The Government of Health Care and the Politics of Patient Empowerment: New Labour and the NHS Reform Agenda in England

Abstract

This article considers the issue of patient empowerment in the context of New Labour's proposed reforms to the National Health Service (NHS) in England. Through an exploration of some of the key measures in the government's white paper High Quality Care for All, the article argues for a conceptualization of patient empowerment as a political technique of governing. Patient empowerment, it is contended, can no longer be understood solely as a quantitative phenomenon to be balanced within the doctor‐patient relationship. Rather, its deployment by the government as a way of governing health and health care more broadly demands that we consider what political functions—including, importantly, it is argued here, managing the problem of the increasing cost of illness and health care—patient empowerment may be involved in performing. In order to assist in this enquiry, the article draws on some of Michel Foucault's work on the art of governing. It is suggested that his understanding of the neoliberal mode of governing best captures the proposed changes to the NHS and the role patient empowerment plays in their implementation.

The commodification of patient opinion: the digital patient experience economy in the age of big data

“…One is the notion of patient engagement or patient empowerment (often termed patient activation in the USA) that has recently emerged in healthcare policy in many developed societies (Andreassen and Trondsen , Morden et al . , Veitch ). In this concept, ideal patient‐citizens are positioned as taking steps in the interests of preserving and promoting their own good health, including accessing relevant information, monitoring their own health and taking responsibility for managing their medical conditions.…”

“…In this concept, ideal patient‐citizens are positioned as taking steps in the interests of preserving and promoting their own good health, including accessing relevant information, monitoring their own health and taking responsibility for managing their medical conditions. These actions are promoted as having the potential to relieve the financial burden on the healthcare system in the current era of austerity (De Vogli , Veitch ).…”

Analysis of the Recomposition of Norms and Representations in the Field of Psychiatry and Mental Health in the Age of Electronic Mental Health: Qualitative Study (Preprint)

“…These discourses position patients as ready to actively engage in their own health care and promote their own health, which may be seen as an attempt to shift the burden of responsibility from the State to the individual [29]. In the discourse of the "digitally engaged" patient, empowerment becomes a set of obligations [30]. There is then a paradigm shift from "my health is my doctor's responsibility" to "my health is my responsibility and I have the tools to manage it" [33].…”

“…In the discourse of these three groups, patients seem to be considered passive targets who are supposed to comply with the prescriptions of health professionals who possess the legitimate knowledge of their condition and the best way to treat it [29][30][31].…”

Planning for an (un)certain future: Choice within English end-of-life care

“…This shift reflects the 'subtle and cumulative manner' in which consumerism and neoliberal values have become part of healthcare policy (Greener, 2009:309). In this new model, patients are 'users' of the NHS rather than passive receipts of care, empowered through their choice (Veitch, 2010), and in turn healthcare professionals and policy-makers shape the ways in which services are accessed and implemented.…”