Trusting in the New NHS: instrumental versus communicative action

Brown, Patrick R (2008) Trusting in the New NHS: instrumental versus communicative action. Sociology of Health & Illness, 30 (3). pp. 349-363. ISSN 0141-9889. (The full text of this publication is not currently available from this repository. You may be able to access a copy if URLs are provided)

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Recent reforms within the UK National Health Service, particularly the introduction of clinical governance, have been enacted with the apparent aim of rebuilding patient trust. This paper analyses the approach taken by policy makers, arguing that it is based very much on an instrumental conception of trust. The assumptions and limitations of this model are discussed and in so doing, a communicative understanding of trust is proposed as an alternative. It is argued that the instrumental rationality and institutional focus inherent to instrumental trust neglect the importance of the communication between patient and medical professional and its affective dimensions. Communicative trust goes beyond a mere cognitive appreciation of the system and rather is dependent on the qualitative interaction at the access point, where the patient comes to believe that the communicative rationality of their best interests is mirrored by the professional’s instrumental rationality. Whilst recent challenges to the confidence of patients in professionals and medical knowledge make some approximation of an ideal speech situation more imperative than previously, the application of an instrumental concept of trust in the NHS makes such interactions less likely, as well as facilitating a divergence between instrumental and communicative rationality in healthcare provision.

Item Type: Article
Projects: [96] PhD studentship
Uncontrolled keywords: trust; risk; rationality; communication; clinical governance
Subjects: H Social Sciences > HM Sociology
R Medicine > R Medicine (General) > R723 Medical ethics
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Divisions: Faculties > Social Sciences > School of Social Policy Sociology and Social Research > Centre for Health Services Studies
Depositing User: Patrick Brown
Date Deposited: 07 Mar 2009 12:34
Last Modified: 06 May 2014 13:53
Resource URI: (The current URI for this page, for reference purposes)
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