This chapter focuses on an ethnographic analysis of Poundbury, a 400-acre urban extension to the town of Dorchester in Dorset, England, built on Duchy of Cornwall land using the architectural principles set out by Prince Charles in his book A Vision of Britain (1989). Charles’s vision fundamentally rejects modernism, and Poundbury regenerates conservative, pastoral and neoclassical architectural styles. However, the chapter argues that Charles’s interest in town planning is distinctly politicised, and he brazenly links architectural trends to social and cultural figurations. Indeed, his vision of Britain seems to be concerned not only with the technicalities of architecture but also with the management of the citizens populating it. The chapter title, a play on Marie Antoinette’s (in)famous saying ‘let them eat cake’, illustrates the ways in which Poundbury (re)creates Charles’s version of a fantasy past mired by privilege. Using ethnographic data from my visit to Poundbury in July 2017, this chapter argues that the town stages a conservative, nostalgic understanding of monarchy based on relations of feudalism, imperialism, colonialism, pastoralism, pre-industrialisation, anti-urbanisation and classed, raced and gendered hierarchies. Simultaneously, Poundbury demonstrates how the Firm engages with capitalist wealth creation, as the Duchy of Cornwall is described in terms associated with corporate capital, particularly rentier capitalism. Charles and Poundbury can be interpreted as a microcosm of the Firm as described in this book: an anachronistic institution utilising contemporary media technologies, socio-political shifts and forms of capital accumulation; yet not willing to forgo historical privileges.
This chapter focuses on Meghan Markle’s introduction into the Firm in 2016, through to her and Prince Harry’s ‘resignation’ in 2020. Media and public commentary of Harry and Meghan’s wedding in 2018 seemed to position it as a feminist, post-racial, meritocratic utopia, as Meghan’s identity as a biracial, divorced, self-identified feminist American actor with a working-class background was seen to diversify the monarchy and illustrate its progressive values. If, as this book argues, royal figures serve particular purposes to reproduce the institution, this chapter reads representations of Meghan as a form of ‘diversity capital’, extending and diversifying the Firm’s markets. It discusses Meghan in terms of the ‘post-racial’, and how Meghan’s racialised identity is absorbed into ideologies about both localised progress within the Firm and inter/national multiculturalism. I expose these narratives as false, due to the Firm’s own histories of inequality and oppression, the current global context, and because Meghan’s initial absorption into the Firm was dependent upon her fitting white, upper-/middle-class norms of respectability. Using the colloquial reference to Harry and Meghan’s resignation as ‘Megxit’, a play on ‘Brexit’, I argue that public and media responses to Meghan are entangled in wider socio-political debates about race, nation, imperialism and nostalgia. Representations of Meghan confront the Firm with longer, complex, intersectional histories of racism, (post-)colonialism, voice(lessness), servitude, media and celebrity, genealogy, gender, feminism, capital accumulation, social injustice and inequalities. Rather than resolving royal histories through ‘progressive values’, representations of Meghan seem to have merely pulled these inequalities into view.
This chapter draws together the various themes in this book. It does so by exploring Prince Harry and Meghan Markle’s emerging roles as ‘post-royals’, and how representations of the couple’s ‘post-royal life’ reveal ongoing tensions in the Firm. From the interrelations with commercialisation and corporate capital; the complexities of the media–monarchy relationship; associations with ‘the elites’; and notions of ‘value’, the chapter argues that Harry and Meghan’s exit from the Firm makes temporarily (and partly) visible the infrastructures, systems and processes through which monarchy is reproduced. That is, their exit disturbs the careful balance between visibility and invisibility in royal representations, and in so doing it threatens to rupture the ideologies that the monarchy relies upon. This moment of their exit holds the potential of being able to throw a more critical spotlight on relations that are usually kept masked. The postscript then reviews the book as a whole by arguing that the case studies explored have shown how the British monarchy invites us to think about wider issues of class, power, inequality, media culture, wealth, capital(ism), ideology, democracy, warfare, national identity, citizenship, belonging, land, gender, race, (post)colonialism and (post)imperialism. It concludes by arguing that monarchy matters because we cannot talk about inequalities in Britain, historically and in the present, without talking about the monarchy.
