Personal Histories in Health Research ~ Edited by Adam Oliver ISBN: 1 905030 11 8 Personal Histories in Health collection © The Nuffield Trust 2005 ‘Ploughing a furrow in ethics’ © Raanan Gillon and The Nuffield Trust 2005 Published by The Nuffield Trust 59 New Cavendish Street London WC1 7LP telephone 020 7631 8450 fax 020 7613 8451 email: [email protected] website: www.nuffieldtrust.org.uk charity number 209201 designed and printed by Q3 Digital Litho telephone 01509 213 456 website: www.Q3group.co.uk Contents 1 Healthy Lives: reflecting on the reflections Adam Oliver 3 2 Health inequalities: from science to policy David Blane 15 3 In sickness and in health: working in medical sociology Mike Bury 29 4 Random assignments: my route into health policy: a post-hoc rationalisation Anna Coote 47 5 Last Season’s fruit John Grimley Evans 65 6 Ploughing a furrow in ethics Raanan Gillon 85 7 The Jungle: an explorer’s experiences of health services research Walter W Holland 101 8 Confessions of a graduate nurse Alison Kitson 121 9 Confessions of an accidental policy analyst, or why I am not a health service researcher Rudolf Klein 139 10 Seeking somewhere to stop Jennie Popay 155 11 Political ideals and personal encounters Albert Weale 173 12 Discovering the QALY, or how Rachel Rosser changed my life Alan Williams 191 13 Health policy, management and gardening Robert Maxwell 207 About the authors About the authors vii David Blane is Professor of Medical Sociology at Imperial College London. He trained in medicine and sociology, and enjoys teaching medical sociology as an applied subject to large classes of trainee doctors, and as an academic discipline to smaller numbers of interested medical students. For more than twenty years he has researched and published on the topic of social class differences in health, particularly their origin in differential exposure to social disadvantage and, more recently, the way in which social disadvantage accumulates across the life course. Mike Bury read Sociology at the University of Sussex. He worked at Bristol and Manchester, before taking up a lectureship at Bedford College (later, Royal Holloway) in the University of London to work with Margot Jefferys in 1980. In 1991 Mike Bury was appointed to a personal chair in Sociology in the University of London. Throughout his time at Royal Holloway, he was closely associated with the MSc in Medical Sociology. His main research interests have been in chronic illness, disability and ageing, and on wider aspects of culture and medicine, and he has conducted both qualitative and quantitative studies in these areas. He was co-editor of the journal Sociology of Health and Illness between 1995–2001, and in 2001 completed a four year term on two boards of the Medical Research Council. He is also a Fellow of the Royal Society of Arts. Anna Coote is a senior executive at the Healthcare Commission, which she joined in 2005 to head its work on patient and public involvement. She was for- merly Director of Health Policy at the King’s Fund, Deputy Director of the Institute for Public Policy Research, adviser to the Minister for Women, a Senior Lecturer in Media and Communications at Goldsmiths College, London University, a producer and editor of current affairs and documentaries for Channel Four TV, Deputy Editor of the New Statesman, and a journalist and broadcaster. She is a member of the UK Sustainable Development Commission. Sir John Grimley Evans is Professor Emeritus of Clinical Geratology at the University of Oxford and recently retired from the post of Consultant Physician in Geriatric and General (Internal) Medicine to the Oxford Hospitals which he had held since 1985. Prior to that he had been Professor of Medicine (Geriatrics) at the University of Newcastle-upon-Tyne, following a period as Lecturer in Epidemiology at the London School of Hygiene and Tropical Medicine. Educated at the Universities of Cambridge and Oxford he pursued postgraduate training in clinical medicine and epidemiology in Oxford and at the University of Michigan USA. Experience as member of a New Zealand team studying the viii Personal Histories in Health Research effects of migration on the health of Polynesian populations in the South West Pacific led to research interests in epidemiological approaches to the prevention and management of disability in later life. Recent work has focused on demen- tia. A Vice-president of the Royal College of Physicians 1993–95, he was also a member of the Medical Research Council and Chairman of its Health Services and Public Health Research Board 1989–94. He served as Editor of Age and Ageing 1988–95, and Senior Editor of the Oxford Textbook of Geriatric Medicine. Professor Raanan Gillon is a hybrid GP and philosopher and Emeritus Professor of Medical Ethics at Imperial College London, where he still does some teaching, especially on its MSc in Medical Ethics, and on its one week intensive course in Medical Ethics which