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Local Participatory Democracy in Britain's Health Service: Innovation or Fragmentation of a Universal Citizenship?
Author(s) -
Milewa Timothy
Publication year - 2004
Publication title -
social policy and administration
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.972
H-Index - 63
eISSN - 1467-9515
pISSN - 0144-5596
DOI - 10.1111/j.1467-9515.2004.00388.x
Subject(s) - citizenship , politics , public administration , entitlement (fair division) , democracy , health care reform , rhetoric , health care , corporate governance , sociology , deliberative democracy , citizen journalism , devolution (biology) , political science , political economy , health policy , law , economics , linguistics , philosophy , mathematical economics , finance , anthropology , human evolution
A political emphasis upon the devolution of governance and management in the British National Health Service has, since 1997, been paralleled by an apparent concern to reinvigorate patient and public involvement in aspects of planning and decision‐making. A quasi‐communitarian rhetoric and echoes of nineteenth‐century welfare mutualism have accompanied significant reform of arrangements for patient and public involvement. This article considers the degree to which this fusion of normative exhortation and structural reform heralds a marked evolution in the principles and practice of participatory democracy in the planning and governance of health care. The reforms, in historical perspective, appear to constitute a significant extension of the arenas within which citizens can explore and debate issues pertaining to the health service. But selective political recourse to quasi‐communitarian sentiment points to an embryonic policy discourse that links entitlements to obligations on the part of those reliant on the NHS. This may be of considerable significance in a system of health care to which entitlement has, historically, been cast as a right of citizenship.