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The Risks of Managing Uncertainty: The Limitations of Governance and Choice, and the Potential for Trust

Published online by Cambridge University Press:  09 December 2009

Patrick Brown  and
Michael Calnan
Patrick Brown
Affiliation:
Research Associate, School of Social Policy, Sociology and Social ResearchUniversity of Kent E-mail: [email protected]
Michael Calnan
Affiliation:
Professor of Medical Sociology, School of Social Policy, University of Kent
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Abstract

The inherent problems and limitations of managing risk and uncertainty are examined in a salient case setting – the English NHS. The ‘dark-side’ of simply trusting professionals to pursue their own craft, as acknowledged by Sennett, has been politicised to under-gird an increased use of quasi-markets, via the choice agenda, and governance. It is argued that these alternatives to trust – price and control – are further dysfunctional still. The innate tendencies of governance, and therefore choice, to lose sight of patient care are even more pronounced than the fallibility of professionals. A new, qualified form of trust is proposed in resolution.

Type
Articles
Information
Social Policy and Society , Volume 9 , Issue 1 , January 2010 , pp. 13 - 24
Copyright
Copyright © Cambridge University Press 2009

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References

Abbott, A. (1988), The System of Professions: An Essay on the Division of Expert Labor, Chicago: University of Chicago Press.CrossRefGoogle Scholar
Adler, P. (2001), ‘Market, hierarchy, and trust: the knowledge economy and the future of capitalism’, Organization Science, 12, 2, 215–34.CrossRefGoogle Scholar
Alaszewski, A. (2002), ‘The impact of the Bristol Royal Infirmary disaster and inquiry on public services in the UK’, Journal of Interprofessional Care, 16, 4, 371–8.CrossRefGoogle Scholar
Alaszewski, A. and Brown, P. (2007), ‘Risk, uncertainty and knowledge’, Health, Risk and Society, 9, 1, 1–10.CrossRefGoogle Scholar
Arrow, K. (1974), The Limits of Organization, New York: Norton.Google Scholar
Bevan, G. and Hood, C. (2006), ‘Have targets improved performance in the English NHS?’, British Medical Journal, 332, 419–22.CrossRefGoogle ScholarPubMed
Blomqvist, P. (2004), ‘The choice revolution: privatization of Swedish welfare services in the 1990s’, Social Policy and Administration, 38, 2, 139–55.CrossRefGoogle Scholar
BMA (2007), ‘Emergency medicine: report of national survey of emergency medicine’, available at: http://www.bma.org.uk/ap.nsf/Content/Emergencymedsurvey07findings, accessed 6 December 2007.Google Scholar
Boyce, R. A. (2008), ‘Professionalism meets entrepreneurialism and managerialism’, in Kuhlmann, E. and Saks, M. (eds.), Rethinking Professional Governance, Bristol: Policy Press.Google Scholar
Brown, P. (2008)a, ‘Trusting in the New NHS: instrumental versus communicative action’, Sociology of Health and Illness, 30, 3, 349–63.CrossRefGoogle ScholarPubMed
Brown, P. (2008)b, ‘Legitimacy chasing its own tail: theorising clinical governance through a critique of instrumental reason’, Social Theory and Health, 6, 184–99.CrossRefGoogle Scholar
Brown, P. (2008)c, ‘The impact of clinical governance and the ‘audit culture’ on patient trust: the opportunity cost of instrumental rationality’, Ph.D. thesis, University of Kent, Canterbury.Google Scholar
Calman, K. and Hine, D. (1995), ‘A policy framework for commissioning cancer services’, a report by the Expert Advisory Group on Cancer to the Chief Medical Officers of England and Wales, Department of Health, London.Google Scholar
Calnan, M. and Rowe, R. (2008), Trust Matters in Healthcare, Buckingham: Open University Press.Google Scholar
Calnan, M. and Sanford, E. (2004), ‘Public trust in healthcare: the system or the doctor’, Quality and Safety in Healthcare, 13, 92–7.CrossRefGoogle ScholarPubMed
Calnan, M., Silvester, S., Manley, G. and Taylor–Gooby, P. (2000), ‘Doing business in the NHS: exploring dentists’ decisions to practise in the public and private sectors’, Sociology of Health and Illness, 22, 742–64.CrossRefGoogle Scholar
