David Donnison
- Published in print:
- 2010
- Published Online:
- September 2012
- ISBN:
- 9780748638666
- eISBN:
- 9780748671939
- Item type:
- chapter
- Publisher:
- Edinburgh University Press
- DOI:
- 10.3366/edinburgh/9780748638666.003.0005
- Subject:
- Political Science, UK Politics
This chapter explores the changing balance of power since World War II between elites and citizens in respect of the health professions. The chapter offers a personal account of the decline of ...
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This chapter explores the changing balance of power since World War II between elites and citizens in respect of the health professions. The chapter offers a personal account of the decline of deference in British society before arguing that an excessive focus on individualistic, market-orientated values undermines the ethos of public services. It explains how the introduction of market values, including both the profit motive and the concept of consumer choice, into the provision of public services reinforces inequality; the ‘inverse care law’ operates — meaning the poorest and sickest get the least good service because they are least able to agitate for their rights. This applies to services beyond health. The provision of independent advocacy as introduced by Scottish Mental Health legislation is a particular help to protect the vulnerable against professional discretion and neglect, but individual advocacy cannot be a general solution to making public-service professions ‘more effective, more accountable and more humane’. Concerted collective action by those with direct experience of services, acting as citizens rather than as customers offers the potential for revitalising our public services.Less
This chapter explores the changing balance of power since World War II between elites and citizens in respect of the health professions. The chapter offers a personal account of the decline of deference in British society before arguing that an excessive focus on individualistic, market-orientated values undermines the ethos of public services. It explains how the introduction of market values, including both the profit motive and the concept of consumer choice, into the provision of public services reinforces inequality; the ‘inverse care law’ operates — meaning the poorest and sickest get the least good service because they are least able to agitate for their rights. This applies to services beyond health. The provision of independent advocacy as introduced by Scottish Mental Health legislation is a particular help to protect the vulnerable against professional discretion and neglect, but individual advocacy cannot be a general solution to making public-service professions ‘more effective, more accountable and more humane’. Concerted collective action by those with direct experience of services, acting as citizens rather than as customers offers the potential for revitalising our public services.
