A death in the family: Citizens' experiences of changing healthcare commissioning practices in South East England

Rebecca Graber, Anna Zoli, Carl Walker, Kepa Artaraz

Research output: Contribution to journalArticlepeer-review


The Brighton Citizens Health Services Survey was an academic activism project to identify and understand citizens' perceptions of and responses to healthcare commissioning practices. Significant legislated changes to the National Health System (NHS) across England have increased marketisation in healthcare provision, yet little research has explored the psychological dimensions of this shifting context and its community impact. Taking a community psychological perspective to social policy, we aimed to understand lay citizens' lived experience of changes in healthcare commissioning and provision. Thematic analysis of 379 free‐text responses yielded two thematic clusters. Cluster 1 describes the lived experience of citizens considering reforms to the NHS, depicting grief, mortality and fear in uncertainty. Cluster 2 explores where these affective responses may derive from by detailing conceptualisations of the NHS in the lived experience, describing how the NHS was experienced as a complex and embodied phenomenological object. Findings suggest people relate affectively to local commissioning practices, feeling a sense of loss when facing the degradation of ‘their’ NHS. We argue that an affective relational perspective centres important questions of silencing, voice‐giving, meaningful engagement and ways of knowing that in turn impact the landscape of community health.
Original languageEnglish
Pages (from-to)603-615
Number of pages13
JournalJournal of Community and Applied Social Psychology
Issue number6
Publication statusPublished - 19 May 2020

Bibliographical note

This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.


  • National Health System
  • healthcare policy
  • thematic analysis
  • lived experience
  • empowerment
  • community health
  • affect
  • marketisation
  • qualitative analysis
  • academic activism
  • service provision


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