Interpreting personalization in England's National Health Service: a textual analysis

Abstract

Different versions of choice are at work in England's National Health Service. A hard version of choice associated with provider competition (and patient exit) appears to be giving way to a ‘softer’ concept of ‘personalization’, emphasizing choice and voice at the micro level, but also drawing on solidaristic themes. As personalization becomes increasingly central to health reform, it is important to interpret the ways in which a personalization narrative is being used. It is also necessary to trace its ambivalent framing of National Health Service patients, staff and structures. This paper uses textual analysis to explore how personalization has been positioned in ministerial speeches and health policy documents. It finds that personalization is located in a discourse of organizational decline and disruption, emphasizing the need for patient exit and voice as recuperative mechanisms, but also one of consolidation, trust and equity, emphasizing loyalty to shared welfare services. Hirschman makes clear that an interplay between exit, voice and loyalty is to be expected. However, there is an ambivalence in their relationship which is being ignored by health policy-makers. Frontline staff and service users are left to negotiate an agenda which positions them as both partners and adversaries.

Keywords:

• personalization
• National Health Service
• choice
• textual analysis
• New Labour

Acknowledgements

I am grateful for the comments received on an earlier draft of this paper at the ECPR Joint Sessions, Lisbon 14–19 April 2009, workshop on ‘Voice and choice in health politics’, and from two anonymous referees.