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Processes of public engagement in decision-making and research are increasingly discussed as ways of addressing democratic deficits in high-income countries. In this paper, we explore why these processes of engagement and involvement in the UK have been less successfully incorporated into social security policymaking aimed at the out-of-work by drawing a comparison with health policy, a sphere in which these processes have now become orthodox (albeit imperfect). There is, for example, no formal or institutionalised imperative to involve people with lived experience of out-of-work social security benefits in processes of policy development. Government departments might focus group new policies with members of the public or hold periodic discussions with beneficiaries but in recent years there have been a number of major reforms to out-of-work social security which have been developed almost entirely without involving those affected. This would have been unacceptable in the health policy arena. We argue that this difference is rooted in structural differences in how the field of power for this form of social policy is organised, in the different social imaginaries which construct patients and out-of-work beneficiaries, and in the limited scope for solidarity and collective action around resisting the stigmatisation of out-of-work beneficiaries.

Copyright © 2022 The Author(s). . Recognising the limited literature detailing the practical application of co-production principles and practices within sport, exercise and health research, critical reflections on co-production principles and practice are shared here, drawing on two participatory action research (PAR) projects in the United Kingdom (UK). Co-production and PAR are distinguished, and their commonalities discussed. Both projects were facilitated by occupational therapists and concerned with health inequities and social justice. The Voices for Inclusive Activity project brought disabled people together online to explore more accessible and inclusive approaches to evaluate disability sport and physical activity. The Positive Mental Attitude project took place with a community-based football league for people with experience of mental distress and explored the nature and value of participation. Both projects involved researching with people who are often excluded from research. Addressing power imbalances can function to engage marginalised people in processes of knowledge production and enable social justice. Co-production offers useful principles that are democratic, inclusive, collaborative, and participatory, but the process is not straightforward. The reflections within this paper focus on the challenges and opportunities the first and second authors faced as facilitators of co-produced research. Participant and co-researcher quotes reveal how participatory methods and approaches address gaps in experiential knowledge of exclusion and marginalisation. The potential for co-produced research to influence policy and practice is outlined. Elizabeth Casson Trust, The Constance Owens Trust, and The Institute of Social Psychiatry, via a Royal College of Occupational Therapists Annual Award.

COVID-19 has had a significant and measurable impact on individuals and families in economically deprived areas both in the United Kingdom and internationally. This article examines issues of community resilience and service adaptability and focuses on the period during the first lockdown in the United Kingdom (May to July 2020). Data were collected from members of the local community in Southend, with specific reference to the ‘A Better Start Southend’ programme of support. The evidence presented in this article uncovers the impact of the ‘first lockdown’ on families with young children, and local children’s and community services.

Data availability statement: The data that support the findings of this study are openly available in the University of Essex Research Repository at https://repository.essex.ac.uk/24364/ Copyright © 2022 The Authors. Introduction: Sport workforce strategy in the United Kingdom (UK) has identified the occupational therapy profession as being ideally positioned to contribute to public health agendas relating to tackling physical inactivity amongst marginalised populations, such as disabled people and people with experience of mental distress. However, a robust understanding of the enablers, restrictions, and exclusions such groups encounter when seeking to participate in sport and physical activity is currently lacking. Methods: This study aimed to gain an in-depth understanding of the different ways people with experience of mental distress talked about their participation in a community-based football league in England, in the UK. Nine people took part in this strand of a larger participatory action research (PAR) study, which used go-along interviews as the method of data collection. In alignment with PAR seeking to address power imbalances, the data from the go-along interviews were analysed through a Foucauldian lens using a collaboratively produced analytic framework. Findings: Participants constructed the community-based football league as fostering feelings of purpose and belonging, against a backdrop of them describing experiencing stigma and exclusion when seeking to be active in their wider communities. They used the concept of occupational marginalisation to further interpret their situation. Conclusion: Understanding why and how people participate in football extends beyond seeing it as an individual exercise to shared social lives and occupations. With this perspective, occupational therapists could address occupational marginalisation in partnership with community sports organisations, collaborating for wider social change beyond specialist services. Funding information: Royal College of Occupational Therapists' Annual Award; Constance Owens Trust; Elizabeth Casson Trust

