Psychiatrists and Citizens

1991 ◽  
Vol 159 (1) ◽  
pp. 1-6 ◽  
Author(s):  
J. L. T. Birley
Keyword(s):  
National Health Service ◽  
Health Service ◽  
Community Care ◽  
Medical Profession ◽  
Basic Premise ◽  
The Public ◽  
False Dichotomy ◽  
The Times ◽  
The Relationship ◽  
Lasting Change

During the last two years, the medical profession in Britain has been participating in a public debate – perhaps in a more exposed way than for some time. Eminent Presidents have been writing letters to The Times, and less eminent ones demonstrating in Downing Street. This can all be seen as contributions to the discussion on the state of the National Health Service. But there is, I believe, a wider and in my view a more long-lasting change going on, namely the relationship between the medical profession and the public – the citizens of this country. You may feel that the basic premise is based on a false dichotomy, rather like the sterile debates on community care. Hospitals are part of the community. Doctors are citizens. Yet there is an implicit or explicit contract, social if not financial, between a country's medical profession and its citizens. As we are in the era of negotiating or inventing or specifying contracts, I wanted to consider this.

scholarly journals Knights and Knaves in the English Medical Profession: the Case of Clinical Excellence Awards

2015 ◽  
Vol 45 (1) ◽  
pp. 83-99 ◽  
Author(s):  
MARK EXWORTHY ◽  
PAULA HYDE ◽  
PAMELA MCDONALD-KUHNE
Keyword(s):  
Health Policy ◽  
National Health Service ◽  
Health Service ◽  
Medical Profession ◽  
Clinical Excellence ◽  
Medical Professional ◽  
Policy Makers ◽  
Written Responses ◽  
Private Interests ◽  
The Uk

AbstractWe elaborate Le Grand's thesis of ‘knights and knaves’ in terms of clinical excellence awards (CEAs), the ‘financial bonuses’ which are paid to over half of all English hospital specialists and which can be as much as £75,000 (€92,000) per year in addition to an NHS (National Health Service) salary. Knights are ‘individuals who are motivated to help others for no private reward’ while knaves are ‘self-interested individuals who are motivated to help others only if by doing so they will serve their private interests.’ Doctors (individually and collectively) exhibit both traits but the work of explanation of the inter-relationship between them has remained neglected. Through a textual analysis of written responses to a recent review of CEAs, we examine the ‘knightly’ and ‘knavish’ arguments used by medical professional stakeholders in defending these CEAs. While doctors promote their knightly claims, they are also knavish in shaping the preferences of, and options for, policy-makers. Policy-makers continue to support CEAs but have introduced revised criteria for CEAs, putting pressure on the medical profession to accept reforms. CEAs illustrate the enduring and flexible power of the medical profession in the UK in colonising reforms to their pay, and also the subtle inter-relationship between knights and knaves in health policy.

‘Playing’ Doctors and Nurses? Competing Discourses of Gender, Power and Identity in the British National Health Service

2003 ◽  
Vol 51 (2) ◽  
pp. 218-237 ◽  
Author(s):  
Pauline Leonard
Keyword(s):  
National Health Service ◽  
Health Service ◽  
National Health ◽  
Organizational Sociology ◽  
Personal Qualities ◽  
And Performance ◽  
Feminist Poststructuralist ◽  
The Relationship ◽  
British National Health ◽  
Doctors And Nurses

This paper adopts a feminist poststructuralist approach to demonstrate the ambiguities and complexities which exist in the relationship between work and subject. Recent studies in organizational sociology have argued that the discourses of work, and changing working cultures, have had a powerful effect on the production of subjectivities. New forms of working behaviour have been constructed as desirable, which often draw on personal qualities such as gender. This paper draws on research conducted with doctors and nurses in the British National Health Service to reveal the ambiguities which exist in the ways in which individuals position themselves in relation to these discourses. The discourses of work and organization are constantly mediated through, and destabilised by, the intertextuality that exists with competing discourses such as those of professionalism, gender, home and performance. Although organizational discourses are clearly powerful in the construction and performance of subjectivities, the interplay between discourses means that these are constantly destabilised and undermined.

