Patient and public healthcare in the new NHS
Patient and public healthcare in the new NHS: choice, voice, and the pursuit of legitimacy
Perhaps even more than other aspects of healthcare organization in England, formal structures for patient and public involvement in the National Health Service (NHS) have been subject to successive upheavals over the last 15 years. The latest reforms, introduced through the 2012 Health and Social Care Act, created a new mechanism for patient and public involvement—a network of local Healthwatch organizations—and with it, a revised remit and a new position in local health and social care economies. In an increasingly marketized healthcare system, Healthwatch is primarily positioned as a champion for consumer rights. However, local Healthwatch organizations also inherit a role premised on collective voice, and are expected to represent the interests of the (variegated) public in strategic health and social care planning decisions. At the same time, Healthwatch are not the only bodies with a claim to represent patients and the public: as organizations commissioned through competitive tender from the voluntary sector by local government, they find themselves in positions riddled with potential conflicts of interest, and ambiguities about accountability and autonomy. They also find themselves in something of a market for public voice, competing with elected local officials, population needs assessments, grassroots organizations, and other mechanisms of involvement, with NHS organizations increasingly free to ‘shop around’ in this market for forms of public involvement that they find most appropriate. This paper explores the consequences of this increasingly complicated governance scene for the actors on the ground who must make sense of it, and pursue practices of involvement that marry compliance with statutory regulation with local expectations, norms, and traditions around participation. Drawing on interviews from a study of patient and public involvement in the East Midlands region of England, it considers how Healthwatch officers navigate the novel structures for involvement and seek a place for Healthwatch that commands legitimacy and influence—though often in ways that differ substantially from the blueprint offered by policymakers.
Followed by wine and nibbles
Seminar Series - Citizen participation in health: critical perspectives
The seminar series brings together social science expertise to reflect critically on policy and practice of citizen participation in health systems. It draws on critical conceptual framings of participation and in-depth empirical work from the UK and elsewhere.
The series aims to focus particularly on the political economy of patient participation in the NHS, the construction of neoliberal patient-professional roles, the emergence of new spaces of citizen engagement in response to the marketization of health, and the relevance of global social movements and health activism to contemporary health systems.
The group is supported by the King’s Interdisciplinary Social Science Doctoral Training Centre.
Admission