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Governing through neutrality: critiquing discourses of 'patient centred care' and 'integrated care' in the English NHS

Lookup NU author(s): Dr Ewan MackenzieORCiD, Robert Wilson, Dr Josephine Go JefferiesORCiD, Dr Rebecca CaseyORCiD, Professor Mike Martin


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The 2012 Health and Social Care Act (HSCA) moved to ‘liberalize’ (i.e. deregulate) care provision in the English National Health Service (NHS) by introducing the ‘any qualified provider’ (AQP) principle; be it private, public or third sector organizations. Professional groups from within and outside the medical profession argued that these changes were ideologically driven and detrimental for the improvement of care, working conditions and cost efficiencies in the English NHS (Unison, 2010; Tallis, 2013). Devolved budgetary authority was granted to General Practitioner (GP) led Clinical Commissioning Groups (CCGs), as brokers in a new ‘liberalized’ and corporatized internal market. The role of government thus became one of the financer of care, rather than the provider of it (Pollock and Price, 2011). Against this political and organizational background, this paper investigates a NHS new care model (NCM) pilot programme that took place in England in 2017. The programme was designed to integrate health and social care and develop a patient centred approach to align with the strategic objectives of the NHS Five Year Forward View (NHS England, 2014). Drawing from Foucauldian concepts of governmentality (Miller and Rose, 2008; Ferlie et al., 2013), the paper conducts documentary analysis of programme materials on the one hand, and examines 33 in-depth interviews with managers and providers of care involved in the programme’s enactment, on the other. In doing so the paper examines not only the programme’s strategic rationalities and discourses, but also their reception among health and social care workers ‘on the ground’, and with respect to ‘what matters to them’. Our findings outline the manner in which prevailing discourses of ‘patient centred care’ and ‘integrated care’ are received, appropriated, and reproduced by participants involved in the pilot programme’s enactment. In particular, our findings illustrate the various and often mundane ways in which these discourses act to naturalize conditions of formal equality and apparent neutrality. We argue that such governmental frameworks exercise a form of power that subtly facilitates a process of ‘liberalization’ in line with the AQP principle, thus side-lining any serious contestation of the politics of health and social care. The paper concludes by highlighting the need for a more radical critique of ‘integrated care’ and ‘patient centred care’ as governmental discourses, those that can act to embed and sustain structural inequalities and the corporatization of the English NHS.

Publication metadata

Author(s): Mackenzie E, Wilson R, Go Jefferies J, Casey R, Martin M

Publication type: Conference Proceedings (inc. Abstract)

Publication status: Published

Conference Name: 11th International Critical Management Studies Conference: Precarious Presents, Open Futures

Year of Conference: 2019

Print publication date: 28/06/2019

Online publication date: 07/05/2019

Acceptance date: 08/03/2019

Publisher: The Open Univeristy



Series Title: Stream 1: An uncertain future for health and social care?