Between a rock and a hard place: Comparing arms' length bodies for public involvement in healthcare across the UK. Issue 4 (April 2020)

• Record Type: Journal Article
• Authors: Stewart, Ellen; Ercia, Angelo; Greer, Scott L.; Donnelly, Peter D.
• Is Part Of: Health policy. Volume 124:Issue 4(2020)
• Page Start: 454
• Page End: 461
• Publication Date: 2020-04
• Subjects: Public and patient involvement -- Health system reform -- Public administration; Medical education -- Periodicals; Medical policy -- Periodicals; Delivery of Health Care -- Periodicals; Education, Medical -- Periodicals; Health Education -- Periodicals; Health Planning -- Periodicals; Public Policy -- Periodicals; Enseignement médical -- Périodiques; Politique sanitaire -- Périodiques; Medical education; Medical policy; Periodicals; Electronic journals; Electronic journals; 362.1
• DOI: 10.1016/j.healthpol.2020.02.004
• Languages: English
• ISSNs: 0168-8510

Abstract

Highlights: UK arms' length bodies for PPI have been repeatedly reformed since the 1970s, but have endured. They vary by health system: England, Northern Ireland, Scotland and Wales. These bodies juggle 'championing' publics views and seeking to influence NHS organisations. Formal accountability to Government strongly shapes organisational development. Abstract: Arms' length bodies are often seen as a tool of technocratic governance, designed to insulate decision-making from the politicizing pressures of populist influence. This article examines a subset of arms' length bodies in the UK which challenge this convention: agencies which exist to 'champion' the voice of patients and the public in the four NHS systems (England, Northern Ireland, Scotland and Wales). We compare the functions of these agencies on paper and through qualitative interviews in each system which focused on public involvement in major service change (such as closing hospitals). We found that agencies in all four systems had struggled to demonstrate their legitimacy, squeezed between the demands of the elected Governments they answer to, the NHS organisations they are meant to support and challenge, and the publics whose voices they are meant to amplify. We argue that the evolving solutions found in each system demonstrate a foundational tension between locally-legitimate actors and nationally-capable political savvy.