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There is a growing acknowledgement of the salience of hope for mental health service-users, in influencing care outcomes and recovery. Understandings of the processes through which hopes are co-constructed, alongside specific conceptualisations of experiences of hoping, remain limited however. This qualitative study explored how a range of stakeholders experienced and dealt with uncertainty within three purposively selected psychosis services in southern England. In this article we focus particularly on the co-construction of hope within participants’ narratives and how this emotion work shaped experiences of hoping. In-depth interviews (n=23) with service-users, professionals, managers and other stakeholders were analysed following a phenomenological approach. Hope was spontaneously identified by participants as a fundamental mechanism through which service-users and professionals managed uncertainty when vulnerable. Professionals were influential in shaping users’ hopes, both intentionally and unwittingly, while some professionals also referred to managing their own hopes and those of colleagues. Such management of expectations and emotions enabled motivation and coping amidst uncertainty, for users and professionals, but also entailed difficulties where hope was undermined, exaggerated, or involved tensions between desires and expectations. Whereas hope is usually reflected in the caring studies literature as distinctly positive, our findings point to a more ambivalent understanding of hope, as reflected in the accounts of both service-users and professionals where elevated hopes were described as unrealistic and harmful, to the well-being of professionals as well as of service-users. It is concluded that a greater awareness within care contexts of how hopes are co-constructed by professionals and service-users, explicitly and implicitly, can assist in improving health care and healthcare outcomes.

In the life sciences, there is an ongoing discussion about a perceived ‘reproducibility crisis’. However, it remains unclear to which extent the perceived lack of reproducibility is the consequence of issues that can be tackled and to which extent it may be the consequence of unrealistic expectations of the technical level of reproducibility. Large-scale, multi-institutional experimental replication studies are very cost- and time-intensive. This Perspective suggests an alternative, complementary approach: meta-research using sociological and philosophical methodologies to examine researcher trust in data. An improved understanding of the criteria used by researchers to judge data reliability will provide crucial, initial evidence on the actual scale of the reproducibility crisis and on measures to tackle it.

Privatisation of the NHS has come in many guises over the last decade. This has had its costs – not least fragmentation, waste, loss of patients’ trust, inequities in access, the creation of a self-seeking for-profit service sector and the potential emergence of a two-tier healthcare system

This paper presents a critical analysis of newspaper articles (N = 60) published in a leading vernacular newspaper about violence against doctors in India. Adopting a theoretical perspective that considers ‘news as a cultural practice,’ a qualitative content analysis was conducted to examine how the phenomenon is framed and presented in the news, i.e., what is problematized, what causal links are drawn or hinted at, what moral stance is taken or alluded to, and what solutions are proffered and why, to arrive at a nuanced understanding of various aspects of this social phenomenon. Three overlapping key themes emerged from the analysis, namely the narrative of victimization, the changing doctor-patient relationship, and the crisis facing the ‘noble profession’ of medicine. It reveals how the media shapes public opinion and attitudes towards the state of the medical profession while in turn, reflecting existing opinions, attitudes, and cultural values; the analysis also reveals missing perspectives such as the voices of the patients and the public. We highlight how the findings are not merely the dominant ways in which the rise in incidents of violence against doctors is reported and is understood in society, but how media might have shaped the popular discourse around the issue and why. We reflect on what the reportage says about the state of the medical profession and its standing in society in India.

The importance of measuring trust in health systems has been accentuated due to its correlation with important health outcomes aimed at reducing COVID-19 transmission. A systematic review published almost a decade ago identified gaps in measures including the lack of focus on trust in systems, inconsistency regarding the dimensionality of trust and need for research to strengthen the validity of measures. Given developments in our understandings of trust since its publication, we sought to identify new scales developed, existing ones adapted in response to identified gaps, and agendas for future research. Using the PRISMA approach for systematic reviews, we conducted a search in four databases. A total of 26 articles were assessed. Twelve new scales were identified, while 14 were adapted for different settings and populations. Literature continues to focus on measuring trust in health professionals rather than systems. Various shortcomings were identified, including some articles not mentioning the dimensions included in the scale and suboptimal use of validity and reliability testing and/or reporting. Moreover, a variety of terms were used for dimensions. Future research is needed to address these gaps and consequently, to understand their correlation with health behaviours and outcomes more accurately

