Patients, Power and Politics. From Patients to Citizens

Citation

Vinten, G. (1999), "Patients, Power and Politics. From Patients to Citizens", British Journal of Clinical Governance, Vol. 4 No. 3, pp. 114-116. https://doi.org/10.1108/bjcg.1999.4.3.114.2

The recent White Paper, The New NHS – Modern, Dependable, is committed to involving users. Christine Hogg provides a full exposition as to what this implies, and concludes by indicating the ramifications in a sample of user types: asthma, mental health problems, eating disorders, maternity services and breast cancer. This is a stimulating text by a self‐confessed non‐conformist who is fully confident with her well‐crafted material. She provides a 360‐degree perspective over the terrain. The opening quotation is apt, and sets the scene:

Depending on who is doing the analysis or the accountancy, patients appear as demand, costs and benefits, input or output, voters, clients or consumers of services, bearers of rights or pursuers of litigation, the “tib and fib” in bed 15, frozen sperm in the deep freeze, diseased bodies or clinical material, points on a graph or numbers crunched on a software program (Porter, 1997).

The chapter on myths ancient and modern debunks the notions of scientific certainty, medical progress and heroic medicine (ancient) and infinite demand and rationing, the patient as consumer, the patient as partner, and the perfectibility of health. Of particular interest is the treatment of the contribution of lobby groups, such as the food and pharmaceutical industries.

The concluding themes are:

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  The real dilemma between our need for hope and the need to learn from the past. Users have rejected some of the myths, but cling on to others.

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  The medicalization of “health” can impact on individual autonomy, such as when “stress” is turned into an illness.

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  Who are the real experts?

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  Health care is not isolated from other aspects of life.

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  Users, carers and the general public may have different interests, and they are often divided.

The overall indictment is that “The views of users and citizens have had little influence on health policies”. Ministers and policy makers need seriously to ponder the messages of this book to think and act on how to turn political rhetoric into reality. Alternatively, they must be content that all that is possible is to leave the present reality to influence the rhetoric if they should ever be so honest as to overturn the popular perception of the politician. Citizens and users should read this book to become empowered.