This paper examines determinants of ethnic disparities in workplace risks of COVID-19 among health and social care workers (HCWs) in the UK. This was undertaken to inform public health policy in the management of COVID-19 relating to health and social care provision. A cross-sectional survey was administered in July–August 2020 (n = 456) to elicit HCWs’ experiences of COVID-19 management in the workplace and their perceptions of exposure, personal protection against infection, involvement in local clinical management, and other workplace hazards. Findings suggest minority ethnic HCWs were twice as likely as White HCWs to be in a patient-facing role (OR = 2.14, 95% CI:1.21; 3.78, P < 0.01) and twice as likely (63% vs 39%) to be caring for COVID-19 positive patients (OR = 2.68, 95% CI: 1.77; 4.06, P < 0.01). Those in nursing, were three times as likely to be redeployed to a COVID-19 care setting (OR = 3.33, 95%CI: 1.23; 9.02, P= 0.02). Minority ethnic HCWs within lower- and mid-level roles carried a higher burden of frontline clinical management of COVID-19 positive patients than their White counterparts. This study found evidence of ethnic disparities across several workplace hazards, with increased exposure to and less protection against infection, more responsibility for the clinical management of infection, and evidence of systemic racial bias in the disproportionate redeployment of minority ethnic nursing staff to COVID-19 areas. An NHS-wide review is required to assess procedural fairness, ensure safe practices now, and to avert future crises.

The National Institute for Health and Care Excellence (NICE) has been presented as politically independent, asserting it is free from industry influence and conflicts of interest so that its decisions may be led by evidence and science. We consider the ways in which soft political factors operate in guideline development processes at NICE such that guidelines are not truly led by science. We suggest that while NICE procedures explicitly incorporate scientific principles and mechanisms, including independent committees and quality assurance, these fail to operate as scientific practices because, for example, decisions may only be challenged through the courts, which regard NICE as a scientific authority. We then examine what the NICE rapid guideline procedure for COVID-19 reveals about the practical reality of claims about the scientific integrity of NICE guidelines. Changes to guideline development processes during the COVID-19 emergency demonstrated how easy it is to undermine the scientific integrity of NICE’s decision-making. The cancellation of the guideline programme and the publication of a rapid guideline process specifically to address the COVID-19 pandemic removed scientific checks and balances, including independent committees, stakeholder consultation and quality assurance, demonstrating that the relationship between NICE and the UK government is more complex than a scientific principle truism. We suggest that NICE is not (and indeed cannot be) truly independent of government in practice, nor can it be truly led by science, in part because of its relationship to the state, which it is simultaneously constituted by and constitutive of.

© 2020 The Author(s). Physical inactivity is a global public health priority, yet people living with a disability or long-term health condition, such as those who experience mental distress, continue to face inequalities and barriers to participation in sport and physical activity. These inequalities are considered an occupational injustice, in terms of participation in health enhancing occupations being restricted for these groups of people, despite them wanting to be more active. This study aimed to gain an in-depth understanding of the nature and value of participating in a UK based community football project, for people with experience of mental distress. Twenty-three people took part in this first strand of a larger participatory action research study, which used the World Café as a method for structuring and recording conversations. Data from the three World Café events were analysed collectively and thematically. The study’s findings reveal tensions, nuances, and subtleties that exist in relation to the reciprocal relationship between playing football and people’s health and well-being. The complexity of enabling participation in sport and physical activity amongst marginalised groups, such as people with experience of mental distress, is highlighted. Elizabeth Casson Trust

This paper focuses on the experiences of disabled people in the UK assigned to the Employment and Support Allowance Work Related Activity Group. Specifically, it considers the impact of processes o...

Quality-of-life measurement in depression is advocated as a patient-centred indicator of recovery, but may instead enhance the mimetic authority of randomised controlled trials (RCTs) which have been roundly critiqued in mental health. In this paper we draw on the social life of methods approach to extend the well-developed critique of RCTs into the field of quality-of-life measurement. We accomplish this through consideration and critique of the conceptual and epistemological development of quality-of-life measurement in depression, including the role of psychometrics in its development. Examining conceptual developments from the 1970s onwards, we consider how the scientific literature on quality-of-life in depression aligns with behavioural economics and consumerism but falls short of engaging with genuinely patient-centred approaches to recovery. We argue that quality-of-life measures in depression were developed within a consumerist model of healthcare in which the medical model was a central pillar and ‘choice’ a rhetorical device only. While quality-of-life instrument development was largely funded by industry, psychometrics provided no coherent solution to the ‘affective fallacy’ (high correlations between quality-of-life and depressive symptoms). Industry has largely abandoned the measures, while psychotherapy research has increasingly endorsed them. We argue that in their design and implementation, quality-of-life measures for depression remain based on a commercial model of healthcare, are conceptually flawed and do not support concepts of patient-centred healthcare.

