ABSTRACT
Since the early 1980s, developments in health service policy and practice have prompted careful reevaluation of the nature and importance of trust relationships in health care contexts (Mechanic 1998). The issue of trust arises across a range of health care conditions and settings including acute and long-term health care provision and primary, secondary and community contexts. This chapter focuses on trust in relation to the secondary care provision for young people with diabetes. Recognition of rising mortality and morbidity associated with poor management of diabetes and a greater emphasis on high-quality services for children and young people (The National Service Framework 2005), raise a number of specifi c issues in relation to trust. This chapter is a collaborative piece of work that pulls together three disciplinary backgrounds-anthropology, management and medicine-to inform fi ndings from an action research project, funded by the patient representative group, Diabetes UK. Carried out between 2002 and 2004, the aim of this project was to examine the experiences of interactions between young people with Type 1 diabetes (T1D) and health professionals in seven outpatient clinics in Scotland. The policy background to this research includes the drive to improve public trust in the National Health Service (NHS) by imposing tighter regulations on high quality diabetes care, synonymous with patientcentered diabetes care and the more general concern to improve trust at a personal level between individual patients and health professionals. Such relationships must be carefully navigated with adult diabetic patients, and additional complexities appear to arise with young people who have diabetes. In particular, we argue that a powerful discourse in the United Kingdom-and indeed in the West generally-that portrays teenagers as a deviant and risk-taking group, who in this case cannot be trusted to manage their diabetes successfully, appears to clash with the ethos in the NHS of greater trust between health professionals and patients.
