Rationality, rhetoric, and religiosity in health care: the case of England's Expert Patients Programme

Policymakers have associated the increasing prevalence and incidence of chronic illness with the threat of unsustainable demands for medical services, requiring deployment of effective demand-management strategies. In this article, the authors consider the rise in policy interest in self-management and examine the metaphors, discourse, official statements, policy developments, and goals shaping the field of chronic illness, especially surrounding the promotion and uptake of self-skills training in England's Expert Patients Programme (EPP). They discuss the shift in relationship between individuals and the state since the 1960s and 1970s; the rise in importance of self-management in relation to an aging population; the evidence and rhetoric associated with policy development; and the relationship of self-care to the notion of the "responsible patient," as seen in policy implementation and EPP course promotion. The authors also draw on qualitative research to examine the transmission of ideology and rhetoric in self-skills training. Self-management policies are part of a shift from patient rights to individual responsibilities, a shift that may be less persuasive than its supporters imagine.