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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.
The National Health Service (NHS) officially ‘opened’ across Britain in 1948. It replaced a patchy system of charity and local providers, and made healthcare free at the point of use. Over the subsequent decades, the NHS was vested with cultural meaning, and even love. By 1992, the former Chancellor of the Exchequer Nigel Lawson declared that the service was ‘the closest thing the English have to a religion’. Yet in 2016, a physician publishing in the British Medical Journal asked whether the service was, in fact, a ‘national religion or national football’, referring to the complex politics of healthcare. Placards, posters, and prescriptions radically illuminates the multiple meanings of the NHS, in public life and culture, over its seventy years of life. The book charts how this institution has been ignored, worshipped, challenged, and seen as under threat throughout its history. It analyses changing cultural representations and patterns of public behaviour that have emerged, and the politics and everyday life of health. By looking at the NHS through the lenses of labour, activism, consumerism, space, and representation, this collection showcases the depth and potential of cultural history. This approach can explain how and why the NHS has become the defining institution of contemporary Britain.
promoted the idea that individualised health risks could be overcome (at least in part) by newly constructed health consumers complying with a myriad of health advice that included specific recommendations about food consumption. Alongside public health authorities, the NHS was creating a new understanding of who the target of public health initiatives was and what was expected of them in the realm of disease
‘Emphasising the “consumer point of view” can be very valuable’.5 To explore the ways in which patient organisations began to re-position the patient through emerging notions of health consumerism and patient autonomy in Britain, this chapter will focus on four areas. Firstly, it will consider the place of autonomy within concepts of bioethics and consumerism as they developed during the 1960s and 1970s. Secondly, the chapter will attempt to uncover what patients themselves thought of health care in this period. This is difficult to do, as the opinions of patients were not
described using the language of consumption.1 Consumerism was also alien to the early NHS. The new system swept away pre-existing forms of patient representation and individual patient voices were rarely heard. It was not until the 1960s that consumerist thought began to be applied to the NHS. Patient groups, such as the Patients Association (established in 1962), and consumer bodies, such as the Consumers’ Association (established in 1956), engaged with health consumerism as a way of giving the patient more say in his or her treatment and that of others. By the 1970s
for communities and governments around the world. Highly fragmented service systems built around complex disciplinary boundaries, strong professional guilds, residual cottage-industry modes of service delivery alongside large-scale state-run systems, and dual public and private financing systems make the task for reformers and innovators daunting to say the least. Medical provider interests are amongst the most powerful of industry interests. Health consumers are amongst the weakest and least organised categories of consumers. In most societies, healthprovider
countries (Health Consumer Powerhouse, 2019 ). For example, the UK scores well on patient rights and information but poorly on accessibility (waiting times for treatment) and “amber” on outcomes. The Netherlands, on the other hand, score even better on patient rights and information than the UK, and also well on accessibility and outcomes (Health Consumer Powerhouse, 2019 ). The Picker Institute notes how Bismarck countries have embedded patient rights in statute. Germany issued a Charter of Rights for People in Need of Long-Term Care and Assistance
groups began to change from the 1990s onwards. Organisations in the health field became more numerous. In the early 2000s, Brian Salter found that there were 2,500 organisations listed in the College of Health database.20 In his study of ‘patients associations’ political scientist Brian Wood found that of 54 per cent of patient groups were founded after 1980, leading him to posit the existence of a ‘patients movement’ from this period.21 Similarly, in their research on health consumer groups Rob Baggott and his colleagues noted that two-thirds of groups were
richness of qualitative data and sociological analysis can provide a valuable complement to these questions of meaning and belief, enhancing and challenging the cultural histories that this collection addresses. Notes 1 Lorelei Jones, ‘What Does a Hospital Mean?’, Journal of Health Services Research & Policy , vol. 20, no. 4 (2015), pp. 254–6 . 2 Alex Mold, Making the Patient-Consumer: Patient Organisations and Health Consumerism in Britain
other consumer goods, and choice was less important than a good collective service that benefited everyone, not just the individual. Such arguments were repeated often in academic discussions about the place of choice in health, but on a practical level choice played little role in health consumerism until the 1980s.13 For many patient groups, choice was bound up with other aspirations such as more information and stronger rights, as discussed in Chapter 4 and Chapter 5. Through the trinity of information, rights and choice, patients would become consumers. But, as