Constructing ‘exceptionality’: a neglected aspect of NHS rationing

The principle of exceptionality involves assessing whether a patient is sufficiently different from the generality of patients to justify providing a treatment, such as an expensive cancer drug, not approved for routine funding. In England, individual requests for certain high-cost treatments are considered by funding request panels that examine exceptionality alongside treatment efficacy and cost as the main criteria for funding. This was also the case in Wales until September 2017. Our paper draws on audio recordings of panel meetings and interviews in a Welsh Health Board to investigate how exceptionality was constructed in discussions. It focuses on the combination of different decision criteria in meeting talk, particularly regarding the discourses associated with efficacy and exceptionality. Exceptionality is a malleable category that raised questions about the evidence-based nature of panel decision making. For example, the paper discusses the use of subgroup data from trials and the difficulty of deciding how small a subgroup of patients should be before it is deemed exceptional. Determining exceptionality has been a key mechanism for deciding that a minority of NHS patients can still receive high-cost treatments not routinely provided for all. As a neglected rationing mechanism

'I like this interview; I get cakes and cats!':the effect of prior relationships on interview talk

Research interviews are a form of interaction jointly constructed by the interviewer and interviewee, what Silverman (2001: 104) calls 'interview-as-local-accomplishment'. From this perspective, interviews are an interpretative practice in which what is said is inextricably tied to where it is said, how it is said and, importantly, to whom it is said (Holstein and Gubrium, 2004). The relationship between interviewer and interviewee, then, is fundamental in research interviews. But what happens when the relationship between interviewer and interviewee is not only that of researcher-informant but also involves other roles such as colleague and friend? In this article we will show how prior relationships are invoked and made relevant by both parties during educational research interviews and how these prior relationships therefore contribute to the 'generation' (Baker, 2004: 163) of interview data. © 2010 The Author(s)

‘Ethnic group’, the state and the politics of representation

The assertion, even if only by implication, that ‘ethnic group’ categories represent ‘real’ tangible entities, indeed identities, is commonplace not only in the realms of political and policy discourse but also amongst contemporary social scientists. This paper, following Brubaker (2002), questions this position in a number of key respects: of these three issues will dominate the discussion that follows. First, there is an interrogation of the proposition that those to whom the categories/labels refer constitute sociologically meaningful ‘groups’ as distinct from (mere) human collectivities. Secondly, there is the question of how these categories emerge, i.e. exactly what series of events, negotiations and contestations lie behind their construction and social acceptance. Thirdly, and as a corollary to the latter point, we explore the process of reification that leads to these categories being seen to represent ‘real things in the world’ (ibid.)

The experience of being a partner to a spinal cord injured person: A phenomenological-hermeneutic study

This qualitative focuses on the personal experiences of partners to a spinal cord injured person. Using a Ricoeurian phenomenological-hermeneutic approach, we analysed seven partners’ narratives 1 and 2 years after their partner's injury. The study revealed how the injury was experienced from the partners’ perspective through the aftermath. In the acute phase after the injury, partners also felt harmed, and support was needed in relation to their own daily activities, eating, resting, and managing distress. During the institutionalized rehabilitation, partners felt torn between supporting the injured partner and the demanding tasks of everyday life outside the institution. After discharge, partners struggled for the injured partner to regain a well-functioning everyday life and for reestablishing life as a couple. The partner struggled to manage the overwhelming amount of everyday tasks. Some sought to reestablish their usual functions outside the family, whereas others focused on establishing a new life together. The partners experienced much distress and appreciated the support they got, but felt that they were mainly left to manage the difficult process on their own

Articulating practice through the interview to the double

The paper aims to realise the critical potential of the practice lens by contributing to the development of a coherent set of methodologies for investigating work and organisational activity. It does so by introducing and critically assessing the "interview to the double" as a method to articulate and represent practice. After briefly illustrating its history and usage, the paper analyses in depth the setting generated by this unusual interview method. It argues that the nature of the encounter produces narratives that are often morally connoted and idealised in character. As a consequence the method is especially useful to capture the going concerns which orient the conduct of the members and the normative and moral dimension of practice. The paper also shows that because it mimics familiar instruction-giving discursive practices, the method constitutes an effective textual device to convey this moral and normative dimension in a way which remains faithful to its situated and contingent nature of practice

Why Operationism Doesn't Go Away: Extrascientific Incentives of Social-Psychological Research

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/69038/2/10.1177_004839318601600302.pd

Constructs of relationships and issues of authority in nursing

The research on which this paper is based was designed to investigate nurses' perceptions of relationships in their work. The most important issue to emerge from their descriptions of relationships was that of the nature of authority. From their own accounts; examples of which are included in this paper; it can be seen that views of authority in the hospital setting are both complex and varied. We have identified four different types of authority as seen by nurses: parental, reciprocal, political and arbitrary. Our research suggests that any analysis of authority relationships based purely on structural arrangements would be too simplistic. One possible implication of the findings we present might be that more explicit discussion of the nature of authority in nursing relationships should be encouraged both in training and subsequently