Trust and moral motivation: redundant resources in health and social care?

The government's modernisation programme for health and social care has introduced institutional arrangements that are characteristic of 'late modernity'. These support heightened surveillance of organisational performance and professional practice, increased bureaucratisation of operational arrangements, instrumental decision making about service provision and a drive to centralise consumer empowerment. Such developments are designed to (re)establish political and public confidence in professional interventions and services that are predictable, reliable and safe. A focus on confidence, however, necessarily neglects the significance of trust for service users and providers. This article argues that privileging confidence over trust fails to acknowledge the role of uncertainty, morality and discretion in the provision of care and has important consequences for service users, managers and frontline practitioners.