Bringing hope to crisis: critical thinking, ethical action and social change

This paper departs from this point to consider whether and how crisis thinking contributes to practices of affirmative critique and transformative social action in late-capitalist societies. I argue that different deployments of crisis thinking have different ‘affect-effects’ and consequences for ethical and political practice. Some work to mobilize political action through articulating a politics of fear, assuming that people take most responsibility for the future when they fear the alternatives. Other forms of crisis thinking work to heighten critical awareness by disrupting existential certainty, asserting an ‘ethics of ambiguity’ which assumes that the continuous production of uncertain futures is a fundamental part of the human condition (de Beauvoir, 2000). In this paper, I hope to illustrate that the first deployment of crisis thinking can easily justify the closing down of political debate, discouraging radical experimentation and critique for the sake of resolving problems in a timely and decisive way. The second approach to crisis thinking, on the other hand, has greater potential to enable intellectual and political alterity in everyday life—but one that poses considerable challenges for our understandings of and responses to climate change...

Undermining patient and public engagement and limiting its impact:the consequences of the Health and Social Care Act 2012 on collective patient and public involvement

Patient and public involvement has been at the heart of UK health policy for more than two decades. This commitment to putting patients at the heart of the British National Health Service (NHS) has become a central principle helping to ensure equity, patient safety and effectiveness in the health system. The recent Health and Social Care Act 2012 is the most significant reform of the NHS since its foundation in 1948. More radically, this legislation undermines the principle of patient and public involvement, public accountability and returns the power for prioritisation of health services to an unaccountable medical elite. This legislation marks a sea-change in the approach to patient and public involvement in the UK and signals a shift in the commitment of the UK government to patient-centred care. © 2013 John Wiley & Sons Ltd.

Logics of marginalisation in health and social care reform:integration, choice, and provider-blind provision

The period 2010–2013 was a time of far-reaching structural reforms of the National Health Service in England. Of particular interest in this paper is the way in which radical critiques of the reform process were marginalised by pragmatic concerns about how to maintain the market-competition thrust of the reforms while avoiding potential fragmentation. We draw on the Essex school of political discourse theory and develop a ‘nodal’ analytical framework to argue that widespread and repeated appeals to a narrative of choice-based integrated care served to take the fragmentation ‘sting’ out of radical critiques of the pro-competition reform process. This served to marginalise alternative visions of health and social care, and to pre-empt the contestation of a key norm in the provision of health care that is closely associated with the notions of ‘any willing provider’ and ‘any qualified provider’: provider-blind provision.