Health care needs and health policy : the case of renal services

This thesis presents a critical ethnography of decision making with respect to the assessment of health care needs in the UK health system. Theories of need, justice and rights are reviewed in relation to structural changes to the National Health Service, together with the different theoretical approaches underpinning health policy based on human needs. The research on which this thesis is based focuses on a case study of an independent review of renal services in London, concentrating on the needs assessment work of the review group set up by the government and the decision making debates this review group engaged in. The methods used are based on a participatory, critical ethnography. The review process is evaluated critically by relating the technical knowledge produced by the group to a theoretical framework for assessing needs and by using a Habermasian perspective to investigate the ways in which the language of need is used to legitimise the agendas of various vested interests. This work is linked with an analysis of quasi-markets in the health service to explore the capacity that the technical discourses of markets and contracting have for reinforcing the ideological distortions identified in the analysis of the group's debates concerning need. Finally, by linking an analysis based on a case study of renal services to theoretical understandings of health care needs and health policy, a general critique of the UK health system is constructed.