IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v73y2011i10p1452-1459.html
   My bibliography  Save this article

Why is UK medicine no longer a self-regulating profession? The role of scandals involving “bad apple” doctors

Author

Listed:
  • Dixon-Woods, Mary
  • Yeung, Karen
  • Bosk, Charles L.

Abstract

This article identifies the role played by a series of medical scandals in the UK, occurring from the mid-1990s onwards, in ending a collegial model of self-regulation of the medical profession that had endured for 150 years. The state’s original motive in endorsing professional self-regulation was to resolve the principal–agent problem inherent in the doctor–patient relationship. The profession, in return for its self-regulating privileges, undertook to act as a reliable guarantor for the competence and conduct of each of its members. Though sufficient to ensure that most doctors were “good”, the collegial model adopted by the profession left it fatally vulnerable to the problem of “bad apples”: those unwilling, incapable or indifferent to delivering on their professional commitments and who betrayed the trust of both patients and peers. Weak administrative systems in the NHS failed to compensate for the defects of the collegium in controlling these individuals. The scandals both provoked and legitimised erosion of the profession’s self-regulatory power. Though its vulnerability to bad apples had been present since the founding of the 19th century profession, it was the convergence of social and political conditions at a particular historical moment that transformed the scandals into an unstoppable imperative for reform. Huge public anger, the voice permitted to a coalition of critics, shifts in social attitudes, the opportunity presented for imposing standards for accountability, and the increasing ascendancy of pro-interventionist managerialist and political agendas from the early 1990s onwards were all implicated in the response made to scandals and the shape the reforms took. Scandals need to be understood not as simple determinants of change, but as one performative element in a constellation of socially contingent forces and contexts. The new rebalancing of the “countervailing powers” has dislodged the profession as the senior partner in the regulation of doctors, but may introduce new risks.

Suggested Citation

  • Dixon-Woods, Mary & Yeung, Karen & Bosk, Charles L., 2011. "Why is UK medicine no longer a self-regulating profession? The role of scandals involving “bad apple” doctors," Social Science & Medicine, Elsevier, vol. 73(10), pages 1452-1459.
  • Handle: RePEc:eee:socmed:v:73:y:2011:i:10:p:1452-1459
    DOI: 10.1016/j.socscimed.2011.08.031
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953611005491
    Download Restriction: Full text for ScienceDirect subscribers only

