Factors that influence the way local communities respond to consultation processes about major service change: A qualitative study

•In England, service change proposals often face public opposition.•We examined the public response to a consultation process about service reorganisation.•The behaviour of key decision-makers led the public to mistrust the process.•This was compounded by the complexity of the consultation methods.•Future consultations should acknowledge public concerns about proposals.

ObjectivesIn England, proposed service changes such as Emergency Department closures typically face local opposition. Consequently, public consultation exercises often involve protracted, hostile debates. This study examined a process aimed at engaging a community in decision-making about service reconfiguration, and the public response to this process.MethodsA documentary analysis was conducted to map consultation methods used in an urban area of England where plans to consolidate hospital services on fewer sites were under discussion. In-depth interviews (n = 20) were conducted with parents, older people, and patient representatives. The analysis combined inductive and deductive approaches, informed by risk communication theories.ResultsThe commissioners provided a large volume of information about the changes, alongside a programme of public events. However, the complexity of the process, together with what members of the public perceived to be the commissioners' dismissal of their concerns, led the community to question their motivation. This was compounded by a widespread perception that the proposals were financially driven.DiscussionGovernment policy emphasises the importance of clinical leadership and 'evidence' in public consultation. However, an engagement process based on this approach fuelled hostility to the proposals. Policymakers should not assume communities can be persuaded to accommodate service change which may result in reduced access to care.