In this chapter, we examine the social forces shaping the design and delivery of the COVID-19 vaccination programme in England. Looking beyond direct inclusion or exclusion in policy decision-making, we view health and health care as an arena containing several powerful interest groups. Our approach considers the influences, interests, and strategies that can work to reshape, constrain, challenge, or reject policy —though we also consider if and how actors might collaborate or develop alliances and allegiances that support and facilitate policy. We analyse these dynamics in the context of various dimensions of the COVID-19 vaccination programme in England (in relation to supply and manufacturing, regulation, prioritisation, vaccine nationalism, and vaccine coverage). Overall, we argue that, though there were examples of actors working to challenge or reject policy and decision-making in the development and delivery of the vaccination programme, there were limited impacts on or resulting changes to policy—particularly where this was counter to the interests of government and/or the pharmaceutical industry. Additionally, groups have to a greater extent acted and collaborated in a manner that has been supportive and facilitative of policy.

The uncertainties, unpredictability’s, and complexities inherent in health care means that trust is a key element and strategy in its effective provision across many national systems and organisational and clinical settings. It incorporates a number of different dimensions – such as macro-level policies, inter-professional cooperation and professional/patient encounters. Trust relations are significant in shaping and facilitating interactions and transactions between patients and professionals, amongst professionals, between professionals and managers and at the system or institutional level. This entry considers the salience and nature of trust relations at these different levels of the health system and the way they might interrelate and shape one another

This book sociologically analyses the policy response to the COVID-19 pandemic in England. The approach places particular analytical emphasis on the interplay between powerful structural interests and the influence on the development of COVID-19 policy. Looking across a range of actors (including the government, scientific experts and the medical profession, commercial actors, the media, and the public) and the nature of their relationships with one another, our overall aim is to identify the key sociological aspects that have shaped, influenced, facilitated, or constrained COVID-19 policy in England. Drawing on published documentary material, it first examines government attempts to contain, mitigate, delay and suppress the spread of the coronavirus with non-pharmaceutical interventions in the absence of a vaccine (during the first wave) and then whilst vaccines were being gradually rolled out (during the second wave and third waves). The focus then is on vaccination policy and the actors central to the design and implementation of the vaccination programme in England. The approach taken to the funding, development, and manufacture of COVID-19 vaccines is also explored and considers vaccine coverage, vaccine hesitancy, and inequalities in take-up between social groups. The book concludes with an assessment of the relative success of the policies on health, social, and economic levels drawing on comparative analysis of successes and failures of policies adopted globally.

Medicalisation has been one of the major conceptual and empirical interests in medical sociology since the late 1960s. A widely accepted definition is that medicalisation is the process whereby social problems come to be defined and treated as medical conditions. During its long history, the concept of medicalisation has passed through several phases of thought, and its influence on the concepts and ideas of medicine and health reflects broader changes in society. This chapter covers three main phases of thought and the associated changes in society, setting out how these have led scholars to question the limits of the explanatory power of medicalisation and the need for alternative concepts, notably pharmaceuticalisation. It begins by exploring the initial accounts of medicalisation encompassing the late 1960s-early1980s and the focus on how deviant behaviours came to be socially defined as a medical issue. It then moves to explore more contemporary arguments, beginning in the mid-1980s. As well as discussing the medicalisation of risk and lifestyle, this section reflects on whether medicalisation is superseded by newer concepts, or whether they are complementary to medicalisation. The following section uses a case study of cardiovascular disease (CVD) and the prescription of statins to illustrate the different strands of the conceptual analysis of medicalisation and pharmaceuticalisation. The final section examines how medicalisation and pharmaceuticalisation can provide one lens to analyse and process the COVID-19 pandemic.

COVID-19 and its socio-economic and public health impact has provided the opportunity for the government to seriously pursue its stated political aim of levelling up.The greater risk of serious illness and death experienced by poorer and marginalised socio-economic groups have been reflected and exacerbated directly by COVID-19. Thus, there is a clear need to refocus policies further upstream digging deeper into the structural causes of absolute and relative deprivation.

The focus in this chapter is on characterizing the nature of recent health policy initiatives and exploring the interplay of powerful structural interest groups which influence the shape of these policies. This chapter is made up of two parts, focusing initially on health service systems, particularly the National Health Service (NHS) in England, including some discussion of policies aimed at controlling the recent pandemic(Covid-19), but then moving upstream to social and public health policies specifically analysing the approach taken to social inequalities in health. Policy in the former area of organizational change is politicized and thus has been high on the policy agenda whereas in the latter area while social inequalities in health have widened, policy approaches have narrowed. However, the policies manifested in the two case studies of recent reforms in the NHS and public health approaches to social inequalities in health have much in common. Both have emphasized, at least until recently, the importance of the market and market principles, highlighting the salience of ‘choice’ for patients in selecting their health care and for the public in selecting their lifestyle. In general terms, both reflect the importance of neoliberal ideology in shaping health policy.

