Trust, Risk and Health Care Reform

Across the developed world, governments face severe challenges in health care reform as demand rises

and resource constraints grow more stringent. In the UK, the current government is devoting

considerable resources to welfare state reform and (arguably) achieving real improvements in services

such as the NHS and education. Despite this, the reforms remain highly controversial and there is

considerable concern about lack of trust in the new welfare policies. A decline in trust may undermine

the public acceptability of the reforms and threaten the ability of government to gain electoral support

for them. Recent work in sociology, political science and psychology indicates that rational deliberative

and non-rational valued-based or affective factors contribute to trust in institutions. At the same time,

theoretical arguments suggest an increasing need for public trust. Trust facilitates the co-ordination of

complex enterprises under conditions of uncertainty, especially valuable at a time when rising demand

and intensifying pressures for spending constraint provide a continuing impetus for reform. One

possibility is that policies designed within a rational actor framework may erode the non-rational

aspects of trust, so that the service improves but trust in it declines, with consequences for the political

sustainability of reformed health care systems. Risk research in health care has a good opportunity to

consider issues of institutional trust and to build inter-disciplinary links in doing so.