Author

H. Barratt

Abstract

Proposed changes to hospital services, such as the closure of Accident & Emergency departments (A&E), often create high profile, contentious debates. Whilst clinicians tend to focus on potential health gains for patients, public concerns may include non-clinical factors such as ease of access to services. Previous research has largely concentrated on policy issues and little is known about the priorities and preferences for emergency hospital care amongst the public at large. The first study in this thesis explored a process carried out to engage the local community with proposals to reconfigure hospital services in North London. This included mapping key areas of concern for the public and critically reviewing the impact of the methods used in the public engagement process. Study 1 demonstrated that the techniques currently used draw on traditional approaches aimed at improving the public understanding of science. This includes an apparent assumption of 'public ignorance' in matters of science and technology, and the belief that science offers a uniquely privileged view of the world. The second study involved a series of in-depth interviews examining priorities for emergency care in more detail. Interviews were conducted with four groups of participants: patients with a chronic condition; parents of young children; older people; patient representatives and community groups campaigning against service closures. Interviews were carried out in an area where a reconfiguration was being discussed and an area where it was not. The analysis drew on theories relating to risk perception and risk communication. It demonstrated the importance of the widespread belief that timely access is associated with better outcomes, as well as the way in which the public's assessment of service quality influences their response to reconfiguration proposals.