The global Covid-19 pandemic is posing considerable challenges for governments throughout the world and has and will have a significant influence on the shape of peoples social and economic life and well-being in the short and longer term. This opinion paper discusses the current health policy response adopted in England to control or manage the epidemic and identifies the key sociological and political influences which have shaped these policies. Drawing on the theoretical approach set out in his recent book which lays emphasis on the interplay of powerful structural and economic interest groups, the author will consider the influence of the key players. Government policy has, at least initially, tied itself to scientific and medical evidence and protecting the NHS so the key roles of the medical profession, public health scientific community and NHS management and their respective and relative powerful influences will be discussed. The government needs the support of the public if their policies are to be successful, so how have the government addressed maintaining public trust in this ‘crisis’ and how much trust do the public have in the government and what has influenced it? The strong emphasis on social distancing and social isolation in the national government policy response to Covid-19 has placed an increasing public reliance on the traditional and social media for sources of information so how the media has framed the policy will be considered. One policy aim is for an effective vaccine and the influence of the drug industry in its development is discussed. Finally, the role of the state will be discussed and what has shaped its social and economic policies.

This chapter focuses on the introduction and implementation of the Health and Social Care Act (2012) in England which reignited the debate about the extent to which the government funded National Health Service (NHS) in England is being privatised and/or marketised. It analyses past health service policy developments as they relate to the role of the private health sector, providing a broad sociological and policy context for the most recent legislation and considering the extent to which these represent a radical shift or an incremental policy change. The chapter draws on an ethnographic study of decision-making by the newly created Clinical Commissioning Groups about the extent to which privatisation is taking place. The central argument is that while there has been a considerable change in the commissioning apparatus, private providers have not yet made inroads into the NHS. The chapter concludes by discussing the possible long-term implications of the legislation, considering the extent to which it may have indirectly, rather than directly, encouraged a drift towards privatisation.

Sociological research offers crucial understanding of the salience of trust for patients in mediating a plurality of healthcare activities and settings. Whilst insights generated surrounding the salience of trust for patients are important, other trusting relations within healthcare have largely been neglected. This paper focuses on the significance of trust for doctors, arguing that trust is salient for doctors in facilitating their professional role, in the management of complexity and uncertainty in contemporary medical practice, and is a key mechanism underpinning professional identity. As such, the paper develops a preliminary conceptual framework for researching trust by doctors built upon the idea of a ‘lattice’ of doctor trust relations in various entities and at various levels that may be interconnected. The lattice of doctor trust is comprised of four primary conceptualisations – trust in patients, self trust, workplace trust, and system trust. The paper explores notions of doctors’ need to trust patients to provide accurate information and to commit to certain treatment pathways; the relationship between the self trust of the doctor, clinical activity and trust in others; the need for doctors to trust their professional colleagues and the broader organisational setting to ensure the smooth running of services and integration of care; and notions surrounding the complexity of the broader systems of modern (bio)medicine and the role of trust by doctors to facilitate system functioning.

In India, over the last decade, a series of stewardship failures in the health system, particularly in the medical profession, have led to a massive erosion of trust in these institutions. In many low- and middle-income countries (LMICs), the situation is similar and has reached crisis proportions; this crisis requires urgent attention. This paper draws on the insights from the recent developments in India, to argue that a purely control-based regulatory response to this crisis in the medical profession, as is being currently envisaged by the Parliament and the Supreme Court of India, runs the risk of undermining the trusting interpersonal relations between doctors and their patients. A more balanced approach which takes into account the differences between system and interpersonal forms of trust and distrust is warranted. Such an approach should on one hand strongly regulate the institutions mandated with the stewardship and qualities of care functions, and simultaneously on the other hand, initiate measures to nurture the trusting interpersonal relations between doctors and patients. The paper concludes by calling for doctors, and those mandated with the stewardship of the profession, to individually and collectively, critically self-reflect upon the state of their profession, its priorities and its future direction.