Checkland, K. (2004), ‘National Service Frameworks and UK general practitioners: street-level bureaucrats at work?’, Sociology of Health and Illness, 26, 951–75.CrossRefGoogle ScholarPubMed
Checkland, K., Harrison, S., McDonald, R., Grant, S., Campbell, S. and Guthrie, B. (2008), ‘Biomedicine, holism and general medical practice: responses to the 2004 General Practitioner contract’, Sociology of Health and Illness, 30, 5, 788–803.CrossRefGoogle Scholar
Connell, N. and Mannion, R. (2006), ‘Conceptualisations of trust in the organisational literature: some indicators from a complementary perspective’, Journal of Health Organisation and Management, 20, 417–33.CrossRefGoogle ScholarPubMed
Darzi, A. (2008), ‘Our NHS, our future’, available at www.networks.nhs.uk/news.php?nid=1802, accessed 18 July 2008.Google Scholar
Department of Health (1997), The New NHS, Modern, Dependable (Cm 3807), London: HMSO.Google Scholar
Department of Health (1998), A first class service – quality in the New NHS, available at www.dh.gov.uk/assetRoot/04/04/49/41/04044941, accessed 11 November 2005.Google Scholar
Department of Health (2000), ‘The NHS Plan: a plan for investment, a plan for reform’, available at www.dh.gov.uk/assetRoot/04/05/57/83/04055783.pdf, accessed 11 November 2005.Google Scholar
Department of Health (2001), Building a Safer NHS for Patients: Implementing an Organisation with a Memory’, available at www.dh.gov.uk/assetRoot/04/05/80/94/04058094.pdf, accessed 11 November 2005.Google Scholar
Department of Health (2007), Trust, Assurance and Safety – The Regulation of Health Professionals in the 21st Century, London: TSO.Google Scholar
Entwistle, V., Sheldon, T., Sowden, A. and Watt, I. (1998), ‘Evidence-informed patient choice: practical issues of involving patients in decisions about health care technologies’, International Journal of Technology Assessment in Healthcare, 14, 2, 212–25.CrossRefGoogle ScholarPubMed
Eraut, M. (1994), Developing Professional Knowledge and Competence, London: Routledge.Google Scholar
Ferlie, E. and Geraghty, K. (2005), ‘Professionals in public service organisations: implications for public service reforming’, in Ferlie, E., Lynn, L. and Pollitt, C. (eds.), The Oxford Handbook of Public Sector Management, Oxford: Oxford University Press, pp. 422–45.Google Scholar
Flynn, R. (2002), ‘Clinical governance and governmentality’, Health, Risk and Society, 4, 2155–70.CrossRefGoogle Scholar
Freidson, E. (2001), Professionalism: The Third Logic, Cambridge: Polity Press.Google Scholar
Fukuyama, F. (1995), Trust: The Social Virtues and the Creation of Prosperity, London: Penguin.Google Scholar
Furedi, F. (1997), Culture of Fear: Risk Taking and the Morality of Low Expectation, London: Cassell.Google Scholar
Gallivan, M. and Depledge, G. (2003), ‘Trust, control and the role of interorganizational systems in electronic partnerships’, Information Systems Journal, 13, 2, 159–90.CrossRefGoogle Scholar
Gilson, L. (2006), ‘Trust in health care: theoretical perspectives and research needs’, Journal of Health Organisation and Management, 20, 5, 359–75.CrossRefGoogle ScholarPubMed
Habermas, J. (1984), Theory of Communicative Action, Volume One: Reason and the Rationalisation of Society, Boston: Beacon.Google Scholar
Habermas, J. (1987), Theory of Communicative Action, Volume Two: Lifeworld and System: A Critique of Functionalist Reason, Cambridge: Polity.Google Scholar
Harrison, S. (2002), ‘New labour, modernisation and the medical labour process’, Journal of Social Policy, 31, 465–85.CrossRefGoogle Scholar
Harrison, S. and Smith, C. (2004), ‘Trust and moral motivation: redundant resources in health and social care’, Policy and Politics, 32, 3, 371–86.CrossRefGoogle Scholar
Kemshall, H. (2002), Risk, Social Policy and Welfare, Buckingham: Open University Press.Google Scholar
Kennedy, H. (2004), Just Law: The Changing Face of Justice – and Why It Matters to Us All, London: Secker & Warburg.Google Scholar
