Chapter Four - Enlisting, Measuring and Shaping the Individual in Healthcare Policy and Practice

Summary

Introduction

As we have seen in the previous chapter, notions of individualism apparent in healthcare are increasingly inflected in a way that is consonant with neoliberal politics and the tendencies towards responsibilization as described. The idea of citizens or patients as rational consumers is coming to the fore as they are depicted in the popular media and policy as choosing between treatment options, hospitals and healthcare organizations or even choosing to have operations abroad. An ever greater variety of elective procedures are available to those who can afford them, and the idea of the patient as an entrepreneur, consumer or rational economic agent is driven ever further into service provision across a variety of service areas. In addition, it is increasingly possible to detect consumerist discourse in research to evaluate the effectiveness of interventions where results are formulated and measured in terms of quality of life, quality adjusted life years, wellbeing and liveability. The wellbeing and satisfaction of the patient is therefore growing in prominence as a focus of policy and interventions. Earlier foci of concern on technical aspects of medicine – parodied in the adage ‘the operation was a success but unfortunately the patient died’ – have been supplemented by an emphasis on the subjective space of the patient as both an evaluative measure and a driver of policy.

The subjective wellbeing of the patient or client taking centre stage with their purported wants and needs providing the rationale for policy was apparent from the outset of the New Labour period.