ABSTRACT
The NHS reforms were the backdrop to the first strategic issues conference (St Andrews, 1993). According to Maynard (1992) the role of the consumer was one of the unresolved issues of the 1989 NHS reforms at a time when there was increasing professional consciousness about the importance of consumer judgment. Consequently the Department of Health (1995) commissioned research into the role of consumers in the NHS which led to the patient partnership strategy. In 1997 a patient partnership coordinator was appointed to oversee this strategy. Why does the NHS need a patient partnership strategy? Quite simply it is because without it the NHS is more likely to fail badly to achieve quality. To understand this it is necessary to consider the meaning of quality. Unfortunately, this thinking task is all but absent from virtually all texts on quality in health services, or in industry. One way of filling this gap is go back and reconstruct the meaning of quality from the social action viewpoints that Habermas (1991) has set out and analysed in great detail. From this, three perspectives on quality management emerge: strategic quality, normative quality and critical quality. These categories permit us to see easily from a practical but theoretically rigorous viewpoint what the plethora of health service quality initiatives stand for – patient partnership included. I will argue that for as long as strategic quality and normative quality continue to dominate the NHS it will face continual reformation. Only critical quality offers the possibility that the achievement of quality in the NHS will not recede like the smile on the face of the Cheshire Cat. I will argue that the patient partnership strategy is a step toward critical quality but this can only happen if the conditions necessary to achieve critical quality are introduced.
