Fugitive Coproduction: Making and Unmaking Hospitals in Scotland’s National Health Service

Hospital closures are one of the most politicised policy issues in the UK, frequently escalating from local administrative decisions to the national political stage. Contentious proposals have revealed tensions in collaboratively-framed approaches to citizen participation in health, and prompted disenchantment from both campaigners and managers. This paper reports three qualitative case studies of change projects around Scottish hospitals. By focusing on the social context of such projects, I shed light on how responses to management proposals emerge from within everyday, informal practices of community care and support for hospitals. Informed by Cooper’s (2016) concept of ‘prefigurative publics’, Griggs et al’s (2014) ‘practices of freedom’ and De Certeau’s (1984) ‘everyday creativity’ I elaborate a concept of ‘fugitive coproduction’, whereby informal community collaboration with local staff creates, sustains and shapes the form and function of small hospitals. Studying how top-down change proposals intervene into these practices reveals the fragility of everyday forms of participation. Managerial drives towards standardisation and centralisation prove difficult to resist, and fugitive coproduction drifts towards either detachment, or agonistic, rather than collaborative engagament. I conclude with suggestions for how we can democratise healthcare governance in ways which reorient it towards respect for existing local knowledge(s) and everyday healthcare practices. Cooper, D. (2016). Transformative state publics. New Political Science, 38(3), 315–334. https://doi.org/10.1080/07393148.2016.1189028 de Certeau, M. (1984). The practice of everyday life. Berkeley: University of California Press. Wagenaar, H. (2014). The Agonistic Experience: Informality, Hegemony and the Prospects for Democratic Governance. In S. Griggs, A. J. Norval, & H. Wagenaar (Eds.), Practices of Freedom: decentred governance, conflict and democratic participation. Cambridge, England ; New York: Cambridge University Press.