Who choosing what? The evolution of the use of ‘choice’ in the NHS, and its importance for New Labour
Bibliographic record
Abstract
Introduction “Choice is an important principle for our reform programme” (Tony Blair, 2002, p 28). Choice is very, very important, for two reasons. First, because it is absolutely in accord with the sort of society in which we live. People make choices in their lives continually. Second, because I think choice is the primary means by which you can drive the NHS to better focus on the needs of its individual patients. (Alan Milburn, Secretary of State for Health, interviewed by Nicholas Timmins, 2002, p 132) This chapter considers the role of ‘choice’ in UK health policy documents, examining the remarkable changes over who is meant to make choices in the National Health Service and what sort of choices they are supposed to be making, especially with regard to New Labour's health policy since 1997. ‘Choice’ is a key aspect of consumerism in contemporary welfare policy; indeed “the maximization of patient choice” is at the top of Nettleton's (1995, p 249) list of what consumerism means in the context of the NHS. But ‘choice’ has meant different things at different times. Given New Labour's recent attempt to place patient choice at the heart of driving reform in the NHS, it is especially salient to compare this initiative with attempts to utilise choice as a policy instrument in the past, and consider what it might mean for the future. The evolution of the health consumer In crude, but essentially accurate, terms we can periodise the 1970s as being a time in which we can discern a mounting criticism of public services both from the public and media. This criticism became more vocal during the 1980s amid a move towards a more individualist model of society (Walsh, 1994; Beardwood et al, 1999), paralleled by the resurgence of neo-conservatism and a populist shift from the collectivist ideals of the post-war consensus to a free-market, individualised ideal to self-care, individual responsibility and the decline of the state (Mishra, 1990).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.021 | 0.020 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.010 | 0.086 |
| Scholarly communication | 0.021 | 0.025 |
| Open science | 0.002 | 0.008 |
| Research integrity | 0.009 | 0.013 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".