Care in place: A case study of assembling a carescape

The “problem” of public resistance to hospital closure is a recurring trope in health policy debates around the world. Recent papers have argued that when it comes to major change to hospitals, “the public” cannot be persuaded by clinical evidence, and that mechanisms of public involvement are ill‐equipped to reconcile opposition with management desire for radical change. This paper presents data from in‐depth qualitative case studies of three hospital change processes in Scotland's National Health Service, including interviews with 44 members of the public. Informed by sociological accounts of both hospitals and publics as heterogeneous, shifting entities, I explore how hospitals play meaningful roles within their communities. I identify community responses to change proposals which go beyond simple opposition, including evading, engaging with and acquiescing to changes. Explicating both hospitals and the publics they serve as complex social phenomena strengthens the case for policy and practice to prioritise dialogic processes of engagement. It also demonstrates the continuing value of careful, empirical research into public perspectives on contentious healthcare issues in the context of everyday life.

“…Recent sociological studies of healthcare facilities (Ivanova et al 2016, Jones 2015D. Martin et al 2015) illuminate the porous boundaries of hospitals.…”

Section: Discussionmentioning

confidence: 99%

Section: Sociological Perspectives On Hospitals and Publicsmentioning

confidence: 99%

A sociology of public responses to hospital change and closure

Stewart

2019

“…More recently, Ivanova et al (2016) explored the multiple ontologies of 'carescapes' in an ethnographic study of a nursing home facing closure on a Dutch island. In this case, the ontology of care embodied in national healthcare governance (as defined by quality standards and protocols) combined with local understandings of the nursing home.…”

Section: Local Meanings Cultures and Identitiesmentioning

confidence: 99%

Exploring the neglected and hidden dimensions of large‐scale healthcare change

Jones

Fraser

Stewart

2019

Forms of large‐scale change, such as the regiona l re‐distribution of clinical services, are an enduring reform orthodoxy in health systems of high‐income countries. The topic is of relevance and importance to medical sociology because of the way that large‐scale change significantly disrupts and transforms therapeutic landscapes, relationships and practices. In this paper we review the literature on large‐scale change. We find that the literature is dominated by competing forms of knowledge, such as health services research, and show how sociology can contribute new and critical perspectives and insights on what is for many people a troubling issue.

“…Of course, various sociological studies have utilised geographic concepts to examine how space is entangled within care practices, for instance, embodied care work and spaces of home (England and Dyck ), how place and care are co‐produced (Ivanova et al . ) and the architectural spaces of healthcare buildings (Martin et al . ).…”

Section: Conceptual Approach: Space and Assemblagementioning

confidence: 99%

“…Brown et al (2017) capture the plurality of subsequent scholarship situated between sociology of health and social geography. Of course, various sociological studies have utilised geographic concepts to examine how space is entangled within care practices, for instance, embodied care work and spaces of home (England and Dyck 2011), how place and care are co-produced (Ivanova et al 2016) and the architectural spaces of healthcare buildings (Martin et al 2015). Nonetheless, while there have been a number of spatially sensitive sociological studies of health care across a range of scales, geographic contributions within healthcare policy and reform remain under-valued.…”

Section: Conceptual Approach: Space and Assemblagementioning

confidence: 99%

Regional assemblage and the spatial reorganisation of health and care: the case of devolution in Greater Manchester, England

Lorne

McDonald

Walshe

et al. 2019

In this paper, we examine how space is integral to the practices and politics of restructuring health and care systems and services and specifically how ideas of assemblage can help understand the remaking of a region. We illustrate our arguments by focusing on health and social care devolution in Greater Manchester, England. Emphasising the open‐ended political construction of the region, we consider the work of assembling different actors, organisations, policies and resources into a new territorial formation that provisionally holds together without becoming a fixed totality. We highlight how the governing of health and care is shaped through the interplay of local, regional and national actors and organisations coexisting, jostling and forging uneasy alliances. Our goal is to show that national agendas continued to be firmly embedded within the regional project, not least the politics of austerity. Yet through keeping the region together as if it was an integrated whole and by drawing upon new global policy networks, regional actors strategically reworked national agendas in attempts to leverage and compete for new resources and powers. We set out a research agenda that foregrounds how the political reorganisation of health and care is negotiated and contested across multiple spatial dimensions simultaneously.