he started in 1983. He is Chairman of the Institute of Medical Ethics and Deputy Chairman of the British Medical Association’s Medical Ethics Committee. He was editor of the Journal of Medical Ethics for twenty years until 2001, and retired from part-time NHS general practice at the end of 2002. Professor Walter Holland qualified from St. Thomas’ Hospital Medical School in 1954. His interests in epidemiology were aroused by his involvement in inves- tigations of the 1957 influenza pandemic while doing his national service in the RAF. After gaining further experience in epidemiology at the London School of Hygiene and at Johns Hopkins University School of Hygiene, he returned to St. Thomas’ in 1962, where he founded the Department of Public Health Medicine and directed the Social Medicine and Health Services Research Unit. Since retirement in 1994, he has been Visiting Professor at the London School of Economics. His major research interests have been in the epidemiology of chronic respiratory disease and the application of epidemiological principles to health services research. He was President of the International Epidemiological Association and of the Faculty of Public Health Medicine. Professor Alison Kitson is Executive Director of Nursing at the Royal College of Nursing (RCN). As part of the RCN’s top team she is responsible for leading on the organisation’s professional nursing agenda and to help it deliver its mis- sion to represent nurses and nursing, promoting excellence in practice and shaping health policies. Previous to this post she was Director of the RCN Institute, responsible for the delivery of professional development, lifelong learning, research and clinical practice support services to members. As Director About the authors ix she instigated and has supported the development of a number of innovative projects including the RCN’s work on Knowledge Utilisation and Transfer and an extensive set of practice-based research programmes. She has a distinguished academic and professional career and has published over 100 academic and pro- fessional articles, representing nursing on many local, national and international stages. In 1991 she was awarded a Fellowship of the Royal College of Nursing for her work on Standards of Care. She is a supernumerary Fellow of Green College Oxford, holds a number of Visiting and Honorary Chairs, and in 2001 was awarded Distinguished Graduate of the Year from her old university, University of Ulster. Professor Rudolf Klein was born 1930 in Prague. Educated in the UK (MA in History at Oxford), he spent the first half of his career as a journalist with the London Evening Standard and The Observer. The second half has been spent as an academic. He was Professor of Social Policy at the University of Bath (1978–1998), and is now Emeritus Professor there. Currently, he is Visiting Professor at the London School of Economics and at the London School of Hygiene. He was awarded the CBE in 2001, and in 2002 was elected to the US Institute of Medicine. At present, he is researching the latest wave of institu- tional innovation in Britain’s NHS Foundation Trusts. Robert Maxwell’s background is in general management, with an emphasis on policy and finance. He worked first in an international mining group, and then in McKinsey and Company, where he became intensely interested in the health services field. During his time at McKinsey’s, he advised on health issues in the UK, the US, the Republic of Ireland, the Netherlands and elsewhere. He drew on this experience in a study (published in 1974) on these issues in some 20 developed countries, and later took a related PhD at the London School of Economics. From 1980 to 1997 he was Chief Executive of the King’s Fund, the London-based independent organisation concerned with health policy, manage- ment and practice. He lives in Gloucestershire where, since 2002, he has chaired the Gloucestershire Partnership NHS Trust, which provides mental health and learning disability services in the county. He is also a Trustee of the Joseph Rowntree Foundation, the country’s leading independent sponsor of social pol- icy research. Adam Oliver is Senior Research Fellow and Deputy Director of LSE Health and Social Care, one of the largest research institutes in the health-related social x Personal Histories in Health Research sciences in Europe. He is Founding Chair of the Health Equity Network, Founding Coordinator of the Preference Elicitation Group, and a former Coordinator of the European Health Policy Group. He is also Founding Co- Editor of the journal, Health Economics, Policy and Law. He has published quite widely in the areas of health equity, economic evaluation, risk and uncer- tainty, and the economics and policy of European health care reform. Jennie Popay is Professor of Sociology and Public Health at the University of Lancaster, and Director of the newly established Collaborating Centre for Community Engagement in England.