As the financial challenges facing the NHS and social care bite, we are likely to hear more talk about the need to shut down wards, social care institutions, and even hospitals. And people won't exactly welcome these discussions. For public service leaders and politicians, it will pose huge challenges.
Why are these closures increasingly on the agenda? The short answer is that the current model for funding NHS services and social care is unsustainable - there is insufficient money available to pay for the growing level of need. We are hearing talk of closing hospital wards and social care institutions, because to make ends meet we have to have fewer high cost, bed-based institutions and move towards more community-based and preventative care.
However, sometimes it may be for the best that some wards are closed or care facilities are shut. Patients will tell you, views which are corroborated by evidence, that hospitals are not places where people should stay too long, especially if they are frail. Perhaps there are better, community-based, ways to support these people. And many institutions do not provide the quality of care that is needed anymore or even care that is safe, as we have seen with care for people with learning disabilities for example.
So some closures may be necessary, with the strong caveat that any closure should be counter-balanced by increased investment elsewhere in the community, for instance, into better home care, end of life or intermediate care.
However, commissioners and managers can struggle to win community and political backing for proposals of this nature, and to effectively make the 'case for change'. Sometimes this is down to poor communications, but more often it is because the public are not involved early enough in decisions. At SCIE we believe that if you treat patients, service users and citizens as equals, and work with them to build solid proposals for change, then not only are the plans more likely to win support, they are also more likely to lead to better services. But if you leave them out of the loop, patronise them, or involve them too late, then there is a high probability that the whole exercise will run into difficulty.
There is much to learn from other studies about how to communicate difficult changes effectively and engage people meaningfully. The importance of engaging local residents, organisations, politicians and patient representatives in decisions is often emphasised.
At SCIE we go further than this by saying that plans for difficult changes should be co-produced with citizens, so that they reflect the needs and aspirations of service users.
Over the coming years, difficult decisions about the future of health and care services will need to be made. It is vital is that the public are not just powerless bystanders in this process, but are active participants in any plans to reshape health and care provision.