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Journal Article (Refereed)
November 2011

Patient choice and participation in decision making is not always that straightforward

Haworth, R 2011, 'Patient choice and participation in decision making is not always that straightforward', British Medical Journal, 343(d7570).


BMJ 2011; 343 doi: 10.1136/bmj.d7570 (Published 23 November 2011)

Cite this as: BMJ 2011;343:d7570

 Patient choice and participation in decision making is not always that straightforward.

Rita Haworth Senior Lecturer Social Policy
The University of Salford
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Patient choice and participation in health care decision making processes have been central to government health policy from both the right and left since the 1970’s. Policy documentation such as The NHS and Community Care Act (1990), The Patients Charter (1995) and subsequent legislation such as The New NHS: Modern and Dependable (1997), The Local Government and Public Involvement Act, and more recently the NHS and Social Care Bill (2011) all state patients and the public should be more involved in health care decision making processes regarding the health care they receive. However, research evidence to date, for example Garliardi et el (2008) Steniszewska et el (20012) Suggest patient participation in health care decision making processes have been minimal.
Therefore, if women are really to be given ‘choice’ on types of delivery (caesarean verses virginal) clinicians and midwifery staff need to concede autonomy, share more knowledge with patients and address this issue in a more collaborative manner.
When considering patient/lay participation in the decision making process within the NHS it is important to look at what forms of knowledge and expertise are valorised in governance. (Newman and Clarke 2009) Culter and Waine suggest there is a ‘generic management’ practice within organisational governance such as medicine that ‘ordinary people’ in this instance expectant mother, with lay knowledge who do not fit this model. Without appropriate training to equip them with necessary Knowledge and attributes to participate in decision making processes women’s choice in decisions related to modes of child birth will if one applies Arnstein’s theory of participation unfortunately remain tokenistic.
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Gagliadi, A. Lemieux-Charles, L. (et al) (2008) Barriers to patient involvement in health service planning and evaluation: an exploratory study. Patient Education and Counselling. 70 (2) pp234-241
Haworth, R. Melling. B. (2009) From Rhetoric to Reality: Breaking down the Barriers. To What Extent are Service users Collaborating in Decision Making Processes within the NHS? Proceedings of the 13th International conference, 10-11 September, Dilemmas in Human Services. University of Staffordshire pp 50-58
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in health Care Purchasing. London. Sage
Newman, J. Clarke, J (2009) Publics, Politics &Power: Remaking Public Services. London. Sage
Staiszewska, S. Mockford,C. (et al) (2012) Moving Forward : Understanding the Negative Experiences and Impacts of Patient and Public Involvement in Health Service Planning, development and evaluation. In Barnes, M. Cottrell, P. (edt) Critical Perspectives on User Involvement. Bristol. Policy Press. Pp129-142

Competing interests: None declared

Rita Haworth, Senior Lecturer

The U niversity of Salford, Allerton Building Frederick Road Salford M6 6PU



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Publication Details

Journal Name
British Medical Journal