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Over the last fifty years, British patients have been made into consumers. This book considers how and why the figure of the patient-consumer was brought into being, paying particular attention to the role played by patient organisations. Making the Patient-Consumer explores the development of patient-consumerism from the 1960s to 2010 in relation to seven key areas. Patient autonomy, representation, complaint, rights, information, voice and choice were all central to the making of the patient-consumer. These concepts were used initially by patient organisations to construct the figure of the patient-consumer, but by the 1990s the government had taken over as the main actor shaping ideas about patient consumerism. Making the Patient-Consumer is the first empirical, historical account of a fundamental shift in modern British health policy and practice. The book will be of use to historians, public policy analysts and all those attempting to better understand the nature of contemporary healthcare.
This chapter explores the complex relationship between ‘the public’ and the ‘self’ in post-war British public health by tracing the development of alcohol health education during the 1970s and 1980s. Health education was put forward during these decades as a way to encourage individuals to moderate their alcohol consumption – to behave responsibly by becoming ‘sensible drinkers’. Yet, at the same time, considerable scepticism was expressed (even by those involved in the campaigns) about the ability of health education to change behaviour. Other approaches, such as increasing the price of alcohol, were suggested as ways of reducing alcohol consumption at the population level. At issue, however, was not simply the capacity for individuals to achieve healthy balance. Policy-makers weighed numerous social, economic and political concerns alongside health outcomes. A growing focus on moderation may have expanded public health’s target population, but a reliance on health education and nebulous concepts like the ‘sensible drinker’ also reflected the ways that disciplinary power could be counterbalanced by broader policy concerns.
The notion of consumerism in health is often seen as controversial. Many regard consumerism, with an emphasis on individual choice, markets, and profit, as antithetical to the universalist, collectivist, free-at-the-point-of-use National Health Service. Yet there were many different understandings of consumerism in British healthcare during the 1980s. This chapter examines how consumerist ideas were manifested in public health policy and practice, and especially the impact that they had on health education and health promotion. Consumerism represented a double-edged sword for health educators. Behaviours linked to consumerism, and especially the consumption of certain products, such as tobacco and alcohol, were linked to significant public health problems. Curbing such behaviours by encouraging people towards practices of ‘sensible’ consumption offered a potential way to address to these issues. Consumption was thus both a problem and a solution. With this in mind, the chapter analyses two health education campaigns from the 1980s, one to promote ‘sensible’ drinking and the other designed to deter children from smoking. Both used consumerist tropes, especially the notion of choice. Looking at how this language of choice was received by the public indicates that consumerist approaches were not hegemonic. Indeed, if health was a choice, it is clear that the public could choose not to choose it.
This chapter analyses the different kinds of information generated by patient-consumer groups and the uses to which they were put. The first section of this chapter considers the purpose and meaning of information for patient-consumer organisations during the late 1980s and early 1990s. The second section of this chapter goes on to look at the activities of patient-consumer organisations both in terms of facilitating access to existing sources of information and in generating new kinds of information. The final section of this chapter assesses the long-running campaign by patient-consumer groups and others to introduce legislation that would allow patients to see their medical records. This chapter suggests that through their information-related activities, patient-consumer organisations were aiming to do more than create a ‘super-patient’ akin to the ‘super-shopper’: they wanted to promote collective as well as individual empowerment by helping patient-consumers as a whole to become better informed.
This chapter explores the ways in which patient organisations began to re-position the patient through emerging notions of health consumerism and patient autonomy in Britain. It does so by focusing on four areas. Firstly, it considers the place of autonomy within concepts of bioethics and consumerism as they developed during the 1960s and 1970s. Secondly, the chapter attempts to uncover what patients themselves thought of health care in this period. Thirdly, the chapter examines the work of the National Association for the Welfare of Children in Hospital (NAWCH) and their attempts to get hospitals to permit the unrestricted visiting of children in hospital. Finally, the chapter studies the activities of the Patients Association (PA) and their campaign to establish a right for patients to consent to participate in the teaching of medical students.
