title: Framing in policy processes: a case study from hospital planning in the National Health Service in England.
abstract: This paper reports from an ethnographic study of hospital planning in England undertaken between 2006 and 2009. We explored how a policy to centralise hospital services was espoused in national policy documents, how this shifted over time and how it was translated in practice. We found that policy texts defined hospital planning as a clinical issue and framed decisions to close hospitals or hospital departments as based on the evidence and necessary to ensure safety. We interpreted this framing as a rhetorical strategy for implementing organisational change in the context of community resistance to service closure and a concomitant policy emphasising the importance of public and patient involvement in planning. Although the persuasive power of the framing was limited, a more insidious form of power was identified in the way the framing disguised the political nature of the issue by defining it as a clinical problem. We conclude by discussing how the clinical rationale constrains public participation in decisions about the delivery and organisation of healthcare and restricts the extent to which alternative courses of action can be considered.
authors.affiliation: Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H9SH, United Kingdom. Electronic address: Lorelei.jones@lshtm.ac.uk.
authors.forename: Lorelei
authors.initials: L
authors.lastname: Jones
authors.affiliation: School of Social Policy, Health Services Management Centre, Park House, University of Birmingham, Edgbaston, Birmingham, B15 2RT, United Kingdom. Electronic address: m.exworthy@bham.ac.uk.
authors.forename: Mark
authors.initials: M
authors.lastname: Exworthy
mesh_terms: D003256:Community Participation; D004739:England; D006752:Hospital Planning / Q000458:organization & administration*; D006801:Humans; D057766:Policy; D011050:Policy Making; D011057:Politics; D013222:State Medicine / Q000458:organization & administration*
keywords: Discourse; England; Ethnography; Healthcare policy; NHS; Rhetoric