We examined perceived self-other differences (self-uniqueness) in appraisals of one’s risk of an infectious disease (COVID-19), one’s adherence to behavioural precautionary measures against the disease, and the impact of these measures on one’s life. We also examined the relationship of self-uniqueness with information seeking and trust in sources of information about the disease. We administered an online survey to a community sample (N = 8696) of Dutch-speaking individuals, mainly in Belgium and The Netherlands, during the first lockdown (late April-Mid June 2020). As a group, participants reported that they were less likely to get infected or infect others or to suffer severe outcomes than average (unrealistic optimism) and that they adhered better than average to behavioural precautionary measures (illusory superiority). Except for participants below 25, who reported that they were affected more than average by these measures (egocentric impact bias), participants also generally reported that they were less affected than average (allocentric impact bias). Individual differences in self-uniqueness were associated with differences in the number of information sources being used and trust on these sources. Higher comparative optimism for infection, self-superiority, and allocentric impact perception were associated with information being sought from fewer sources; higher self-superiority and egocentric impact perception were associated with lower trust. We discuss implications for health communication. ispartof: Psychologica Belgica vol:62 issue:1 pages:152-167 status: published

The 2012 English Health and Social Care Act marked a fundamental reform of statutory healthcare in England in ways which elevated the interests of the government over the interests of patients or the professions, and which undermined traditional alliances between professions and patients. Drawing on a countervailing powers framework we present a thematic analysis of parliamentary papers, press releases and other publicly available materials produced across the reform process by four key actors in the healthcare field—the government, medical profession, patients and ‘for profit’ providers. This analysis explores how the pursuit of sectional interests by these actors may have acted to constrain potential alliances and ultimately contributed to the enactment of the legislation by default. This conclusion has relevance for other Beveridge model healthcare systems undergoing health and social care reform under the auspices of austerity.

Purpose This paper aims to explore right wing populist government responses to the coronavirus pandemic. Design/methodology/approach This paper is a narrative overview of right-wing populist policies and strategies, which is loosely structured around fascistic themes set out in Albert Camus’ allegorical novel, The Plague. Findings Although individual responses to the coronavirus pandemic among right-wing populists differ, they appear to coalesce around four central themes: initial denial and then mismanagement of the pandemic; the disease being framed as primarily an economic rather than a public health crisis; a contempt for scientific and professional expertise; and the “othering” of marginal groups for political ends. Populist responses to the pandemic have given rise to increased levels of xenophobia, the violation of human rights and the denigration of scientific expertise. Research limitations/implications This is a narrative overview from a personal viewpoint. Originality/value Drawing on themes in Camus' novel The Plague, this is a personal perspective on right wing populist government responses to the coronavirus pandemic. Populist responses to the pandemic have given rise to increased levels of intolerance and xenophobia and the violation of human rights and civil liberties.

In this chapter, Speed and Mannion develop understandings of the genesis of populist health policies and their impact on professional practice. In a case study drawn from the 2015/2016 excess weekend mortality controversy in the UK, they consider how various political actors utilised a populist political frame to structure the debate, and the influence this had on the medical profession regarding the imposition, by government, of a new contract of employment. Implications for the medical profession in the context of wider political (national and international) contexts are elucidated from the case study.

Building on Rinaldi and Bekker’s scoping review of articles on the impact of populist radical right (PRR) politics on welfare and population health, this short article formulates three pointers towards a framework that might help structure future research into PRR, populist politics more generally, and coronavirus disease 2019 (COVID-19) and other health issues. First, we discuss the centrality of welfare chauvinism to the PRR’s impact on health, taking this as a cue for a broader reflection on the importance on distinguishing between the nativist and populist dimensions of PRR politics. Secondly, we turn our attention to the potential moderating effect of the PRR’s welfare chauvinism on the welfare cuts proposed by their right-wing coalition partners, comments we see as pointing to the need to focus on nativist, populist, neoliberal and other threats to welfare policy more generally, rather than on the PRR only. Thirdly, we reflect on the paradoxical nature of welfare chauvinism – its negative consequences for the health of the ‘own people’ it proclaims to defend – as a starting point for a brief discussion of the need to consider carefully the not-so-straightforward relation between the PRR’s political rhetoric, its (impact on) policy and institutions, and the outcomes of such policy.