Keynes, J. M. (1921), A Treatise on Probability, London: Macmillan.Google Scholar
Kuhlmann, E. (2006), Modernising Health Care: Reinventing Professions, the State and the Public, Bristol: The Policy Press.Google Scholar
Le Grand, J. (2003), Motivation, Agency and Public Policy: Of Knights and Knaves, Pawns and Queens, Oxford: Oxford University Press.CrossRefGoogle Scholar
Le Grand, J. (2007), The Other Invisible Hand: Delivering Public Services through Choice and Competition, Princeton, NJ: Princeton University Press.Google Scholar
Lewis, J. and Weigert, A. (1985), ‘Trust as a social reality’, Social Forces, 63, 967–85.CrossRefGoogle Scholar
Lindeberg, T. (2005), ‘The circularity of quality: a new relationship between auditing and society’, paper presented at Risk and Regulation: Research Student Conference, CARR, LSE, 15 September 2005.Google Scholar
Marcuse, H. (1964), One Dimensional Man: Studies in the Ideology of Advanced Industrial Society, Boston: Beacon.Google Scholar
Marcuse, H. (1989), ‘From ontology to technology: fundamental tendencies of industrial society’, in Bronner, S. and Kellner, D. (eds.), Critical Theory and Society: A Reader, London: Routledge, pp. 119–29.Google Scholar
McDonald, R., Harrison, S. and Checkland, K. (2008), ‘Incentives and control in primary health care: findings from English pay-for-performance case studies’, Journal of Health Organisation and Management, 22, 1, 48–62.CrossRefGoogle ScholarPubMed
Möllering, G. (2006), Trust: Reason, Routine, Flexibility, Oxford: Elsevier.Google Scholar
National Audit Office (2005), Patient Choice at the Point of GP Referral, London: The Stationary Office.Google Scholar
Nettleton, S., Burrows, R. and Watt, I. (2008), ‘Regulating medical bodies? The consequences of the ‘modernisation’ of the NHS and the disembodiment of clinical knowledge’, Sociology of Health and Illness, 30, 3, 333–48.CrossRefGoogle ScholarPubMed
Power, M. (1997), The Audit Society: Rituals of Verification, Oxford: Oxford University Press.Google Scholar
Power, M. (2003), ‘Evaluating the audit explosion’, Law and Policy, 25, 185–202.CrossRefGoogle Scholar
Propper, C., Wilson, D. and Burgess, S. (2006), ‘Extending choice in English health care: the implications of the economic evidence’, Journal of Social Policy, 35, 537–57.CrossRefGoogle Scholar
Public Administration Select Committee (House of Commons) (2003), On target? Government by Measurement, London: TSO.Google Scholar
Rothstein, H. (2006), ‘The institutional origins of risk: a new agenda for risk research’, Health, Risk and Society, 8, 3, 215–21.CrossRefGoogle Scholar
Royal College of Nursing (2008), ‘Nurses spend more than a million hours every week on mountain of paperwork’, says RCN, available at www.rcn.org.uk/newsevents/press_releases/uk/nurses_spend_more_than_a_million_hours_every_week_on_mountain_of_paperwork,_says_rcn, accessed 7 May 2008.Google Scholar
Saks, M. (1995), Professions and the Public Interest: Medical Power, Altruism and Alternative Medicine, London: Routledge.Google Scholar
Scally, G. and Donaldson, L. (1998), ‘Clinical governance and the drive for quality improvement in the new NHS in England’, British Medical Journal, 317, 61–5.CrossRefGoogle ScholarPubMed
Schön, D. (1983), The Reflective Practitioner: How Professionals Think in Action, New York: Basic Books.Google Scholar
Sennett, R. (2008), The Craftsman, London: Allen Lane.Google Scholar
Sheaff, R. and Pilgrim, D. (2006), ‘Can learning organizations survive in the newer NHS?’, Implementation Science, 1, 27.CrossRefGoogle ScholarPubMed
Som, C. (2005), ‘Nothing seems to have changed, nothing seems to be changing and perhaps nothing will change in the NHS: doctors’ response to clinical governance’, International Journal of Public Sector Management, 18, 463–77.CrossRefGoogle Scholar
Taylor-Gooby, P. (2008), Reframing Social Citizenship, Oxford: Oxford University Press.CrossRefGoogle Scholar
Weber, M. (1978), ‘The development of bureaucracy and its relation to law’, in Runciman, W. (ed.), Weber: Selections in Translation, Cambridge: Cambridge University Press, pp. 341–56.CrossRefGoogle Scholar