Reconfiguring care infrastructures workshop, November 2017

This month, Kate Weiner presented research from Tracking Ourselves? at a two-day workshop at the University of Sussex (15-16th November). The workshop was called Reconfiguring care infrastructures: austerity and innovation in European Welfare Services, and attracted participants from Spain, Germany, Greece, Russia, Denmark, Italy, Netherlands, Norway, UK, and Bulgaria. The event was organised by Tracking Ourselves? team member Catherine Will, Henriette Langstrup and Angela Genova.

The event invited papers that explored the way in which austerity policies, welfare reforms and healthcare innovations relocate or relegate the work and practice of care in particular settings. This was considered in relation a variety of empirical contexts. For example, Ivaylo Vassilev (Southampton) explored narratives of experiences of managing chronic illnesses in Bulgaria and the UK, and Angela Genova (Urbino) considered Italian policy and practice in relation to autism spectrum disorders.

Brit Ross Winthereik (University of Copenhagen) gave a keynote at the event, and Catherine presented a paper that explored new configurations of public health and welfare in the UK context, with a focus on housing and homes.

The paper presented by Kate was entitled The role of self-monitoring in care infrastructures: policy imaginaries and everyday practices. Drawing on research from the first phase of the project, it presented analysis of policy and professional texts to explore how key actors producing and receiving self-monitoring data are imagined in the context of the UK’s NHS. The paper then contrasted these imaginaries with data drawn from 30 interviews with people who monitor their blood pressure. You can read a full abstract for the paper below.

 

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The role of self-monitoring in care infrastructures: policy imaginaries and everyday practices.

K Weiner, R Williams, C Will, F Henwood

The UK’s publicly funded national health service (NHS) is engaged in ongoing digital service provision planning intended to increase service sustainability amidst intense funding pressure. Policies related to this describe futures wherein health self-monitoring data will be shared between individuals and doctors. Through analysis of policy and professional texts, we explore how key actors producing and receiving self-monitoring data are imagined in the local contexts of the UK’s NHS.  We go on to contrast these imaginaries with lay people’s accounts of one form of self-monitoring – blood pressure monitoring – drawing on interview data.

Policies lay out obligations underpinning use of an increasingly digital healthcare system: ‘patients’ and ‘citizens’ should want (and demand) capabilities to provide self-monitoring data and access their health records, ultimately being ‘empowered’ to take responsibility for their own health. These imaginaries of individuals in smart homes using smartphones don’t include those who can’t, or don’t wish to, self-monitor or see their records.

These policies also anticipate support from a clinical community who trust (and can make sense of) people’s self-monitoring data, who have time to incorporate these data into practice. This brackets off more ambivalent actors. Clinicians, for example, are concerned about the utility and accuracy of patient data, their responsibilities to act on the basis of such data, and the potential negative effects of self-monitoring on their patients.  Our accounts of those who self-monitor both resonate with and counter these clinical concerns, while largely standing in opposition to policy imaginaries They suggest that people who self-monitor do this for a variety of reasons, only some of which align with clinical interests, data and record keeping were often not central to monitoring, and interviewees were perfectly aware that clinicians might be sceptical of their data.

We propose that while policy futures stand to have material implications (Brown and Michaels 2003) for investment and (material) infrastructure, they neither take into account the clinical enclosure (Miller and Rose, 1992) of healthcare, nor understand the nature of domestic care infrastructures (Lanstrup, 2013).