The Brighton Citizen's Health Services Survey (BCHSS) was developed to explore and potentially challenge how knowledge is used and by whom in the production of local health commissioning institutions and relations. Through the creation of an ‘animating set of questions’, it sought to open up spaces through which to make visible some of the ways of knowing and valuing the NHS and health services that had been minimised through the commensuration practices of post-2012 public engagement. In this way there was a clear agenda to facilitate a form of knowledge democratisation which opened up and validated different 'health publics’, in order to explore and broaden participative engagement opportunities. The paper provides an account of the project. It considers the theoretical and methodological underpinnings of this example of ‘evidence-based activism’, reflects on the impact of the project on local commissioning and considers the range of controversies that arose as a result of the work. It explores the way that research straddling the boundary between academic inquiry and political activism speaks to the many issues that are prevalent in the changing HE sector as well as NHS privatisation, health commissioning and public sector cuts.

The purpose of this paper is to offer a critical insight into the ubiquity of technology enhanced learning. The use of technology in higher education is underpinned by a promise that techno...

Background Comparative optimism, the belief that negative events are more likely to happen to others rather than to oneself, is well established in health risk research. It is unknown, however, whether comparative optimism also permeates people’s health expectations and potentially behaviour during the COVID‐19 pandemic. Objectives Data were collected through an international survey (N = 6485) exploring people’s thoughts and psychosocial behaviours relating to COVID‐19. This paper reports UK data on comparative optimism. In particular, we examine the belief that negative events surrounding risk and recovery from COVID‐19 are perceived as more likely to happen to others rather than to oneself. Methods Using online snowball sampling through social media, anonymous UK survey data were collected from N = 645 adults during weeks 5‐8 of the UK COVID‐19 lockdown. The sample was normally distributed in terms of age and reflected the UK ethnic and disability profile. Findings Respondents demonstrated comparative optimism where they believed that as compared to others of the same age and gender, they were unlikely to experience a range of controllable (eg accidentally infect/ be infected) and uncontrollable (eg need hospitalization/ intensive care treatment if infected) COVID‐19‐related risks in the short term (P

Over the past decade, some of the world's most stable parliamentary democracies have witnessed a revival in right-wing populist political parties, movements and leaders. Although there is a growing body of theoretical and empirical literature documenting the rise of populism, there has been very little exploration of the implications for health policy of this important political development. In this article, we draw from three illustrative international cases, originating from the USA, the UK and Italy, to explore the ways in which right-wing populism influences health policy: the election of President Trump in the United States (and subsequent healthcare reforms), the United Kingdom's vote to withdraw from the European Union (Brexit), and how this has played out in the context of the UK National Health Service, and the rise of a politically aligned anti-vaccination movement in Italy. Drawing on the work of the influential socio-political theorist Ernesto Laclau, we interpret populism as a performative political act, predicated on drawing logics of equivalence (and difference) between different actors. We use this theoretical framing to explore the ways in which the recent upsurge in right-wing populism creates a specific set of barriers and challenges for access to healthcare and the health of populations.

Existing studies show that nurses often experience moral distress when the care they deliver to patients does not meet their professional values. We draw on ethnographic data collected in June 2015 from one acute care trust in England and present how frontline healthcare staff experience organizing complex hospital discharges. Our findings demonstrate how problems with the panel responsible for allocating funding for National Health Service continuing healthcare cases contributed to healthcare staff experiencing moral distress. Our findings offer a basis for further research on how other aspects of the complex hospital discharge-planning process may contribute to nurses’ experiencing moral distress.

Meta-governance involves orchestrating the ‘rules of the game’ in public management. Arm’s-length bodies are particularly important vehicles for this. We consider the case of an arm’s-length body (NHS England) created to oversee the English NHS’ day-to-day operation, and remove ‘political interference’. Although mandated by the Department of Health it has increasingly operated as policy-maker, developing policies in tension with existing legislation, while Ministers have faded from public-facing accounts of service operation. This suggests NHS England operates as a meta-governor, insulating government whilst pursuing its own agenda, and raises crucial questions about governmental accountability whilst simultaneously making answers harder to obtain.

