Editorial : the importance of sociological approaches to the study of service change in health care

Fraser, Alec and Stewart, Ellen and Jones, Lorelei (2019) Editorial : the importance of sociological approaches to the study of service change in health care. Sociology of Health and Illness, 41 (7). pp. 1215-1220. ISSN 0141-9889 (https://doi.org/10.1111/1467-9566.12942)

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Change is an enduring facet of healthcare policy and practice. Service change ranges from far reaching macro-level political reforms such as the Health and Social Care Act of 2012 in the UK, or the Patient Protection and Affordable care Act of 2010 in the US, to regional system-wide reorganisations such as the devolution of health and social care in the Greater Manchester region of England from 2014. It also comprises meso-level programmes of change in local healthcare services, which may generate national media interest out of proportion with their apparent national significance. Particularly when such changes highlight conflicting view points and concern over perceived 'down-grading' of services – the Kidderminster case from the 1990s being a particularly high-profile example of this in the UK – campaigns against change can capture a wider public imagination. Service change likewise encompasses quotidian, micro-level modifications in healthcare service provision– for example de-coupling or co-locating certain clinical services in new configurations – which can have profound consequences for particular populations of staff and service users. All such service change – from the large to the small scale – affects the social and spatial realities for multiple groups (patients, publics and those employed by and within healthcare institutions). As the anthropologist Elisabeth Colson (1971) observed, large-scale change 'hurts' a fact largely ignored by planners and politicians concerned with the economic but not the social costs.