the research

Several countries are reorganising at a large-scale the way health services are delivered to tackle the challenge of meeting rising needs for healthcare with decreased resources. The type of large-scale changes to health services might include for example, relocation of hospital services in the community, downgrading or closing down some hospital services, relocating health services or centralising them. 

Some countries have pushed for patients and members of the public to be included in decision-making regarding major health service changes (in the UK for example it is a legal requirement). This is usually referred to Patient and Public Involvement or PPI (in the UK).


This research aims to develop the way people are involved in decision-making in the context of large-scale changes to health services, to find out “what works” and provide evidence to make future involvement more meaningful.

Through a review of the literature and two case studies, we will be looking at how this involvement is conceptualised in this context, how patient and public involvement is carried out in practice and what kind of PPI has on the decision-making process in plans to reconfigure health services at a large-scale. 

This research is conducted in collaboration with the CLAHRC North Thames' Research Advisory Panel, made up of patients, carers and members of the public. 

Nehla Djellouli

UCL Department of Applied Health Research

Pr. Sandy Oliver

UCL Institute of Education

Dr. Helen Barratt

UCL Department of Applied Health Research

Dr. Lorelei Jones

UCL Department of Applied Health Research

Dr. Angus Ramsay

UCL Department of Applied Health Research

Steven Towndrow

CLAHRC North Thames





Nehla Djellouli is a Health Foundation Improvement PhD fellow based at University College London.

She is working with a supervision committee with extensive research background in large-scale change and/or patient and public involvement.


and funding

This research is undertaken at University College London (UCL); is funded by The Health Foundation; and supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North Thames at Barts Health NHS Trust.

The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.