This paper problematizes the ways in which the policy process is conceived in published psychological research. It argues that these conceptions of the policy process fail to adequately reflect the real-world dynamism and complexity of the processes and practices of social policy-making and implementation. In this context, psychological evidence needs to be seen as one type of evidence (amongst many others). In turn this requires researchers to take account of broader political processes that favour certain types of knowledge and disparage others. Rather than be regarded as objective and scientific, policy in this characterisation is regarded as a motivated form of politics. This multi-layered, multi-level hybrid structure is not immediately amenable to the well-intentioned interventions of psychologists. While the tendency of many psychologists is to overestimate the impact that we can have upon policy formation and implementation, there are examples where psychological theory and research has fed directly into UK policy developments in recent years. This paper draws on the recent Improving Access to Psychological Therapies (IAPT) initiative and the work of personality researcher Adam Perkins on the UK’s social security system to ask whether psychology has a sufficiently elaborated sense of its own evidence base to legitimately seek to influence key national areas of public policy. The article cautions against dramatic changes to policy predicated upon any one reading of the variegated and, at times, contradictory psychological evidence base. It concludes that, in order to meaningfully contribute to the policy development process in a way which increases equality and social justice, psychologists need to be more strategic in thinking about how their research is likely to be represented and misrepresented in any particular context. Finally some possible directions for psychologists to take for a more meaningful relationship with policy are suggested.

From the 1980s onwards, discourses of risk have continued to grow, almost in ubiquity. Ideas and practices of risk and risk aversion have extended to UK mental health care where services are expected to assess and manage risks, and high-quality clinical assessment has been revised to incorporate risk assessment. This article problematises practices of risk assessment in mental health provision, focussing on the base-rate problem. It presents an analysis of audio recordings of risk assessments completed within a primary care mental health service. The analysis is informed by a critical logics approach which, using ideas from discourse theory as well as Lacanian psychoanalysis, involves developing a set of logics to describe, analyse and explain social phenomena. We characterise the assessments as functioning according to social logics of well-oiled administration and preservation, whereby bureaucratic processes are prioritised, contingency ironed out or ignored, and a need to manage potential risks to the service are the dominant operational frames. These logics are considered in terms of their beatific and horrific fantasmatic dimensions, whereby risk assessment is enacted as infallible (beatific) until clients become threats (horrific), creating a range of potential false negatives, false positives and so forth. These processes function to obscure or background problems with risk assessment, by generating practices that favour and offer protection to assessors, at the expense of those being assessed, thus presenting a challenge to the stated aim of risk assessment practice.

Walking and cycling have been transformed by digital technologies, which range from mapping apps for way-finding, through ‘wearables’ which monitor activity, to social media apps for comparing activity within social groups. Some technologies are explicitly orientated to health projects, others are not, yet all have potentially profound effects on bodies, health-orientated identities and understandings of health.This paper uses the concept of biomedicalisation to explore emerging literature on the intersection of digital technologies with everyday mobility, focusing on walking and cycling. Beyond simply ‘medicalising’ mobility (by bringing it into the realm of public health), digital technologies contribute to various transformations of health: encouraging some health practices, inhibiting others; creating or excluding individual and collective health-related identities; and reconfiguring health and wellbeing. There is research evidence on the contingent and multiple relationships between digital technologies and social practices, with specific themes including: quantification; the role of apps in framing walking as extraordinary, cycling as competitive; enabling users to perform as healthy, neoliberal citizens; and digital careers. There has been less attention on how social divisions are reproduced or disrupted by the mediation of mobility through digital technologies. Further research should consider the impact of digital technologies on political economies of health.

