Put simply where has the idea of people as consumers of health care come from? There are a number of possible tangents off from this question, and I will hopefully be able to semi-coherently blog about them over my month as guest bloggerâ€¦The first tangent for me is trying to make sense of the historical processes that created the conditions in which it is possible to conceive of patients as consumers. Going back a step, the medical patient did not always exist, but was itself the product of disciplinary struggles and negotiations between different parties with vested interests. Patients are an essential component of the modern medical project. Without them, medicine is simply about anatomy or physiology. The import of the practice of locating illness or disease within the individual bodies of patients cannot be understated in relation to the development of modern medicine. As such, any changes to this conception of the person with the condition requiring treatment are obviously of sociological interest. In a UK context, the rise of the health consumer corresponds with the rise of principles of managerialism enacted after the 1983 Griffiths Report, commissioned by a Thatcher government just beginning their second term in office. In a broader socio-historical context, the Griffiths Report can be allied to the neoliberal agenda and New Public Management (NPM) reforms which were being pushed aggressively through the public service policies of Thatcher and Reagan in the early 1980s. To borrow from Foucault, the Griffiths Report marks the beginning of the caesura between the patient and the consumer.
An inherent feature of these NPM reforms was the translocation of a public services framework from a model predicated on providing care and treatment for patients, to a model predicated upon the (supposed) sovereignty of the consumer. What I want to pursue over my remaining guest blogs for the month are some of the implications and consequences of these changes, starting with how an emphasis on meeting the needs of the consumers (through provision of choice and through quality assurance and processes of governance) can be seen to meet the needs of just about everyone except those self same â€˜consumersâ€™â€¦