    File URL: https://libkey.io/10.1016/j.socscimed.2011.08.031?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Avner Offer, 1997. "Between the gift and the market: the economy of regard," Economic History Review, Economic History Society, vol. 50(3), pages 450-476, August.
    2. Timothy Besley & Maitreesh Ghatak, 2005. "Competition and Incentives with Motivated Agents," American Economic Review, American Economic Association, vol. 95(3), pages 616-636, June.
    3. Yeung, Karen & Dixon-Woods, Mary, 2010. "Design-based regulation and patient safety: A regulatory studies perspective," Social Science & Medicine, Elsevier, vol. 71(3), pages 502-509, August.
    4. repec:dau:papers:123456789/1713 is not listed on IDEAS
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Bryce, Marie & Luscombe, Kayleigh & Boyd, Alan & Tazzyman, Abigail & Tredinnick-Rowe, John & Walshe, Kieran & Archer, Julian, 2018. "Policing the profession? Regulatory reform, restratification and the emergence of Responsible Officers as a new locus of power in UK medicine," Social Science & Medicine, Elsevier, vol. 213(C), pages 98-105.
    2. Michał Krawczyk & Krzysztof Szczygielski, 2019. "Do professions curb free-riding? An experiment," European Journal of Law and Economics, Springer, vol. 47(3), pages 361-376, June.
    3. James Arthur & Stephen R. Earl & Aidan P. Thompson & Joseph W. Ward, 2021. "The Value of Character-Based Judgement in the Professional Domain," Journal of Business Ethics, Springer, vol. 169(2), pages 293-308, March.
    4. Ong, Bie Nio & Morden, Andrew & Brooks, Lauren & Porcheret, Mark & Edwards, John J. & Sanders, Tom & Jinks, Clare & Dziedzic, Krysia, 2014. "Changing policy and practice: Making sense of national guidelines for osteoarthritis," Social Science & Medicine, Elsevier, vol. 106(C), pages 101-109.
    5. Tarrant, Carolyn & Leslie, Myles & Bion, Julian & Dixon-Woods, Mary, 2017. "A qualitative study of speaking out about patient safety concerns in intensive care units," Social Science & Medicine, Elsevier, vol. 193(C), pages 8-15.
    6. Dewan, Yasir, 2019. "Corporate crime and punishment : The role of status and ideology," Other publications TiSEM 08d87b94-7449-4a1f-a3ae-0, Tilburg University, School of Economics and Management.
    7. Guillemin, Marilys & Archer, Julian & Nunn, Suzanne & de Bere, Samantha Regan, 2014. "Revalidation: Patients or process? Analysis using visual data," Health Policy, Elsevier, vol. 114(2), pages 128-138.
    8. Hunter, Benjamin M. & Murray, Susan F. & Marathe, Shweta & Chakravarthi, Indira, 2022. "Decentred regulation: The case of private healthcare in India," World Development, Elsevier, vol. 155(C).
    9. Byrne Catherine, 2016. "Ready or not? Statutory registration, regulation and continuing professional development for social care workers in Ireland," Administration, Sciendo, vol. 64(2), pages 9-29, August.
    10. Szczygielski, Krzysztof, 2022. "A model of competitive self-regulation," International Review of Law and Economics, Elsevier, vol. 70(C).
    11. Jane Hendy & Danielle A. Tucker, 2021. "Public Sector Organizational Failure: A Study of Collective Denial in the UK National Health Service," Journal of Business Ethics, Springer, vol. 172(4), pages 691-706, September.
    12. Price, Tristan & Tredinnick-Rowe, John & Walshe, Kieran & Tazzyman, Abigail & Ferguson, Jane & Boyd, Alan & Archer, Julian & Bryce, Marie, 2020. "Reviving clinical governance? A qualitative study of the impact of professional regulatory reform on clinical governance in healthcare organisations in England," Health Policy, Elsevier, vol. 124(4), pages 446-453.
    13. McGivern, Gerry & Nzinga, Jacinta & English, Mike, 2017. "‘Pastoral practices’ for quality improvement in a Kenyan clinical network," Social Science & Medicine, Elsevier, vol. 195(C), pages 115-122.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Oindrila Dey & Swapnendu Banerjee, 2014. "Status Incentives with Discrete Effort: A Note," Economics Bulletin, AccessEcon, vol. 34(2), pages 1205-1213.
    2. Daniel Ripperger-Suhler, 2024. "Matching with Nonexclusive Contracts," Games, MDPI, vol. 15(2), pages 1-39, March.
    3. Josse Delfgaauw & Robert Dur, 2008. "Incentives and Workers' Motivation in the Public Sector," Economic Journal, Royal Economic Society, vol. 118(525), pages 171-191, January.
    4. Manna, Ester, 2013. "Mixed Duopoly with Motivated Teachers," MPRA Paper 52041, University Library of Munich, Germany.
    5. Dietrichson, Jens, 2013. "Coordination Incentives, Performance Measurement and Resource Allocation in Public Sector Organizations," Working Papers 2013:26, Lund University, Department of Economics.
    6. Tobias Böhm & Nadine Riedel, 2013. "On Selection into Public Civil Service," CESifo Economic Studies, CESifo Group, vol. 59(1), pages 34-71, March.
    7. Elliott Ash & W. Bentley MacLeod, 2015. "Intrinsic Motivation in Public Service: Theory and Evidence from State Supreme Courts," Journal of Law and Economics, University of Chicago Press, vol. 58(4).
    8. Canice Prendergast, 2016. "Bureaucratic Responses," Journal of Labor Economics, University of Chicago Press, vol. 34(S2), pages 183-215.
    9. Katherine Casey & Rachel Glennerster & Edward Miguel & Maarten Voors, 2023. "Skill Versus Voice in Local Development," The Review of Economics and Statistics, MIT Press, vol. 105(2), pages 311-326, March.
    10. Inés Macho-Stadler & David Pérez-Castrillo, 2018. "Moral hazard: Base models and two extensions," Chapters, in: Luis C. Corchón & Marco A. Marini (ed.), Handbook of Game Theory and Industrial Organization, Volume I, chapter 16, pages 453-485, Edward Elgar Publishing.
    11. Delfgaauw, Josse & Souverijn, Michiel, 2016. "Biased supervision," Journal of Economic Behavior & Organization, Elsevier, vol. 130(C), pages 107-125.
    12. Ester Manna, 2013. "Intinsically Motivated Agents: Blessing or Curse for Firms ?," Working Papers ECARES ECARES 2013-37, ULB -- Universite Libre de Bruxelles.
    13. Robert Dur & Heiner Schmittdiel, 2019. "Paid to Quit," De Economist, Springer, vol. 167(4), pages 387-406, December.
    14. Dora Gicheva, 2020. "Occupational Social Value and Returns to Long Hours," Economica, London School of Economics and Political Science, vol. 87(347), pages 682-712, July.
    15. Ferraz, Claudio & Finan, Frederico S., 2008. "Motivating Politicians: The Impacts of Monetary Incentives on Quality and Performance," IZA Discussion Papers 3411, Institute of Labor Economics (IZA).
    16. Canh Thien Dang & Trudy Owens, 2024. "Non-governmental organizations’ motivation to diversify: self-interest or operation-related? Evidence from Uganda," Oxford Economic Papers, Oxford University Press, vol. 76(2), pages 561-584.
    17. Simon Burgess & Carol Propper & Marisa Ratto & Emma Tominey, 2017. "Incentives in the Public Sector: Evidence from a Government Agency," Economic Journal, Royal Economic Society, vol. 127(605), pages 117-141, October.
    18. Yahagi, Ken, 2021. "Law enforcement with motivated agents," International Review of Law and Economics, Elsevier, vol. 66(C).
    19. Dora Gicheva, 2022. "Altruism and Burnout: Long Hours in the Teaching Profession," ILR Review, Cornell University, ILR School, vol. 75(2), pages 427-457, March.
    20. Vanessa, Mertins & Jeworrek, Sabrina & Vlassopoulos, Michael, 2018. ""The Good News about Bad News": Feedback about Past Organisational Failure Bad ist Impact in Worker Productivity," VfS Annual Conference 2018 (Freiburg, Breisgau): Digital Economy 181644, Verein für Socialpolitik / German Economic Association.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:73:y:2011:i:10:p:1452-1459. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.