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EPDF and EPUB available Open Access under CC-BY-NC-ND licence.It is often claimed that the UK is unusually attached to its National Health Service, and the last decade has seen increasingly visible displays of gratitude and love. While social surveys of public attitudes measure how much Britain loves the NHS, this book mobilises new empirical research to ask how Britain love its NHS.

Ellen A. Stewart offers timely critique of both the potential, and the dysfunctions, of Britain's complex love affair with its healthcare system.

Cover -- Half Title -- Title Page -- Copyright Page -- Dedication -- Table of Contents -- List of Figures and Tables -- Acknowledgements -- List of Acronyms -- 1 Introducing Citizen Participation in Health Systems -- 2 Scotland's NHS: Citizen Participation and Mutuality in Scottish Health Policy -- 3 Administering the System: Citizen Participation as Committee Work -- 4 Extending the System: Citizen Participation as Outreach Work -- 5 Electing the System: Citizen Participation as Representative Democracy -- 6 Fighting the System: Citizen Participation as Protest

AbstractWithin public administration, coproduction is a ubiquitous policy discourse, and increasingly an analytic lens through which public relationships with public services are viewed. This article reports an interpretive qualitative study of community practices around three changing hospitals in the Scottish NHS, comprising semi‐structured qualitative interviews with citizens, NHS staff, politicians and journalists, as well as non‐participant observation of community and NHS events. Initially focused on community opposition to top‐down hospital change, the study identified a surprising range of supportive community actions for their local hospitals, including volunteering, fundraising and innovative co‐delivered service models. Building on these examples, the paper presents a model of 'fugitive coproduction,' where individuals and groups within communities collaborate with local staff in ways which significantly shape the provision of local services, without permission or authorisation from relevant authorities, and in modes that are centrally concerned with immediate perceived need not strategic change. I argue that these forms of public action can make valuable contributions to public services, and that they hold lessons for the wider reform of public administration.

Within public administration, coproduction is a ubiquitous policy discourse, and increasingly an analytic lens through which public relationships with public services are viewed. This paper reports an interpretive qualitative study of community practices around three changing hospitals in the Scottish NHS, comprising semi-structured qualitative interviews with citizens, NHS staff, politicians and journalists, as well as non-participant observation of community and NHS events. Initially focused on community opposition to top-down hospital change, the study identified a surprising range of supportive community actions for their local hospitals, including volunteering, fundraising and innovative co-delivered service models. Building on these examples, the paper presents a model of 'fugitive coproduction', where individuals and groups within communities collaborate with local staff in ways which significantly shape the provision of local services, without permission or authorisation from relevant authorities, and in modes that are centrally concerned with immediate perceived need not strategic change. I argue that these forms of public action can make valuable contributions to public services, and that they hold lessons for the wider reform of public administration.

Academic research on health policy divergence across the United Kingdom since devolution has characterised Scotland's approach as 'professionalistic' or 'collaborative'. This article argues that more nuanced studies of particular policy areas are needed, and offers an exploration of the Scottish approach to public involvement as an example. An analysis of policy documents since devolution reveals the shifting significance of public involvement, and the introduction of new instruments for its accomplishment. The Scottish National Party's vision of 'a mutual National Health Service' is presented as a complex, even contradictory, project, which warrants further empirical attention both within and beyond the context of four-system comparisons.

"This book provides a comprehensive overview of mental health in rural America, with the goal of fostering urgently needed research and honest conversations about providing accessible, culturally competent mental health care to rural populations. Grounding the work is an explanation of the history and structure of rural mental health care, the culture of rural living among diverse groups, and the crucial "A's" and "S": accountability, accessibility, acceptability, affordability, and stigma. The book then examines poverty, disaster mental health, ethics in rural mental health, and school counseling. It ends with practical information and treatments for two of the most common problems, suicide and substance abuse, and a brief exploration of collaborative possibilities in rural mental health care."--

Background Many policymakers, researchers and commentators argue that hospital closures are necessary as health systems adapt to new technological and financial contexts, and as population health needs in developed countries shift. However closures are often unpopular with local communities. Previous research has characterised public opposition as an obstacle to change. Public opposition to the siting of wind farms, often described as NIMBYism (Not In My Back Yard), is a useful comparator issue to the perceived NOOMBYism (Not Out Of My Back Yard) of hospital closure protestors. Discussion The analysis of public attitudes to wind farms has moved from a fairly crude characterisation of the 'attitude-behaviour gap' between publics who support the idea of wind energy, but oppose local wind farms, to empirical, often qualitative, studies of public perspectives. These have emphasised the complexity of public attitudes, and revealed some of the 'rational' concerns which lie beneath protests. Research has also explored processes of community engagement within the wind farm decision-making process, and the crucial role of trust between communities, authorities, and developers. Summary Drawing on what has been learnt from studies of opposition to wind farms, we suggest a range of questions and approaches to explore public perspectives on hospital closure more thoroughly. Understanding the range of public responses to service change is an important first step in resolving the practical dilemma of effecting health system transformation in a democratic fashion.

Concerns about the limited influence of research on decision making have prompted the development of tools intended to mediate evidence for policy audiences. This article focuses on three examples, prominent in public health: impact assessments; systematic reviews; and economic decision-making tools (cost-benefit analysis and scenario modelling). Each has been promoted as a means of synthesising evidence for policy makers but little is known about policy actors' experiences of them. Employing a literature review and 69 interviews, we offer a critical analysis of their role in policy debates, arguing that their utility lies primarily in their symbolic value as markers of good decision making.

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.

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.

Alongside efforts to improve evidence use in policy, grassroots demands and governance-driven democratisation are informing an ever-increasing range of public engagement processes in UK policy. This article explores how these simultaneous efforts intersect within three policy organisations working at different levels of UK policy: local (Sheffield City Council), regional (Greater Manchester Combined Authority) and national (devolved) (Scottish Government). Employing documentary analysis and 51 interviews with individuals working in these organisations, we argue that there are organisational similarities in approaches to evidence and engagement, including: conceiving of both 'data' (statistics tracked by internal analysts) and 'evidence' (external analysis) in primarily quantified terms; and a tendency to limit the authority of publics to advising and consulting on predefined issues. Yet, we also find growing interest in more in-depth understandings of publics (for example, via 'lived experiences') but uncertainty about how to use these qualitative insights in settings that have institutionalised quantitative approaches to evidence. We identify four distinct responses: (1) prioritising public engagement; (2) strategically using public engagement and evidence to support policy proposals; (3) prioritising quantified evidence and data; and (4) attempting to integrate these distinct knowledge types. Surprisingly (given the organisational importance afforded to metrics), we categorised most interviewees in Cluster 4. Finally, we explore how interviewees described trying to do this kind of integration work, before reflecting on the promise and limitations of the various mechanisms that interviewees identified.