UBC Theses and Dissertations

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UBC Theses and Dissertations

To what extent should the public be involved in health disinvestment decision making : a mixed methods investigation into the views of health professionals in the English NHS Daniels, Thomas Andrew


Demand for health services is growing, but funding is often failing to keep pace. To ensure that budgets are balanced and that delivered services continue to be high quality, decision makers are having to set priorities, removing funding from some services- this is disinvestment. This thesis details research incorporating a literature review followed by a two stage empirical investigation into the way that disinvestment decisions are made and whether or not the public should be involved. The first stage is a Q-Methodology study, the second is in-depth interviews. The population for the study is NHS health professionals (including managers and clinicians). 55 participants took part in the Q-study, and of these, 20 took part in follow-up interviews. The study highlighted three distinct perspectives, all of which supported public involvement. One was unequivocal in its support, another highlighted some potential disadvantages to involving the public and the third suggested that the public should have the freedom to choose whether they became involved. The follow up interviews re-iterated participants’ support for involvement but suggested that the public should become involved earlier and to a greater extent in those disinvestment decisions which affected more patients and/or resulted in a tangible loss of services.

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