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Public trust in healthcare systems requires a balance to be struck between the macro concerns of “public” confidence and the microdynamics of “private” interpersonal trust between patients and health professionals
The role of trust in public services has received increasing attention over the past decade.1 In the UK, for the most part, attention has only been focused on public trust in the wake of serious service failings—failings that have had such impacts on the national psyche that they are often recalled by a single name of place, perpetrator or victim (see box)—for example, in the police service (Stephen Lawrence, Soham), rail transport (the Paddington, Hatfield, and Potters Bar disasters), and farming/food policy (foot and mouth disease and BSE). British public health care (the NHS) has, in particular, come under intense scrutiny following widespread public dismay over numerous scandals (Alder Hey, Bristol, various malpractice cases at the General Medical Council and, most notorious of all, Harold Shipman). In each of these cases “public trust betrayed” has emerged as a common theme.
But what is “public trust”? Too often the term appears to be a convenient “catch all” expression used for making rather general statements about the relationships between groups (patients, service users, the public) and their service providers (doctors, hospitals, the NHS). Yet “trust”—the set of expectations that one party holds about another’s likely behaviour in a situation entailing risk to that first party—is more usually something that resides within individuals than in groups. How, then, can we move from this individualised understanding of trust to notions of collective …
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