chapter  11
Individual Patient Choice in the English National Health Service: The Case for Social Fantasy Seen from Psychoanalytic Perspective
Pages 16

I propose to address this gap by considering policy making as a sociosymbolic process, whereby policies originate in the imaginary foundations of the individual psychic life taking the form of socially constructed fantasies. In the sections that follow, I will present an analysis of a policy specifi cally concerned with extending individual patient choice in the British National Health Service (NHS) during the 1990s and again, more recently, to illustrate why policies become idealistic and why this misrecognized idealization is at the root of policy failure. To argue my point, I examine important unconscious mechanisms present in today’s policy conception, occurring at a distance from organizational reality and going largely unacknowledged. My aim is to bring to light factors stirring up the policy process but also disabling its realization. In doing so I will use the example of the reappearance of individual patient choice not to argue for or against its introduction into health care systems but to illustrate why and how its complex and diffuse concepts are being translated into simplistic policy pronouncements without taking into account multiple contextual realities, including diverse needs of different user groups or dynamics underlying the experience of being a patient. I will argue that this disregard disables policy effectiveness leading to disillusionment with public policy-making.