The UK National Health Service (NHS) has long espoused patient and public engagement. Recent years have seen increasing use of internet-based methods of collecting feedback about patient experience and public and staff views about NHS services and priorities. Often hailed as a means of facilitating participative democratic patient engagement, these processes raise a number of complex issues. A key aspect of it is the opportunity for comment to be made anonymously. Our research reveals an anonymity paradox whereby patients clearly demonstrate a perception that anonymity is a prerequisite for effective use of these feedback processes, whereas professionals demonstrate a perception that patient anonymity is a barrier to effective use. The risks of anonymity are constructed very differently by patients and professionals. Patient concerns around anonymity were not motivated by a general concern about a loss of privacy, but more that a positive identification might compromise future care. For professionals, concerns were voiced more around risks of reputational damage for specific practitioners or practices (in that anyone could say anything) and also that this anonymous feedback was available publicly and that it might go against the medical opinion of the professional. These concerns pointed to important differences in perceptions of patient and professional vulnerability. In the qualitative analysis that follows the key finding was that while anonymity makes service users feel less vulnerable, it can have the opposite effect on managers and clinical staff. This raises important implications for the use and utility of internet-based methods of collecting patient feedback.

Purpose – Previous research has established that there is a relationship between housing and mental health, however, understanding about how and why housing affects mental health is still limited. The purpose of this paper is to address this deficit by focusing on the experiences of residents of houses in multiple occupation (HMOs). Design/methodology/approach – Semi-structured interviews were carried out with 20 HMO residents who were asked about their housing career and experience of living in a HMO. Participants were recruited with assistance from community organisations and landlords. Findings – The physical properties and social environment of the property, as well as personal circumstances experienced prior to the move into the property, all influenced how mental health was affected. The authors identify and discuss in detail three key meditating factors: safety, control and identity which may affect how living in the property impacts the mental health of tenants. Practical implications – Good property management can lessen the potential harmful effects of living in a HMO. However, poorly run properties which house numerous vulnerable people may increase the risk of poor mental health due to attendant high levels of stress and possible risk of abuse. Originality/value – Based on the reports of HMO residents, the authors outline the key mediating processes through which living in HMOs may affect mental wellbeing, as well as illuminating the potential risks and benefits of HMOs, an overlooked tenure in housing research.

Drawing on the traditions of discursive psychology and critical discourse analysis this study examined the presentation of attention deficit hyperactivity disorder (ADHD) in women in a sample of the most commonly identified online YouTube videos on this topic. The video material selected represented a combination of first-person testimonies from the “sufferer” and the sharing of “expertise” by “professionals.” Analysis involved the identification of common rhetorical devices and evaluation of the role of these devices in conveying various key meanings or themes. The categories generated by this method told a story of the construction of an “ADHD product” presented to women by other women, and unproblematically positioned within the biomedical discourse. Stimulant medication was endorsed for its ability to improve performance at work and in the domestic sphere. Women sufferers in the videos appear as “active consumers” promoting the ADHD diagnosis for its ability to enable them to fulfil the “superwoman” i...

Patient and public involvement (PPI) in UK National Health Service (NHS) research has become an imperative in policy and practice. However, lack of clarity on what PPI is (or might be) has given rise to a poorly monitored, complex field of activity, variously framed by the expectations of policy makers, funders, host organizations, researchers, health professionals, individual recruits, volunteers, activists, and third sector organizations. The normative shift toward PPI has taken place within a neoliberal policy context, the implications of which needs to be explicitly considered, particularly after the Brexit referendum which has left policy makers and researchers wondering how to better appeal to a distrustful public subjected to “post-truth” and “dog whistle” politics. This commentary examines the prospects for a more critical approach to PPI which addresses context, is evidence-informed and mindful of persistent inequalities in health outcomes, at a time when models of PPI in NHS health research tend to be conceptually vague, derived from limited clinical and managerial settings, and centered on a construction of the abstract, rational, compliant, and self-managing patient or layperson.

In this paper we revisit the notion of civil society in the light of recent attempts to privatize health care in England via the passing of the Health and Social Care Act of 2013. This legislation promises a re-commodification of the National Health Service (NHS) in England. The Bill was bitterly contested during its passage through parliament, most vigorously in 2011. Much of the opposition occurred at a time of widespread, global rebellion, most notably in the 'Arab uprisings' and through the 'occupy movement'. Despite a plethora of protests, we argue, a non-porous boundary between what we call the 'protest sector' of civil society and the wider public sphere of the lifeworld has become apparent in England. A good deal of collective action, whether campaign-focused (like opposition to the Health and Social Care Bill) or more generalized (like rejections of corporate greed), has so far proved ineffective, at least in the short-term; no crisis of legitimation is apparent. We highlight a new 'class/command dynamic', leading to oligarchic rule, in the present era of financial capitalism. We use this health care case-study to re-examine the notion of civil society and its changing properties in what Castells calls a 'networked society'. The contribution ends with a discussion of the role of the sociologist re-civil society and the advocacy of both 'action' and 'foresight sociologies'.