National identities, sovereignty and the body politic
This chapter explores the relationship between the monarch and national identities. On 20 September 2014, in the wake of the Scottish Independence Referendum, the British broadsheet the Daily Telegraph’s front page was dominated by a photograph of Queen Elizabeth II in the grounds of her Balmoral estate in the Scottish Highlands, under the headline ‘Queen’s pledge to help reunite the Kingdom’. The photograph, entitled Queen of Scots, Sovereign of the Most Ancient and Most Noble Order of the Thistle and the Chief of Chiefs, was taken as an official portrait of the monarch by Julian Calder. This chapter analyses the Daily Telegraph’s use of this image to explore how the Queen’s body becomes a site of symbolic struggle over particular discourses of national identities and citizenship during the Scottish Independence Referendum, embodying complex interrelations of ‘Britishness’, ‘Englishness’ and ‘Scottishness’. The historical context of the photograph is unpacked to consider the union of Scotland and England, the concept of the body politic, the figure of Leviathan and the relationship between the monarchy and the Highlands, in order to expose the meaning this gives to its specific use in the Daily Telegraph, and what this reveals about the infrastructures and systems of monarchy. This chapter presents the use of Queen of Scots by the Daily Telegraph as a moment when British hegemony is temporarily fractured by the independence vote, and representations of the Queen shift from banal to purposeful, regulated symbols of authority and historical legitimacy.
The British royal family has experienced a resurgence in public interest in recent years. During the same period, global inequalities have expanded, leaving huge chasms of wealth inequality between ‘the elites’ and ‘the rest’. Yet, the monarchy is mostly absent from conversations about contemporary inequalities, dismissed as an archaic and irrelevant institution. This is the only book to argue that we cannot talk about inequalities in Britain today without talking about the monarchy. Running the Family Firm is about the contemporary British monarchy (1953 to present). It argues that media representations (of, for example, royal ceremonies or royal babies) are the ‘frontstage’ of monarchy: this is what we usually see. Meanwhile, ‘backstage’, there are a host of political-economic infrastructures that reproduce the institution: this is what we don’t typically see. This book pulls back the stage curtain of monarchy and exposes what is usually hidden: how it looks versus how it makes its money and power. Drawing on case studies of key royal figures – the Queen, Prince Charles, Prince Harry, Kate Middleton and Meghan Markle – the book argues that media representations of the royal family are carefully stage-managed to ‘produce consent’ for monarchy in the public imagination. That is, the corporate power of monarchy (the Firm) is disguised through media representations of the royal family (the Family Firm). In so doing, the book probes conventional understandings of monarchy, and offers a unique and radical answer to the question ‘why does monarchy matter?’
This chapter focuses on the ‘frontstage’ of monarchy and regimes of visibility in media culture. The royal image has always been mediated, and royal history is a history of representations in different forms. Queen Elizabeth II has reigned over rapid technological expansion and socio-political change. From the emergence of television, through tabloid newspapers and paparazzi, to social media and citizen journalism (processes related to democratisation), the Firm has consistently faced new challenges in public engagement with monarchy. We now, arguably, have more access to monarchy than ever before. This chapter is interested in the effects of this access. The chapter maps representations of monarchy from the Queen’s coronation in 1953, through other notable media/monarchy moments, including the Royal Family documentary (1969), It’s a Royal Knockout (1987), Princess Margaret’s and Princess Diana’s engagement with paparazzi cultures, the Netflix drama The Crown (2016–) and the development of royal social media accounts. What differences do particular media forms make to the (re)production of monarchy? And what challenges might these new media forms pose to royal representation? For example, how does royal representation play out when new media cultures offer increasing ‘intimacy’ with royalty, from live television to direct, public contact on social media? The chapter argues that the visibility of royal representations is carefully balanced with a paradoxical but co-dependent invisibility. The Firm cannot be too visible to public scrutiny, or it loses its mystique and its operations are unmasked. Therefore, visibility has to be tightly stage-managed and controlled.
