series event

Transforming health systems: for, against, or with the public?

Internationally, Beveridge-type health systems are considered unusually prone to dramatic ‘big bang’ reorganisations. However, in the UK there is a perception that organisations cannot make significant changes to acute services, such as closing hospitals, because of public opposition. Given significant pressures for centralisation of acute services, the consistent unpopularity of such changes, and the requirement for healthcare organisations to involve the public in their decision-making, this research explores policy and practice for involving the public effectively in major service changes across the UK’s four health systems: England, Northern Ireland, Scotland and Wales. I argue that efforts towards healthcare transformation need to understand public involvement as an intrinsic part of change, rather than as a communications issue for implementation. Effective public involvement can help organisations to make positive, major changes to acute services, but costs time and money. In the current climate of financial crisis, organisations may be tempted to adopt less transparent approaches to change. These are, however, unlikely to be implemented without public (and political) support.  

Ellen Stewart is a social scientist working at the intersection of medical sociology, health policy and public administration. She currently holds a Chief Scientist Office Postdoctoral Fellowship, and the research reported in this seminar is supported by a Health Foundation Policy Challenge Fund grant. Her monograph, Publics and their health systems: rethinking participation was published in 2016.


The Faculty of Public Health and Policy Seminar Series provide a forum for presenting current research on health systems and policy in low-, middle- and high-income countries. The series cover empirical research, theoretical and methodological issues, and gives an opportunity for staff and students to participate in debate and learn about new developments in health systems and policy research.

Series organised by: Dina Balabanova and Alec Fraser