Linking the UK Coalition Government's Health and Social Care Act to historical trend to 'outsource' government IT projects to privately owned tech firms and to processes of technologisation in the National Health Service, this article explores both the reality and the rhetoric of the government's purported 'information revolution' in the NHS. It takes issue with a view of technological fixes as being merely at the service of scientific, medical, or political masters, and argues for the importance of considering the role of IT in the marketisation of healthcare in the United Kingdom. Technology influences both the way information is gathered and the nature of what is measured, but these processes are rarely subject to any critical review; and once data has been produced, its reduction of complex processes to arithmetical categories can be forgotten, and decisions more easily made through market practices.

Austerity hangs like a global spectre over health and welfare spending and provision. It is the new orthodoxy, an accepted popular ‘fact’ that we are all living in an ‘age of austerity’ (Farnsworth...

The 2012 Health and Social Care Act, introduced by the coalition government, has been seen as fundamentally changing the form and content of publicly funded health care provision in England. The legislation was hugely controversial and widely criticized. Much of this criticism pointed to the ways in which the reforms undermined the funding of the National Health Service, and challenged the founding principle of free universal provision. In this commentary we take issue with the argument that the Act represented a radical break with the past and instead suggest that it was an extension of the previous Labour government’s neo-liberal reforms of the public sector. In particular, the Act invoked the principles of ‘new professionalism’ to undermine professional dominance, and attract private providers into statutory health care at the expense of public providers. In turn, this extension of new professionalism may encourage public distrust in the medical profession and absolve the state of much of its statutory health care obligation.

Time banking is a third-sector initiative that enacts principles of co-production and offers a model with which to understand how users can become actively involved with professionals and other stakeholders in the delivery of public services. This article explores possible lines of tension between principles that underpin time banking practices and principles informing the health policy field in the United Kingdom. We develop a framework rooted in the logics approach to critical policy analysis with which to track shifts in conceptions of co-production at three nodes situated along the full length of the public service chain: (1) service provision and distribution; (2) service delivery; and (3) service governance. Our analysis reveals discrepancies in the way co-production principles can be defined, interpreted, and linked to broader notions of social justice: recognition-based interpretations with a transformative accent, and choice-based interpretations with an additive accent. We conclude that the heal...

In their editorial, Speed and Mannion identify two main challenges "the rise of post-truth populism" poses for health policy: the populist threat to inclusive healthcare policies, and the populist threat to well-designed health policies that draw on professional expertise and research evidence. This short comment suggests some conceptual clarifications that might help in thinking through more profoundly these two important issues. It argues that we should approach right-wing populism as a combination of a populist down/up (people/elite) axis with an exclusionary nationalist in/out (member/non-member) axis. And it raises some questions regarding the equation between populism, demagogy and the rejection of expertise and scientific knowledge.

The UK National Health Service (NHS) has long espoused patient and public engagement. Recent years have seen increasing use of internet-based methods of collecting feedback about patient experience and public and staff views about NHS services and priorities. Often hailed as a means of facilitating participative democratic patient engagement, these processes raise a number of complex issues. A key aspect of it is the opportunity for comment to be made anonymously. Our research reveals an anonymity paradox whereby patients clearly demonstrate a perception that anonymity is a prerequisite for effective use of these feedback processes, whereas professionals demonstrate a perception that patient anonymity is a barrier to effective use. The risks of anonymity are constructed very differently by patients and professionals. Patient concerns around anonymity were not motivated by a general concern about a loss of privacy, but more that a positive identification might compromise future care. For professionals, concerns were voiced more around risks of reputational damage for specific practitioners or practices (in that anyone could say anything) and also that this anonymous feedback was available publicly and that it might go against the medical opinion of the professional. These concerns pointed to important differences in perceptions of patient and professional vulnerability. In the qualitative analysis that follows the key finding was that while anonymity makes service users feel less vulnerable, it can have the opposite effect on managers and clinical staff. This raises important implications for the use and utility of internet-based methods of collecting patient feedback.