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Chronic disease and clinical bureaucracy in post-war Britain

Through a study of diabetes care in post-war Britain, this book is the first historical monograph to explore the emergence of managed medicine within the National Health Service. Much of the extant literature has cast the development of systems for structuring and reviewing clinical care as either a political imposition in pursuit of cost control or a professional reaction to state pressure. By contrast, Managing Diabetes, Managing Medicine argues that managerial medicine was a co-constructed venture between profession and state. Despite possessing diverse motives – and though clearly influenced by post-war Britain’s rapid political, technological, economic, and cultural changes – general practitioners (GPs), hospital specialists, national professional and patient bodies, a range of British government agencies, and influential international organisations were all integral to the creation of managerial systems in Britain. By focusing on changes within the management of a single disease at the forefront of broader developments, this book ties together innovations across varied sites at different scales of change, from the very local programmes of single towns to the debates of specialists and professional leaders in international fora. Drawing on a broad range of archival materials, published journals, and medical textbooks, as well as newspapers and oral histories, Managing Diabetes, Managing Medicine not only develops fresh insights into the history of managed healthcare, but also contributes to histories of the NHS, medical professionalism, and post-war government more broadly.

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medical management reviewed in this book would appear to provide part of the reason for such a change. To what extent do shifts in the outlook and practice of medical professionals reflect a colonisation of medical professionalism by the state and its construct of managerialism? 61 The present work would suggest that a division between professionalism, managerialism, and the state rests on faulty assumptions. The regulation of medical practice (often connected with ‘managerialism’) was a professional project from the 1970s onwards, and in some

in Managing diabetes, managing medicine

1990s. In short, elite guideline-creating bodies increasingly produced prescriptions for the content of clinical practice, and in so doing challenged the concepts and structures of clinical autonomy at the core of traditional views of medical professionalism. One of the earliest movements in this direction came from the BDA. In view of its strong links with elite specialists and its dedication to improving care for patients with diabetes, it was perhaps unsurprising that the Association would be at the forefront of guidance production. In 1982

in Managing diabetes, managing medicine
Open Access (free)
Managing diabetes, managing medicine

autonomy at the expense of reduced individual clinical freedom. 26 Nonetheless, such interpretations still set professional activity as a rear-guard campaign fought in opposition to the state. ‘Managerialism’, moreover, is taken to represent an external, state-originated construct that ran counter to ideals of medical professionalism, ideals predicated upon collective control over standard-setting and work content. 27 Thus, much of the extant literature has tended to understate the complicated, often synergistic, relationships between state agencies and professional

in Managing diabetes, managing medicine