The individual and primary care: Service user, reflexive choice maker and collective actor

Abstract

AB S T R A C T Many health policy interventions re ect implicit assumptions of cause and effect, contestable values and partial rationales-particularly in healthcare systems based on notions of entitlement and obligation. The objective-oriented nature of policies and the potential cacophony of narratives that underpin such interventions are not, though, explicable solely in terms of the achievement of particular ends envisaged by different policy actors. These ends re ect, often opaquely, notions of responsibilities, rights and ideas of social justice-issues central to perennial debates around 'welfare citizenship'. But, just as notions of entitlement, rights and obligations are open to challenge and change, so too are discourses around the meaning and implications of far more fundamental phenomena: the individual and individualism. In this paper we focus on the evolution of primary healthcare in the UK in order to demonstrate that changing ideas of the 'individual' and individualism are central to the implicit and explicit narratives and parameters that underpin the formulation of health policy. The individual and individualism are seen as malleable phenomena that can act as the focus for renegotiations of the relationship between systems of healthcare and the patient-citizen at a personal and collective level. Contestable and contested notions of the individual are thus, at one level, fundamental to the meanings and thus the ultimate nature and outcome of health policy interventions.

Local Participatory Democracy in Britain's Health Service: Innovation or Fragmentation of a Universal Citizenship?

“…Conversely, there appears to have been a proliferation of user and advocacy movements in recent decades that focus on very specific issues. Examples include campaigns around women's reproductive rights, the treatment and status of people with mental health problems and the rights of disabled people (Tovey et al 2001). These movements have typically framed debates around health care in terms that move beyond entitlement to medical treatment by challenging ideas, practices and legislation that are seen to limit the right of certain groups to “live the life of a civilised being according to the standards prevailing in … society” (Marshall 1963: 74).…”

Health Policy and the Politics of Evidence

“…For a large part of the postwar period sociological approaches to expertise suggested that the development of a highly complex state administration has facilitated the rise of interests based upon the possession of technological, economic and bureaucratic expertise—an expertise seen as necessary, if not broadly beneficial, to society as a whole. But the supposed rise of a far more atomized and fragmented society, together with greater disenchantment with comprehensive state intervention, has, it is often claimed, been reflected in an increasing willingness on the part of interest groups (and politicians) to challenge such authority (Pickstone 2000; Tovey et al 2001). This challenge can manifest itself in direct conflict or, instead, stimulate reforms in the governance or oversight of particular policy domains to render them more inclusive or transparent (Chandler 2001).…”