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Posted Mon, 27 Feb 2006 11:11:20
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British Sociological Association
*London Medical Sociology Group Meeting*
*Wednesday 8th March 6pm*
*Managing the 'enterprise' of primary care? Neo-liberalism and NHS LIFT*
*Rachel Aldred (Goldsmiths College)*
*Venue*
King's College London
Franklin Wilkins Building
Room 1.16
Stamford Street
London SE1 8WA
nearest train/tube station: Waterloo
*Abstract*
This paper will build on my case study research to draw conclusions
about the nature of neoliberalism and the sources of its power. Has
there been a successful ‘culture change’ within local NHS organisations,
accepting marketised rationalities and logics? To what extent are local
NHS managers convinced by neoliberal discourses, and do these discourses
help them to manage staff and patients? Beginning with an overview of
changing power relations in the NHS over the past sixty years, I will
move on to discuss the significance of my case study material, which
involves NHS LIFT (a public-private partnership to modernise primary
care premises). This section of the talk will also compare neoliberal
discourse about the private sector in the NHS with local experiences of
implementing NHS LIFT. One prominent theme in my data has been the
development of closed networks inhibiting dissent. GPs feel that they
are kept in the dark about developments, and Patients’ Forums seem to be
even more marginalised. Chains of communication have either been broken
or are organised so as to run in only one direction: downwards. While
neoliberal discourse appears smooth and powerful, when used in practice
it seems to generate contradictions. For example, the government has
talked of encouraging entrepreneurial GPs, yet the LIFT initiative
shifts ownership of primary care buildings from GPs (and from the public
sector) to large international corporations. Such fissures in neoliberal
discourse are likely to create new legitimation crises: I will conclude
by examining state and private sector strategies to prevent these.
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