Building spaces for controversial public engagement – Exploring and challenging democratic deficits in NHS marketization

Abstract

The Brighton Citizen's Health Services Survey (BCHSS) was developed to explore and potentially challenge how knowledge is used and by whom in the production of local health commissioning institutions and relations. Through the creation of an 'animating set of questions', it sought to open up spaces through which to make visible some of the ways of knowing and valuing the NHS and health services that had been minimised through the commensuration practices of post-2012 public engagement. In this way there was a clear agenda to facilitate a form of knowledge democratisation which opened up and validated different 'health publics', in order to explore and broaden participative engagement opportunities. The paper provides an account of the project. It considers the theoretical and methodological underpinnings of this example of 'evidence-based activism', reflects on the impact of the project on local commissioning and considers the range of controversies that arose as a result of the work. It explores the way that research straddling the boundary between academic inquiry and political activism speaks to the many issues that are prevalent in the changing HE sector as well as NHS privatisation, health commissioning and public sector cuts.

Clinician-led evidence-based activism: a critical analysis

“…Theorizations of EBA (Rabeharisoa et al, 2013;Walker et al, 2018) have built on the more established concept of evidence-based medicine (EBM). EBM was defined by its founders as 'the integration of the best research evidence with clinical expertise and patient values' (Sackett et al, 2000, p. 1).…”

“…Services were forced by the legislation to compete with one another, rather than collaborate, resulting in fragmentation (Leys, 2016). More recent non-legislative changes have attempted to re-integrate services (Walshe et al, 2018), but funds have remained restricted (for more on NHS reforms, see (Hammond et al, 2017(Hammond et al, , 2018Krachler & Greer, 2015;Leys, 2016;Pushkar, 2019;Timmins, 2018;Walker et al, 2018). Waiting times have increased (QualityWatch, 2019), staff morale has nosedived (Beech et al, 2019), many quality indicators and outcome measures have deteriorated (Scobie, 2019).…”

“…Third, having generated an evidence base, a conscious decision was made to use doctors to disseminate that knowledge. It is this third facet that allows us to describe our cases as CLEBA, thus differentiating it from the EBA described by Rabeharisoa et al (2013) and Walker et al (2018). In this section, we evaluate CLEBA as a tactic.…”

“…The first is to introduce the concept of CLEBA, delineating it from EBA. In Rabeharisoa et al's (2013) and Walker et al's (2018) descriptions of EBA, the activists in question are patients, service users, and civic actors. These individuals collaborate with clinicians and scientists and strive to rebalance unequal power relations by engaging in knowledge production.…”

Patient and public involvement in priority‐setting decisions in England's Transforming NHS: An interview study with Clinical Commissioning Groups in South London sustainability transformation partnerships

“…And since then, research indicates that publics are struggling to mobilize, weakened by their not sharing a collective identity . Furthermore, since 2016, critiques of the top‐down ‘structuring’ of public engagements, along with managerial and clinician conceptualizations of PPI as a means of mediating and ‘softening oppositions’ in public opinion, focussed on legitimation, have returned …”