Trust relations in health care: developing a theoretical framework for the “new” NHS

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Abstract
Purpose – This paper seeks to address how and why trust relations in the NHS may be changing and presents a theoretical framework for exploring them in future empirical research.Design/methodology/approach – This paper provides a conceptual analysis. It proposes that public and patient trust in health care in the UK appears to be shaped by a variety of factors. From a macro perspective, any changes in levels of public trust in health care institutions appear to derive partly from top‐down policy initiatives that have altered the way in which health services are organised and partly from broader social and cultural processes. A variety of policy initiatives, including the introduction of clinical governance and the resulting use of performance management to scrutinise and change clinical activity, increasing patient choice and involvement in decision‐making regarding their care, are examined for how they have changed the context for trust relations within the NHS.Findings – It is argued that these policy i...