Background The Health Service Executive (HSE) has embarked on a series of regional system re-designs to radically change the organisation of urgent and emergency care services in Ireland, at a time when budgets and staff levels have been substantially reduced and there is growing awareness of problems with quality and safety. The first priority of this initiative is to “develop integrated services across all stages of the care journey” with the goal of increasing efficiency and improving performance. Major changes initiated so far include the reconfiguration of acute hospital services and the introduction of ambulance bypass protocols. Our aim was to examine the consultation process in re-designing urgent and emergency care services, with a specific focus on trade-offs and the role of evidence.

Methods Two qualitative methods were employed. A documentary analysis was conducted of current national and regional policy documents. In addition, approximately 200 semi-structured interviews were conducted with key providers of urgent and emergency care at a national and local level, along with health service campaigners, local politicians and media, across eight geographical regions covering the whole of the country. Information from the documentary analysis and the interviews was synthesised using NVivo software. Yin’s multiple case study methodology was used to collate information at a regional level. Findings from all eight regions were compared and contrasted.

Results Preliminary findings suggest that policy documents considered contextual evidence and local consultation. However, data from the interviews identified mixed levels of stakeholder involvement in the consultation process across the eight regions. Moreover, there was a perceived hierarchy of policy drivers behind the system re-design at a regional level and a concern over the resource implications behind the trade-offs that arose from the changes to acute hospital services.

Conclusion Planning change for urgent and emergency services is a complex process, guided by local as well as national stakeholder considerations, resources and motivations. The results of this study shed a more transparent light on national and regional healthcare system planning for urgent and emergency care to date. Policy makers need to consider stakeholder perceptions of proposed changes. It is important that there is local engagement from the outset and that this is followed through to secure support for implementation across different regional contexts.