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  • Author or Editor: Ellen Stewart x
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Academic research on health policy divergence across the United Kingdom since devolution has characterised Scotland's approach as ‘professionalistic’ or ‘collaborative’. This article argues that more nuanced studies of particular policy areas are needed, and offers an exploration of the Scottish approach to public involvement as an example. An analysis of policy documents since devolution reveals the shifting significance of public involvement, and the introduction of new instruments for its accomplishment. The Scottish National Party’s vision of ‘a mutual National Health Service’ is presented as a complex, even contradictory, project, which warrants further empirical attention both within and beyond the context of four-system comparisons.

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This chapter reviews quantitative data on the British public’s views on the NHS. I review comparative data which suggests public support for the NHS is relatively, but not exceptionally high in international comparison, and national surveys such as the British Social Attitudes Survey and ad hoc commissioned opinion polls. I use the concept of epistemic infrastructures to argue that approaches to surveys, and the thinktanks which fund and report polls, structure the possibilities for knowing how Britain feels about the NHS.

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This chapter introduces the topic and sets out the book’s approach. I outline the conventional wisdom that the NHS has a particular, and internationally unusual, place in the public’s heart. I justify a focus on ‘love’ as a sentiment, over less emotive terms such as ‘satisfaction’. Finally, I introduce the book’s empirical focus on public practices of care and contestation.

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Practices of Care and Contestation

EPDF and EPUB available Open Access under CC-BY-NC-ND licence.

What does it mean to love a healthcare system?

It is often claimed that the UK population is unusually attached to its National Health Service and the last decade has seen increasingly visible displays of gratitude and love. While social surveys of public attitudes measure how much Britain loves the NHS, this book mobilises new empirical research to ask how Britain loves its NHS.

The answer delves into a series of public practices – such as campaigning, donating and volunteering within NHS organisations – and investigates how attitudes to the NHS shape patient experience of healthcare. Stewart argues that these should be understood as practices of care for, and contestation about the future of, the healthcare system.

This book offers a timely critique of both the potential, and the dysfunctions, of Britain’s complex love affair with the NHS.

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This chapter draws together findings from the previous empirical chapters about ‘how’ Britain loves the NHS, and demonstrates why this matters.

I review the practices of care and contestation presented in earlier chapters and propose that we need to understand Britain’s love for the NHS as having multiple dimensions: affective, cultural, material and political.

I review some of the dysfunctional political consequences of Britain’s love for the NHS and argue that, rather than ‘correct’ public attachment to the healthcare system, we might build on it to renew the solidaristic basis of the welfare state.

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This chapter reviews the current landscape of volunteering in the NHS. I bring together auto-ethnographic insights from volunteering in a hospital café, with an analysis of, and interviews with people volunteering at the local level in Scotland and wider research on why people give their time to volunteer within the NHS. I emphasise volunteering as a practice of care, rooted in social connection and enjoyment, and a practice of contestation, through which volunteers enact patterns of care that they value.

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This chapter explores public campaigns which are oriented around ‘the NHS’. I analyse online materials produced by two current campaigns: Keep our NHS Public and Your NHS Needs You to explore their representations of a ‘public’ NHS.

Then, drawing on qualitative data from studies of campaigns to ‘save’ local hospitals, I explore the activist practices through which members of the public seek to influence local configurations of the NHS. In this, I explore specifically how ‘the NHS’ functions as object of contention within debates about local hospitals.

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This chapter reports an analysis of public contributions to the Care Opinion website (a health and care reviewing site which works in partnership with many NHS organisations). I analyse contributions which refer not to the hospital or organisation where care was offered, but which specifically mention ‘the NHS’, to explore how people connect and mobilise the NHS in relation to their positive and negative experiences as patients. I explore how reviews exhibit various narrative strategies to cushion and present criticism, concluding that these actively sought out opportunities to offer feedback as a gift to the NHS are both cultural and political acts.

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This chapter explores how we can interpret fundraising as an act of ‘love’ for the NHS. Examining the upsurge of charitable financial donations for NHS charities during the COVID-19 pandemic, I demonstrate the relative spontaneity of the appeal, and its remarkable success. Then I report a qualitative analysis of fundraising pages created by members of the public on JustGiving and GoFundMe, to explore how the NHS is constructed as a cause for public gratitude and support.

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Concerns about the limited influence of research on decision making have prompted the development of tools intended to mediate evidence for policy audiences. This article focuses on three examples, prominent in public health: impact assessments; systematic reviews; and economic decision-making tools (cost-benefit analysis and scenario modelling). Each has been promoted as a means of synthesising evidence for policy makers but little is known about policy actors’ experiences of them. Employing a literature review and 69 interviews, we offer a critical analysis of their role in policy debates, arguing that their utility lies primarily in their symbolic value as markers of good decision making.

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