Alder Hey's heart of gold: charity, cardiac surgery and the distortion of paediatric provision in a nationalised health service, 1948-91.

IF 1.2 3区 社会学 0 HUMANITIES, MULTIDISCIPLINARY
Michael Lambert
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引用次数: 0

Abstract

Liverpool is perceived as exceptional, a city apart from the nation, and its health services are no different. Alder Hey, the city's children's hospital, reaffirms this perspective. Its name is inseparable from the scandal surrounding the unlawful removal and retention of thousands of organs, mostly hearts, from children for research purposes over decades culminating in the 2001 Redfern report. This paper contextualises these events by reconstructing how paediatric cardiac surgery, as an emerging subspecialty, disproportionately shaped the development of children's hospital services for the city and its region. Such cumulative, compounding impacts are invisible in the historiography, focused on national trends and high politics. Recognising but eschewing established policy narratives, the paper follows enduring tensions between teaching and research, service and specialty, centre and periphery, managers and clinicians and patients and professional prestige, which remained unresolved from the inception of the National Health Service (NHS) in 1948 to the Royal Liverpool Children's Hospital becoming a self-governing trust in 1991. Using archival documents to reconstruct complex organisational and clinical decision-making within the shifting architecture of the NHS at national, regional and local levels over time, this paper shows how children's hospital services in Liverpool were distorted by another heart. One of gold: charity. Public appeals and philanthropic support for paediatric provision outweighed competing claims for compassionate giving in Liverpool. The availability of alternative funding to develop highly specialised paediatric cardiac surgery, and to lever further statutory resources at the expense of competing specialties, impacted the shape of nationalised health services in the city and its wider region. Ultimately, the paper demonstrates how children's care, clinicians and charity confounded efforts to organise universal, nationalised health services.

Alder Hey的黄金之心:慈善、心脏手术和1948-91年国有化医疗服务中儿科服务的扭曲。
利物浦被认为是一个例外,一个独立于国家的城市,它的医疗服务也不例外。阿尔德·嘿,城市儿童医院,重申了这一观点。它的名字与围绕数十年来非法摘取和保留数千个儿童器官(主要是心脏)用于研究目的的丑闻密不可分,最终在2001年的雷德芬报告中达到顶峰。本文通过重建儿科心脏外科作为一个新兴的亚专科,如何不成比例地塑造了城市及其地区儿童医院服务的发展,从而将这些事件置于背景下。这种累积的、复合的影响在聚焦于国家趋势和高层政治的史学中是看不见的。本文承认但回避了既定的政策叙述,遵循了教学与研究、服务与专业、中心与外围、管理人员与临床医生、患者与专业声望之间持久的紧张关系,这些紧张关系从1948年国家卫生服务(NHS)成立到1991年皇家利物浦儿童医院成为一个自治的信托机构,一直没有得到解决。随着时间的推移,使用档案文件来重建国家、地区和地方各级NHS不断变化的架构中复杂的组织和临床决策,本文显示了利物浦儿童医院服务是如何被另一颗心扭曲的。黄金之一:慈善。在利物浦,公众呼吁和慈善机构对儿科提供的支持超过了对富有同情心的捐赠的竞争要求。发展高度专业化的儿科心脏手术的替代资金的可用性,以及以牺牲竞争性专业为代价进一步调动法定资源,影响了该市及其更广泛地区国有化保健服务的形态。最后,这篇论文展示了儿童护理、临床医生和慈善机构如何阻碍了组织全民、国有化医疗服务的努力。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Medical Humanities
Medical Humanities HUMANITIES, MULTIDISCIPLINARY-
CiteScore
2.60
自引率
8.30%
发文量
59
期刊介绍: Occupational and Environmental Medicine (OEM) is an international peer reviewed journal concerned with areas of current importance in occupational medicine and environmental health issues throughout the world. Original contributions include epidemiological, physiological and psychological studies of occupational and environmental health hazards as well as toxicological studies of materials posing human health risks. A CPD/CME series aims to help visitors in continuing their professional development. A World at Work series describes workplace hazards and protetctive measures in different workplaces worldwide. A correspondence section provides a forum for debate and notification of preliminary findings.
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