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Managing diabetes, managing medicine

. Wood, ‘Policy emergence and policy convergence: the case of “Scientific-Bureaucratic Medicine” in the United States and United Kingdom’, British Journal of Politics and International Relations , 4:1 (2002), 1–21; S. Harrison and W. I. U. Ahmad, ‘Medical autonomy and the UK state 1975 to 2025’, Sociology , 34:1 (2000), 129–46; Flynn, ‘Clinical governance and governmentality’, pp. 155–6, 159–60; Kirkpatrick et al., The New Managerialism . 22 R. Klein, ‘The crises of the welfare states’, in R. Cooter and J. Pickstone (eds.), Medicine in the

in Managing diabetes, managing medicine

engaged with diabetes management as a clinically and financially important concern. In the political arena, diabetes management itself was simultaneously transformed into a clinical and public health act, one which provided a promising laboratory for practices of clinical governance, service management, and NHS reform. Finally, in telling the story of central government interest in retinopathy, this chapter also begins to trace the importance of international conditions and British neoliberal politics to diabetes management, concerns that are taken up in Chapters 5

in Managing diabetes, managing medicine

that state–professional relations were not always smooth. It was here that the strength of the diabetes policy community became important. Through a vocal lay-professional organisation, interested civil servants, persuasive specialist advocates, and international pressure (especially from the WHO), diabetes was established as an important subject for novel managerial technologies. Diabetes thus provides a lens through which to view managerial policy, not only because of how it was conceived as a possible model for change, but also because of the ways in which it

in Managing diabetes, managing medicine
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National Diabetes Audit after 2005. However, in the following pages I want to set the developments in diabetes management explored over the preceding six chapters against changes in chronic disease care more generally, and to consider the story of British professional management in relation to international and present-day comparators. In so doing, this Epilogue returns to themes and questions laid out in the Introduction, reflecting on diabetes’ historic position as a model chronic condition and drawing out the relationship between chronic disease and professional

in Managing diabetes, managing medicine

the perfect candidates for referral, and a significant proportion of GPs passed all diabetes care on to specialists. 10 Financial factors in referral were buttressed by intra-professional aversions and anxieties. On a local level, consultant staff and GPs could maintain good relations, but the existence of private medicine often helped to facilitate friendly co-operation. 11 In terms of diabetes, some GPs even served as ‘clinical assistants’ in specialist outpatient clinics, undertaking clinical assessments and consultation under direction of

in Managing diabetes, managing medicine

according to predicted patterns. However, as complex individuals enrolled in various relations with competing demands, doctors and patients varied in their commitment to follow-up. For patients, clinics and their doctors could be remote, producing financial and temporal strains. 33 Decisions to attend were also based upon complex physical and psychological assessments. One interviewee with diabetes (diagnosed when aged seven in 1976) reflected on how she often had to wait for over an hour and a half for a consultation as a teenager, only to become ‘aggrieved’ with the

in Managing diabetes, managing medicine

This book examines the payment systems operating in British hospitals before the National Health Service (NHS). An overview of the British situation is given, locating the hospitals within both the domestic social and political context, before taking a wider international view. The book sets up the city of Bristol as a case study to explore the operation and meaning of hospital payments on the ground. The foundation of Bristol's historic wealth, and consequent philanthropic dynamism, was trade. The historic prominence of philanthropic associations in Bristol was acknowledged in a Ministry of Health report on the city in the 1930s. The distinctions in payment served to reinforce the differential class relations at the core of philanthropy. The act of payment heightens and diminishes the significance of 1948 as a watershed in the history of British healthcare. The book places the hospitals firmly within the local networks of care, charity and public services, shaped by the economics and politics of a wealthy southern city. It reflects the distinction drawn between and separation of working-class and middle-class patients as a defining characteristic of the system that emerged over the early twentieth century. The rhetorical and political strategies adopted by advocates of private provision were based on the premise that middle-class patients needed to be brought in to a revised notion of the sick poor. The book examines why the voluntary sector and wider mixed economies of healthcare, welfare and public services should be so well developed in Bristol.

Guerrilla nursing with the Friends Ambulance Unit, 1946–48

portrait. Acculturation occurs differently for everyone. Moreover, feminist international relations scholars have recently cautioned against the assumption that ‘those from outside a particular state or region are “inauthentic knowers” and actors who cannot understand or share in struggles outside of locales from which they come’.95 Both nurses admired the Chinese people’s resilience and courage and in different ways viewed MT19 as ‘home’. But why did Margaret Stanley become a more effective cultural diplomat? Skilled cross-cultural brokers must balance ‘bridging social

in Colonial caring

complete population of children and defined the total population using behavioural criteria. Wing’s definition was coming to be acclaimed internationally. Her astute, yet subtle, creation of a comprehensive model of inclusive human relations was lapped up by behaviourists, government officials and others struggling to create some way of conceptualising social development in children now that

in The metamorphosis of autism
The cultural construction of opposition to immunisation in India

, the controversial BCG vaccine against tuberculosis to India. In late 1948 the Government of India secured international assistance in introducing mass BCG vaccination. The Indian BCG campaign developed into the largest immunisation campaign the world had seen, and the goal was to reach all Indians below the age of 25 (estimated at 170 million people) by the end of the second five-year plan period in 1961. It was, however, difficult to

in The politics of vaccination