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Values underlying the National Service Framework for coronary heart disease in England : a discourse analysis

journal contribution
posted on 2006-04-01, 00:00 authored by M Rayner, P Scarborough, Steven AllenderSteven Allender
OBJECTIVES: The National Service Framework (NSF) for Coronary Heart Disease--published by the English Department of Health in 2000--sets out how those within the health service should seek to prevent and treat coronary heart disease and care for people with the disease. Its prescriptions are partly based on what is known about coronary heart disease and partly on its underlying 'values'. This paper seeks to identify those values.

METHODS:An analysis of the discourses within the text of the NSF based on critical discourse analysis.

RESULTS: Three different discourses can be identified: the managerial, the clinical and the political. The managerial discourse is dominant. Each discourse has its own values. The main 'aspirational' values within the NSF are efficiency, effectiveness, autonomy (choice), universalism and equity. Some aspirational values--particularly equity--appear to be largely rhetorical and lead to few recommendations or prescriptions. Some values that might have been expected to underlie the framework, such as compassion and democracy, are largely absent.

CONCLUSIONS: Discourse analysis provides a more systematic and transparent method of describing the values behind health care policy than the methods that have been used previously.

History

Journal

Journal of health services research and policy

Volume

11

Issue

2

Pagination

67 - 73

Publisher

Royal Society of Medicine Press

Location

London, England

ISSN

1355-8196

eISSN

1758-1060

Language

eng

Publication classification

C1.1 Refereed article in a scholarly journal

Copyright notice

2006, Sage Publishers

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