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This chapter focuses on the experiences and impacts of both active and passive hostility and hate against disabled people when using public transport, in particular buses. Significantly, disabled people often have no alternative to using public transport. The chapter examines the opportunism of hostility and hate, techniques of collaboration and justification, and why bystanders tend not to intervene. The chapter draws on evidence from a study of experiences of disabled people of verbal abuse and physical harassment on public transport in the UK. Victims’ voices are brought to the fore highlighting the ordinariness of hate crime, the expectation of victims and the acceptance of onlookers. The chapter concludes with potential solutions to reducing acts of hostility, including bus design, training for staff, support for reporting of incidents and education.
The National Health Service in Britain could not ensure that doctors … would choose overnight to be ‘better’ doctors; all it could do was to provide that particular framework of social resources within which potentially ‘better’ medicine might be more easily chosen and practiced. (Titmuss, quoted in Moon and North, 2000, p 72)
This chapter discusses how, some 40 years after Titmuss wrote the above, some of the last refuges of medical professional autonomy and individualism are being challenged. It describes the latest ‘framework of social resources’ – Primary Care Groups and Trusts (PCG/Ts) – and evaluates their prospects for success in, among other things, generating ‘better’ doctors (and nurses and other primary health professionals).
Historically, primary care – particularly the healthcare provided through general practitioners (GPs) – has constituted both the cornerstone and the Achilles heel of the National Health Service (NHS). Both as the provider of easily accessible, low cost, first contact and continuing care and as the gatekeeper to more expensive specialist health services, primary care has played a major role in ensuring universal healthcare is available in Great Britain, at relatively low cost. However, wide variations in the levels and standards of primary care services, difficulties in containing costs within a demand-led service, and the separation of primary care from mainstream NHS management and planning have together prevented the development of a service that is either of consistently high quality or integrated with other community-based health services. For the past 50 years, general practice has remained a ‘cottage industry’ on the fringes of the NHS, based on “individualistic, small shopkeeper principles” in which “the principles of free choice of doctors by patients and complete medical autonomy … remain sacrosanct” (Klein, 1983, p 14).
