Governmentality and risk: setting priorities in the new NHS

Abstract

The aim of this paper is to explore priority setting issues in the British National Health Service (NHS). It focuses on the changing way in which rationing issues are managed by a sample of English health authorities in the wake of Health Service reforms and the separation of function between purchasing and providing health care. The paper employs the conceptual framework of ‘governmentality’, associated with the French social theorist Michel Foucault, to analyse this aspect of contemporary British health policy. Governmentality analysis situates social and economic change as reflecting shifts in the ‘mentality’ of government. The consequence of this new articulation is that the concepts of priority setting and rationing become embedded as dominant discourses and emergent practices within health policy. Equally important is the way in which the perceived shift in the formula of governance also results in a different conceptualisation of the subject of health governance based on the management of individual risk.