Governmentality and risk: setting priorities in the new NHS

Joyce, Paul

doi:10.1111/1467-9566.00267

Cited by 47 publications

(37 citation statements)

References 16 publications

(10 reference statements)

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“…Webster, in his political history of the NHS, asserts that the level of funding made available to the NHS is determined by the state of the economy rather than objective merit (Webster, 2002). The NHS therefore becomes an instrument for rationing resources rather than meeting needs (Klein, 2010, Joyce, 2001. How much money to allocated to the NHS is a political choice, influenced by wider economic circumstances and policies than purely the healthcare needs of the population.…”

Section: Continual Concerns About Costsmentioning

confidence: 99%

New models of care: the policy discourse of integrated care

Hughes¹

2017

PPP

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New models of care are being pursued throughout England to balance increasing demand for improved health and social care services against reducing public expenditure. A dominant discourse has emerged about the value of community-based integrated care, despite failures of integrated care programmes to consistently demonstrate reductions in hospital admissions. Discourse analysis of integrated care policy establishes how issues of aging, hospital admissions and fragmentation are problematised, and how solutions of integrated care are made possible by the argumentative structures of the policy. These findings are discussed in relation to historical and political accounts of English health policy to identify the discursive conditions that contribute to making this discourse possible. It is argued that the policy of integrated care works as a discourse to manage tensions associated with health and social care funding, rather than as an intervention that can achieve a reduction in hospital admissions.Keywords: Interpretative policy analysis, discourse analysis, integrated health and social care, emergency hospital admissions, chronic health conditions, older people.Interpretative policy analysis, discourse analysis, integrated health and social care, emergency hospital admissions, chronic health conditions, older people Integrated care is a long-standing policy response by successive UK governments to concerns about the cost and complexity of the NHS and social services. The policy to integrate health and social care is intended to address inter-related financial, organisational and patient-centred concerns. Policies of integration and joining-up of services, budgets and government departments are neither limited to health policy, nor are new. A case study of the successful integration of health and social care for older people in Torbay (Thistlethwaite, 2011) refers to the Central Policy Review Staff's Joint Framework for Social Policies produced in 1975 to demonstrate the longevity of an approach that endorses inter-agency working. Similarly to efforts to integrate care, the Joint Framework seeks to constrain expenditure on social programmes and improve coordination between services, as well as conducting better analysis of complex problems (HMSO, 1975). Concerns relating to the high proportion of public sector resources people with complex needs consume as they receive a multiplicity of interventions from

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Section: Continual Concerns About Costsmentioning

confidence: 99%

New models of care: the policy discourse of integrated care

Hughes¹

2017

PPP

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“…This shift is reflected in a rapid increase in the use of the term 'risk' in medical journal articles (2). Joyce (3) goes further in describing a new twoway form of health agency, whereby the role of health agencies is limited to providing individuals with resources to combat risks that they cannot reasonably be expected to avoid through self-governed aspects of lifestyle. This is part of what Beck (4) and others refer to as 'reflexive modernization', the creation of a new social order based on the monitoring of self and others through the burgeoning availability of information.…”

Section: Introductionmentioning

confidence: 99%

Perspectives on risk for older people with dementia in extra care housing in the UK: Findings from a longitudinal study

Evans¹,

Means²

2006

International Journal on Disability and Human Development

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This paper discusses the findings from a qualitative, longitudinal study into the suitability of extra care housing for people with dementia. Particular attention is paid to the perceptions and responses of care professionals to risk management in relation to the specific needs of people with dementia Extra care housing is widely promoted as a popular option for older people with dementia, largely because it can maximize independence and offer a homely alternative to other forms of housing with care. At the same time, older people with dementia are often perceived as one of society's most vulnerable and 'at risk' groups who are in particular need of protection. This paper explores the potential paradox between managing risk and at the same time supporting independence in the extra care housing setting. Conclusions drawn suggest that care staff adopt a guarded approach to managing risk, shaped by social and organizational preoccupations and policies that overemphasize risk elimination. This leads to the undermining of attempts to support independence and choice for tenants with dementia. The paper recommends the development of comprehensive risk-assessment processes and strategies for supporting behaviors that staff experience as anxiety provoking and difficult to manage. These developments should be based on a person-centered approach to identifying the needs, preferences, and values of individuals to maintain safety while promoting independence.

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“…integrated into routine decision-making through mechanisms such as non-availability, primary care gate-keeping and waiting lists (Heginbotham quoted in Robert) rather than explicit (Coast, 1997). However, since the 1980s the development of the purchaser/provider split in health care (requiring purchasers to be explicit about what services to commission), together with the trend towards more open and accountable forms of government, has prompted the development of more explicit systems of priority setting (Joyce, 2001;Light & Hughes, 2001).…”

Section: Priority Setting In Primary Carementioning

confidence: 99%

“…But he argues, the particular nature of this health economics discourse is such that it simultaneously 'presents a form of explicit rationing as a reasoned and ethical response to the contemporary problem of maximising the benefits of health care within a state-funded and predominantly state-provided health care system'. (Joyce, 2001) Joyce's analysis points to the inherent tension between economic and welfare models of health care and how PCTs are positioned trying to serve the duality of market-oriented values of the NHS and its original aims and values relating services to needs and ensuring universal access.…”

Section: '…What the Forum Agreed When It Was Founded And That The Bomentioning

confidence: 99%

Rhetoric, Evidence and Policymaking: a Case Study of Priority Setting in Primary Care*

Russell¹,

Greenhalgh²

2011

Evidence, Inference and Enquiry

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This chapter describes a study undertaken as part of the UCL Evidence programme to explore how policymakers talk about and reason with evidence. Specifically, researchers were interested in the micro-processes of deliberation and meaning-making practices of a group of people charged with prioritising health care in an NHS Primary Care Trust in the UK. The chapter describes how the research study brought together ideas from rhetorical theory and methods of discourse analysis to develop an innovative approach to exploring how evidence is constituted at the micro-level of social interaction and communication. It presents empirical data to illuminate the representation and meaning of evidence within one particular policymaking forum, and to highlight contrasting constructions of the policymaking process.

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Governmentality and risk: setting priorities in the new NHS

Cited by 47 publications

References 16 publications

New models of care: the policy discourse of integrated care

New models of care: the policy discourse of integrated care

Perspectives on risk for older people with dementia in extra care housing in the UK: Findings from a longitudinal study

Rhetoric, Evidence and Policymaking: a Case Study of Priority Setting in Primary Care*

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