This chapter examines the development of patient complaints in the 1970s and early 1980s. It centres on three areas. The first concerns the activities of patient-consumer organisations around complaining. Groups such as the Patients Association and the CHCs played an important role in informing patients about complaints procedures and assisting them to make complaints, as well as using patient complaints as a tool to point to wider failings within the health service. Secondly, patient-consumer organisations also lobbied for the reform of complaints procedures. Complaints mechanisms in hospitals and family practitioner services were re-examined and reinforced, partly as a result of consumer group pressure. Finally, the capacity of the patient to complain was further strengthened by the introduction of the Health Service Commissioner, or the Ombudsman, in 1973. Complaint, this chapter will suggest, was an area of disputed territory that brought patient-consumers into direct conflict with the medical profession. For doctors, patient complaints were a threat to their ability to practise as they saw fit and posed a fundamental challenge to their power and authority. Yet, for patient-consumer organisations, complaint was both a vital consumer right and an opportunity to improve services for individuals and the wider population.
The aim of this chapter is to explore the broader meaning and application of rights talk in connection with health from the 1970s to the early 1990s. It begins by considering the various ways in which the language of rights was used in the context of health. The chapter then moves on to consider the application of such language, through attempts to introduce a Rights of Patients Bill. A selection of patient’s rights guides and charters are also analysed, and the chapter suggests that it was unclear whether these were addressed to the individual patient, or all patients. A more collective understanding of patients’ rights was exhibited by organisations such as the Community Rights Project, which aimed to enhance democracy and accountability within the NHS through the language of rights. The establishment of Department of Health’s The Patient’s Charter in 1991, however, undermined such collective conceptualisations of rights. Addressed to the individual patient rather than all patients, The Patient’s Charter was indicative not only of an individualised approach to patients’ rights, but of a wider shift in the conceptualisation of the patient as consumer and who could speak for this figure.
This chapter will explore how it was that patient choice came to occupy a central position within health policy from the late 1990s onwards. Beginning with an exploration of the notion of choice in health prior to this period, the chapter will then go on to chart the rise of choice as a central objective of health policy under the New Labour government. The chapter suggests that although the notion of choice was present in earlier formulations of patient consumerism, the meaning and relative importance ascribed to choice changed in the late 1990s and early 2000s. A crucial shift took place that involved a move away from choice as something that was of importance to patients collectively and towards a focus on choice as an individual matter. Such a focus on the patient rather than patients undermined the position of patient-consumer organisations that aimed to represent patients as a group. Speaking for patients was more difficult when the individual was thought to be best at determining his or her own needs.
The Introduction sets the making of the patient-consumer in historical and theoretical context, delineates the key themes of the book and the issues covered. It begins by considering historical approaches to the separate figures of the patient and the consumer, and then examines how these two distinct entities were brought together in the early 1960s. The application of consumerism to health was (and to a great extent remains) contested. Key debates about the meaning of consumerism within health care, such as whether or not it was appropriate to talk about consumerism in the context of health, and the extent to which the patient-consumer can even be said to exist, will be examined. Finally, the content and key arguments of the book are surveyed.
This chapter examines attempts to represent the patient-consumer during the 1970s, focusing particularly on the part played by the Community Health Councils (CHCs). It suggests that a lack of clarity about what patient-consumer representation was, who was being represented, how this could best be achieved, and its ability to have any impact on health services, beset the CHCs from the outset. Uncertainty about the meaning and purpose of patient representation manifested itself in conflicting views about the CHCs’ role and effectiveness that impinged upon their ability to represent patients’ interests. Moreover, the CHCs had to contend with better established and more powerful interest groups within health care such as health professionals and health service administrators. Beginning with the origins of the CHCs, moving on to consider the meanings of representation, and then assessing the effectiveness of the councils, this chapter will demonstrate that having a voice and being heard were not the same thing.