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This paper seeks to determine the value of theoretical ideal-types of medical control. Whilst ideal types (such as the iron cage and gaze) need revision in their application to medical settings, they remain useful in describing and explaining patterns of control and autonomy in the medical profession. The apparent transition from the cage to the gaze has often been over-stated since both types are found in many contemporary health reforms. Indeed, forms of neo-bureaucracy have emerged alongside surveillance of the gaze. These types are contextualised and elaborated in terms of two empirical examples: the management of medical performance and financial incentives for senior hospital doctors in England. Findings point towards the reformulation of medical control, an on-going re-stratification of the medical profession, and the internalisation of managerial discourses. The cumulative effect involves the medical profession's ability to re-cast and enhance its position (vis-à-vis managerial interests).
Keywords: medical profession, medical control, iron cage, gaze

Health policy has been termed a 'chameleon concept', referring to its ability to take on different forms of disciplinarity as well as different roles and functions. This paper extends Paton's analysis by exploring the paradox of health policy as a field of academic inquiry—sitting across many of the boundaries of social science but also marginalised by them. It situates contemporary approaches within disciplinary traditions, explaining its inter- and multi-disciplinary character. It also presents a 'way of seeing' health policy in terms of three axes: central/local, profession/management, and health/healthcare. The paper concludes with a call for a new research agenda which recognises health policy's pedigree but also one which carves a distinctive future of relevance and rigour.

This paper examines the personal experience of illness and healthcare by health managers through their illness narratives. By synthesising a wider literature of illness narratives and health management, an analytical framework is presented, which considers the impact of illness narratives, comprising the logic of illness narratives, the actors involved and strategies, including the contexts in which those illness narratives are used and the impact they have. The framework incorporates conceptual and categorical approaches to the interactions between their narratives and health management. This framework advances understandings of illness narratives in healthcare: why this narrative was given in this way to this audience. However, as such narratives constitute crucial evidence about health services that is unobtainable elsewhere, the need for more research in this field is pressing. As data on such narratives are poorly collated, the paper calls for more research in this field and presents the analytical framework to shape such empirical inquiry.

Relations between managers and professionals in the public sector have often centred on the control of work performance. Work performance strategies and techniques have been transformed by recent public sector policies involving managerialisation and quasi-markets. In particular, the clinical audit programme in the National Health Service has traditionally been the preserve of professionals, mainly doctors but managers and purchasers have become more involved recently. Based on an empirical study, this paper explores the ways in which Health Authorities were approaching their responsibilities, the consequences of such strategies for purchasers and providers, and the implications for professional-managerial relations. The paper concludes that purchasers have not made substantial progress in assessing work performance because of professional resistance and the non-threatening environment fostered by some purchasers.

General Managers (GMs) represent a relatively new cadre in the British National Health Service (NHS) who have become closely aligned with central government policy in recent years. GMs have increasingly been appointed to local levels in the NHS which could potentially lead to a clash with other professional domains. This paper uses the example of a decentralisation policy to trace the contest between GMs and professionals during its implementation. The paper focuses on Community Health Services (CHS) where the negotiated order of the hospital does not apply, where professional interests are more fluid and where organisational boundaries are ill-defined. It concludes that, at the local level, GMs are not simply agents of the centre but actively negotiate with other stakeholders and modify the policy according to local exigencies. The conclusion explores the implications for CHS of locally and centrally inspired policy initiatives and the place of CHS in the emerging mixed economy of welfare.

AbstractThere has been longstanding international fascination with the British National Health Service since it was established in 1948. The British population itself has offered enduring support for the principles and institutions of public provision. However, coverage of the NHS has typically been uneven in academic and policy debates. There is limited understanding of some darker corners of NHS provision resulting in a partial picture of public service provision. Public dentistry has been a Cinderella service in broader debates about the NHS and a check‐up is overdue. We offer a long‐term view of dentistry that assesses the current state of dental health policy, including its gradual decay. We examine the purpose of dentistry and the challenge of injecting fundamental National Health Service values (weighted capitation and a focus on need) into services and which necessitates redistribution and tackling shibboleths of NHS provision. Alongside political values and public attitudes, we examine the interests of professional stakeholders and how the combination of values, attitudes, and interests does not currently cohere into a sustainable policy. We explore how dentistry might recover purpose and respond to need. Discussion is prescient considering an acknowledged crisis in British dental care, including widespread public and media coverage, and with 2024 being a general election year with NHS provision a familiar battleground.

This paper reports from an ethnographic study of hospital planning in England undertaken between 2006 and 2009. We explored how a policy to centralise hospital services was espoused in national policy documents, how this shifted over time and how it was translated in practice. We found that policy texts defined hospital planning as a clinical issue and framed decisions to close hospitals or hospital departments as based on the evidence and necessary to ensure safety. We interpreted this framing as a rhetorical strategy for implementing organisational change in the context of community resistance to service closure and a concomitant policy emphasising the importance of public and patient involvement in planning. Although the persuasive power of the framing was limited, a more insidious form of power was identified in the way the framing disguised the political nature of the issue by defining it as a clinical problem. We conclude by discussing how the clinical rationale constrains public participation in decisions about the delivery and organisation of healthcare and restricts the extent to which alternative courses of action can be considered.

Abstract The UK National Health Service is introducing policies offering patients a choice of the hospital where they would like to be treated. 'Patient choice' policies form part of a wider debate about the access to health care and the interaction between providers (including information, provision, performance and reputation) and patients (including knowledge, resources and willingness to travel). As the hospital of 'choice' might not necessarily be the 'local' provider, such policy developments are predicated on an assumption that some patients will be willing to travel further. This will, in turn, affect patients' access to services. In general, use of services decreases with distance but this is dependent on accessibility to services, the organization of those services, the socio‐economic characteristics of the patient, perceptions of the provider and the condition for which they are to be treated. This article reviews the evidence on patients' willingness to travel in terms of access to health care and assesses the emerging implications of and for current UK policy on patient choice.