The chapter is prefaced by a brief summary of the policy background. Urgent and emergency care is, by its very nature, different from planned care. The diagnosis is not always easy to nail down, the patient might be in considerable pain, distress or shock, and the trajectory of care can be uncertain. Cancer care raises issues of its own. Emergency, planned and cancer care all have waiting time targets in the NHS in England. These were successful in significantly reducing long waits. However, the system was already coming under increasing pressure before the COVID-19 pandemic, with performance deteriorating and an inexorable rise in waiting times. Coordination of care with GPs and other primary care services remains an issue. This chapter contains four stories in which hospital was a significant site for care. The stories cover planned care, emergency care and a story about cancer. The first story is about what happened to Jill following an accident involving her knee, including her follow-up care. The second is about a planned operation to remove Andrea’s gallbladder. The third concerns Lucy’s experience when she was hospitalised with sepsis. The final story concerns Shona’s journey to recovery from breast cancer, and what helped along the way. We invite readers to assess how these narratives compare with the four characteristics of patient-centred care outlined in Chapter 1. As with the other chapters, we pose questions arising from these stories, to simulate thinking and reflection. We have divided these into questions of immediate or operational concern, and those which are more strategic or policy-related.
The chapter is prefaced by a brief summary of the policy background. A number of child health outcomes in the UK lag behind those in other comparable countries. Children from deprived areas or with a black or other minority ethnic family background are twice as likely to be obese and this inequality is widening. Children with complex needs and disabilities are often under-served. Four contrasting stories are presented here. Dan is a normally healthy teenager who was hospitalised with an acute bacterial infection from which he has now recovered. His father Jonathan tells the story from his perspective. Dan’s illness took place during the COVID-19 pandemic. Jim was a severely disabled young man from birth until his death aged 36. His parents Justin and Lucinda cover his entire life – and death – in their account. In a story fragment, Eve remembers as a child how she came to be diagnosed with type 1 diabetes. Finally, Eileen tells of her experiences as a carer for a teenage son with a diagnosis of scoliosis, including the length of time taken to get an appropriate tertiary referral. She found a support group was helpful. We invite readers to assess how these narratives compare with the four characteristics of patient-centred care outlined in Chapter 1. As with the other chapters, we pose questions arising from these stories, to simulate thinking and reflection. We have divided these into questions of immediate or operational concern, and those which are more strategic or policy-related.
In this concluding chapter, we examine how far William Osler’s injunction – to just listen to the patient – is heeded in today’s NHS. We assess the value of gathering stories in this way as a contribution to truly listening to patients and their families. We reflect on the extent to which the spirit of the NHS Constitution is being upheld, especially in relation to whom the NHS belongs. From the stories we identify five dimensions to care which is organised around patients: kindness, attentiveness, empowerment, organisational competence and professional competence. We compare these themes with the case and the evidence for patient-centred care outlined in Chapter 1. We consider what the stories tell us about the things that patients value, the extent to which these things are put into practice, and what the obstacles are. We reflect on the five themes as the basis for a call to action for improvement. We discuss vital questions of context: in particular, straitened funding and workforce shortages in the NHS, and the experiences of COVID-19. Finally we touch on future trends, for example the rise of digital healthcare, and consider the implications for better organising care around patients.
We explain what we mean by organising care around patients and our alternative term patient-centred care. We set out the key characteristics of patient-centred care. These are summarised as: understanding and valuing what matters to patients; seeing the whole person; respecting people’s rights and autonomy; and being customer focussed. We go on to provide a brief history of developments in patient-centred care, in policy, attitudes and practice, comparing the record and performance of the NHS in England with other countries. In light of this history, we review whether and to what extent the NHS can be viewed as patient-centred and the obstacles to further progress. Our approach to storytelling as a means of eliciting important truths about patient-centred care is outlined. We provide information about how we sourced the storytellers, the ethical and methodological issues we encountered, and what we learned from the process of listening to the stories. Finally, we summarise the structure of the rest of the book and suggest how the reader might engage with and learn from the stories it contains.