspect of contemporary practice.


Stewart, E., Greer, S., Ercia, A., & Donnelly, P. (n.d.). Transforming health care: The policy and politics of service reconfiguration in the UK's four health systems. Health Economics, Policy and Law, 1-19. doi:10.1017/S1744133119000148

You might also like...

Press release

Health and care services face a perfect storm of pressures in the coming months

Health Foundation response to NHS England monthly performance stats for September.

Press release

Press release

More strategic, long-term investment needed across government for a healthy and prosperous nation

New Health Foundation report shows government is failing to invest in the nation’s health by focusing on short-term spending.

Kjell-bubble-diagramArtboard 101

Work with us

We look for talented and passionate individuals as everyone at the Health Foundation has an important role to play.

View current vacancies
Artboard 101 copy 2

The Q Community

Q is an initiative connecting people with improvement expertise across the UK.

Find out more