Search results

Open Access (free)
Governing Precarity through Adaptive Design

, with the harvest still months away, is being pressed to decide whether to make the long-term investment of sending a child to school. This is happening when there is a hole in the roof, the kerosene has run out and finding clean water is a constant effort. In addition, his neighbour is also expecting reciprocal help with medical bills because the farmer’s family received similar support in the past. For behavioural economics, poverty is an experience grounded in the constant grind of having to make hard choices: educate a child, fix a roof or

Journal of Humanitarian Affairs
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.

Open Access (free)

professionalism? And what do more recent developments indicate about the shifting relationship between professionals and the state? As the foregoing history of diabetes management shows, medical professionals in Britain were rarely united in the post-war period, and new forms of activity embodied in chronic disease care and professional management were contested. Like those in the USA, British academic clinicians and health service researchers, although often involved with teaching hospitals, assumed new managerial roles over medical practice when creating

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

particular on the services provided through workplace ‘sick clubs’, the chapter examines the development of medical responses to sickness and injury in and around coalmining communities in late eighteenth- and nineteenth-century Britain and shows how the coal industry was innovative both in the extent of medical provision available to workers 56 DISABILITY IN THE INDUSTRIAL REVOLUTION and in a variety of responses to workplace injury from first aid to specialist convalescent homes. The expansion of medical services made mineworkers, like other industrial workers

in Disability in the Industrial Revolution
New Labour and public sector reform

recalled) ‘an extremely jaundiced view of the medical profession’ (interview with a former government adviser, 2006). Traditional Labour faith in professionalism had been misplaced. In a system of what Blair called ‘professional domination of service provision’ professionals had acquired too much power ‘to define not just the way services were delivered but also the standards to which they were delivered’. The result was too often a poor standard of service which left service-users ‘disempowered and demoralised’ (Blair 2004). In the private sector the need to capture

in In search of social democracy
Open Access (free)
Nursing work and nurses’ space in the Second World War: a gendered construction

.’29 Nonetheless, he, like others after him, included nurses’ work as a side-­line to the important role of the medical officers. Both Harrison and Kevin Brown acknowledge the importance of the female nurses of the QAs, although their main focus is on the work of the male medical officers and their care of male soldiers, supported by male orderlies. Harrison’s analysis of the nursing sisters is that although there had been some ‘friction’ between them and the medical officers, they were ‘generally admired for their professionalism and technical competence’,30 whereas

in Negotiating nursing

through formal regulatory devices. Devices to structure medical practice could become a ‘managerial’ technology in a more formal sense, though, only with observation and review. The power of norms derived, in part, from the possibility that adherence, omission, or deviation would be visible to self and others. 106 Thus it was only when recall, records, and protocol were connected to medical audit that their capacity to reshape and manage professional action was fully realised. As noted in the coming chapters, different visions of professionalism

in Managing diabetes, managing medicine

with many groups of women and men as they established hospitals and schools of nursing in Nigeria. Sisters combined religious commitment and medical science to relieve physical and spiritual suffering; indeed, they were bound by strong ties of gender, professionalism and religion. Nuns were strongly affected by the Catholic Church’s emphasis on women’s authority in the home and family; and when sisters ran hospitals and clinics, many focused on maternal care and children. They also recruited women for their religious congregations and engaged women as students in

in Colonial caring