Quality and safety in healthcare settings are underpinned by organisational cultures, which facilitate or impede the refinement, sharing and application of knowledge. Avoiding the use of the term culture as a residual category, we focus specifically on describing chains of (dis)trust, analysing their development across relatively low-trust service contexts and their impact upon knowledge-sharing and caregiving. Drawing upon data from in-depth interviews with service users, healthcare professionals, service managers and other stakeholders across three mental healthcare (psychosis) teams in southern England, we identify micro-mechanisms that explain how (dis)trust within one intra-organisational relationship impacts upon other relationships. Experiences and inferences of vulnerability, knowledge, uncertainty, interests and time, among actors who are both trustees and trusters across different relationships, are pertinent to such analyses. This more micro-level understanding facilitates detailed conceptualisations of trust chains as meso-level tendencies that contribute to wider vicious or virtuous cycles of organisational (dis)trust. We explore how knowledge-sharing and caregiving are vitally interwoven within these chains of trust or distrust, enhancing and/or inhibiting the instrumental and communicative aspects of quality healthcare as a result.

The moral component of living with illness has been neglected in analyses of long-term illness experiences. This paper attempts to fill this gap by exploring the role of the moral experience of illness in mediating the ability of those living with a long-term condition (LTC) to normalise. This is explored through an empirical study of women of Punjabi origin living with rheumatoid arthritis (RA) in the UK. Sixteen informants were recruited through three hospitals in UK cities and interviews conducted and analysed using a Grounded Theory approach. The intersection between moral experience and normalisation, within the broader context of ethnic, gender and socio-economic influences, was evident in the following: disruption of a core lived value (the centrality of family duty), beliefs about illness causation affecting informants’ ‘moral career’, and perceived discrimination in the workplace. The data illustrate the importance of considering an ethnic community’s specific values and beliefs when understanding differences in adapting to LTCs and changing identities.

Policy discourse shaped by neoliberal ideology, with its emphasis on marketisation and competition, has highlighted the importance of choice in the context of healthcare and health systems globally. Yet, evidence about how so-called consumers perceive and experience healthcare choice is in short supply and limited to specific healthcare systems, primarily in the Global North. This special issue aims to explore how choice is perceived and utilised in the context of different systems of healthcare throughout the world, where choice, at least in policy and organisational terms, has been embedded for some time. The articles are divided into those emphasising: embodiment and the meaning of choice; social processes associated with choice; the uncertainties, risks and trust involved in making choices; and issues of access and inequality associated with enacting choice. These sociological studies reveal complexities not always captured in policy discourse and suggest that the commodification of healthcare is particularly problematic.

Pharmaceutical products are commonly relied upon by professionals and correspondingly patients, within a wide range of healthcare contexts. This dependence, combined with the inherent risk and uncertainty surrounding both medical practice and the drugs it harnesses, points towards the importance of trust in the pharmaceutical industry - a subject which has been much neglected by researchers. This article begins to address this deficiency by mapping out a conceptual framework which may form a useful basis for future research into this important topic. The often negative portrayal of the pharmaceutical industry in the public sphere belies a state of apparent confidence in its products. The role of prescribing professionals as 'mediators of trust' amid a faceless system of production and alongside regulators as bases of assurance in the quality of drugs goes some way towards explaining this contradiction. Recent policy moves towards fostering increased patient 'expertise' and responsibility for illness management, a widening of over-the-counter medication availability and a growing market of products (mainstreamand illicit) via the internet suggest this role of 'facework' in facilitating trust may be becoming more marginal. This heightened requirement for trusting amid the unfamiliar, and an apparent willingness to do so, underlines the need for further research into trust in the industry - both mainstream and underground - and its products. Within this discussion an agenda for furthering our understandings of the political-economy of the pharmaceutical industry becomes apparent, one which might be most effectively approached by way of a broader political-economy of hope and trust.

A lack of trust between clinicians and junior/middle managers is well documented in health care systems but under-theorized. Face-to-face interactions between clinicians and managers, through which trust is constructed, are vitally shaped by assumptions drawn from local organizational characteristics, which in turn are embedded within national policy structures. These latter conditions reform in order to enhance the quality and effectiveness of National Health Service management.

There is considerable uncertainty about the implications of the new genetics for health services. These are the enthusiasts who argue that molecular genetics will transform health care and others argue that the scope for genetic interventions is limited. The aim of this paper is to examine some of the questions, tensions and difficulties which face health care providers particularly in developed countries as they try to come to terms with the dilemmas raised by new genetic health care technologies (NGHTs). It identifies questions for research which may help the development of robust and flexible strategies for implementation.