Accountability for Rationing — Theory into Practice

2005 ◽  
Vol 33 (4) ◽  
pp. 660-668 ◽  
Author(s):  
Christopher Newdick
Keyword(s):  
Health Care ◽  
National Health Service ◽  
Health Service ◽  
National Health ◽  
Health Care Systems ◽  
The Public ◽  
Modern Health Care ◽  
Concept Of Health ◽  
Care Systems ◽  
Health Need

Most now recognize the inevitability of rationing in modern health care systems. The elastic nature of the concept of “health need,” our natural human sympathy for those in distress, the increased range of conditions for which treatment is available, the “greying” of the population; all expand demand for care in ways that exceed the supply of resources to provide it. UK governments, however, have found this truth difficult to present and have not encouraged open and candid public debate about choices in health care. Indeed, successive governments have presented the opposite view, that “if you are ill or injured there will be a national health service there to help; and access to it will be based on need and need alone.” And they have been rightly criticized for misleading the public and then blaming clinical and managerial staffin the National Health Service (NHS) when expectations have been disappointed.

The Beveridge Report and the Implementation of the Welfare State

2018 ◽  
pp. 260-285
Author(s):  
George R. Boyer
Keyword(s):  
National Health Service ◽  
Health Service ◽  
Welfare State ◽  
Social Welfare ◽  
Universal Coverage ◽  
Social Welfare Policy ◽  
Economic Insecurity ◽  
The Public ◽  
Welfare Reforms ◽  
The Welfare State

This chapter explores the story of the 1942 Beveridge Report and the beginnings of the welfare state. The policies proposed by Beveridge and the 1945–48 legislation were logical extensions of government's expanding role in social welfare policy beginning with the Liberal Welfare Reforms. This does not mean that the importance of the postwar legislation should be downplayed. Because of the adoption of the National Health Service, universal coverage, and equality of treatment, Britain after 1948 deserves to be called a welfare state, while Edwardian and interwar Britain do not. Unfortunately, despite the enthusiasm with which the public greeted the welfare state, the postwar policies did not eliminate economic insecurity.

scholarly journals Guardians of public interest: the expectation and experience of non-executive directors in National Health Service commissioning boards in England

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Joy Tweed ◽  
Louise M. Wallace
Keyword(s):  
National Health Service ◽  
Health Service ◽  
National Health ◽  
Public Interest ◽  
Open Systems ◽  
Executive Directors ◽  
Goal Model ◽  
Content Type ◽  
The Public ◽  
Systems Model

PurposeThe purpose of the study is to examine how Non-Executive Directors (NEDs) in the English National Health Service (NHS) commissioning bodies experienced their role and contribution to governance.Design/methodology/approachSemi-structured interviews were conducted with a purposive sample of 31 NEDs of Primary Care Trusts (PCTs) and 8 Clinical Commissioning Group (CCG) NEDs. Framework analysis was applied using a conceptualisation of governance developed by Newman, which has four models of governance: the hierarchy, self-governance, open systems and rational goal model.FindingsNEDs saw themselves as guardians of the public interest. NEDs’ power is a product of the explicit levers set out in the constitution of the board, but also how they choose to use their knowledge and expertise to influence decisions for, as they see it, the public good. They contribute to governance by holding to account executive and professional colleagues, acting largely within the rational goal model. CCG NEDs felt less powerful than in those in PCTs, operating largely in conformance and representational roles, even though government policy appears to be moving towards a more networked, open systems model.Originality/valueThis is the first in-depth study of NEDs in English NHS local commissioning bodies. It is of value in helping to inform how the NED role could be enhanced to make a wider contribution to healthcare leadership as new systems are established in the UK and beyond.

The relationship between academic training and National Health Service practice

BDJ ◽  
1970 ◽  
Vol 129 (6) ◽  
pp. 288-293
Author(s):  
A H Rowe ◽  
R Stubley ◽  
T C White ◽  
C E Wilde
Keyword(s):  
National Health Service ◽  
Health Service ◽  
National Health ◽  
Academic Training ◽  
The Relationship
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