Search results

The aim of this chapter is to discuss the complexities and ambiguities of health-related citizenship in the neoliberal era. The scholarly discussions investigating the impact of neoliberalism on health and health care have primarily focused on the power of the neoliberal system. At the same time, the capacity of patients and citizens to act against neoliberal principles has been rarely discussed. Against this backdrop, we explore the ways in which civically engaged patients and citizens cope with neoliberal governance. To do so, we focus on the Czech context, as one that is not narrowly dominated by market-driven neoliberal logic but that blurs the distinction between marketisation and social protection. More specifically, we address the following two questions: What are the reactions of citizens and patients to the imperatives of neoliberalism? What are the implications for our understanding of health-related citizenship in the neoliberal era? Our analysis is underpinned by interviews and observations of public and patient involvement in the Czech Republic. Furthermore, the data gathered from interviews were enriched through a review of available documents, including media articles, policy briefs, political statements and websites. We conclude that the neoliberal era is not only connected with the emergence of individualised, conscious citizens whose health is governed at a distance, but also with the occurrence of collectively organised, health-care conscious citizens who problematise the nature of contemporary health-care governance. We thus explain and illustrate how neoliberal ideology is imprinted on the behaviour of patients and citizens, as well as how they resist and strategically appropriate neoliberal imperatives.

One of the aspects that characterises neoliberal societies is the increasing attribution of individual responsibility. Citizens are required to commit themselves to adopting ‘appropriate’ lifestyles and to self-managing their health. Individual responsibility translates into a set of knowledge and techniques of self-governance, through which individuals learn and are expected to act in an increasingly autonomous way in order to prevent or mitigate health risks. This fostering of self-governance and individual responsibility affects both children and adults; in accordance with it, adults are required to transmit a sort of model of “pedagogy of responsibility” (Neyrand & Mekboul, 2014), through which children learn to acquire self-management of their health. This scenario becomes complicated if we take into consideration the two usual and contrasting representations of childhood in western societies: children as active subjects, or children as vulnerable subjects. Our work explores these contrasting representations through the narrations of adults and children of their experiences of Type 1 Diabetes.

The purpose of this article is to assess whether tele‐nursing in Scotland (NHS24), when compared with traditional face‐to‐face nursing, facilitates greater employee control over working time and therefore a potentially better work‐life balance.

The article draws on evidence from two independent research projects; a survey of 64 ward nurses and midwives, which involved face‐to‐face interviews; and a field study of tele‐nursing in a large site in Scotland, using interviews and observations of 15 nurse advisors or tele‐nurses.

Three elements of work organisation are central in shaping nurses' working hours and their control over the balance between their work and their home life: the management of working hours; the degree of mutual dependency of nurses within teams; and the nature of patient care.

The two pieces of research reported offer a strong basis for comparative study. However, the two projects were designed independently, though research questions overlapped and one researcher conducted the field work in both settings; there is an imbalance in the number of interviews conducted in each setting; and the nurse advisor interviewees are of the same clinical grade, whereas a variety of grades and clinical areas are represented among the hospital nurse interviewees.

This is the first study of work‐life balance amongst tele‐nurses. The research demonstrates that call centre work has rationalised, depersonalised and yet enabled more “control” by nurses over their work‐life balance, while paradoxically offering less autonomy in their task environment. In conventional work settings professional values make it difficult for nurses to disengage from the workplace.

In recent years, the clinical performance of named cardiac surgeons in England has been disclosed. This paper aims to explore the nature and impact of disclosure of clinical performance.

The paper draws on literature from across the social sciences to assess the impact of disclosure, as a form of transparency, in improving clinical performance. Specifically, it employs the “programme theory” of disclosure.

The “programme theory” of disclosure involves identification, naming, public sanction and recipient response. Named individual (consultant) surgeons have been identified through disclosure but this masks the contribution of the clinical team, including junior surgeons. Mortality is the prime performance measure but given low mortality rates, there are problems interpreting this measure. The naming of surgeons has been achieved through disclosure on web sites, developed between the health‐care regulator and the surgical profession itself. However, participation remains voluntary. The intention of disclosure is that interested parties (especially patients) will shun poorly performing surgeons. However, these parties' willingness and ability to exercise this sanction appears limited. Surgeons' responses are emergent but about a quarter of surgeons are not participating currently. Fears that surgeons would avoid high‐risk patients seem to have been unrealised. While disclosure may have a small effect on individual reputations, the surgical profession as a whole has embraced disclosure.

While the aim of disclosure has been to create a transparent medical system and to improve clinical performance, disclosure may have the opposite effect, concealing some performance issues and possibly strengthening professional autonomy. Disclosure therefore represents greater transparency in health‐care but it is uncertain whether it will improve performance in the ways that the policy intends.