The Risks of Managing Uncertainty: The Limitations of Governance and Choice, and the Potential for Trust

Abstract

The inherent problems and limitations of managing risk and uncertainty are examined in a salient case setting – the English NHS. The ‘dark-side’ of simply trusting professionals to pursue their own craft, as acknowledged by Sennett, has been politicised to under-gird an increased use of quasi-markets, via the choice agenda, and governance. It is argued that these alternatives to trust – price and control – are further dysfunctional still. The innate tendencies of governance, and therefore choice, to lose sight of patient care are even more pronounced than the fallibility of professionals. A new, qualified form of trust is proposed in resolution.