Conclusions

Abstract

It is not possible to generalise about the specific properties of the screening system explored in this book. On the contrary, a broad sweep analysis of a single case shows that such systems operate as complex totalities in which the formal, evidence-based specification provides only one component. Other elements include: the translation, more or less, of system design into operational practice; the communication of risk information to service users navigating such systems; the power relationships between practitioner groups; and the wider cultural backdrop of relevant social attitudes. In the UK at least, where access to health services for the majority of the population which uses the NHS is determined by locality, prenatal genetic screening provides a good example of the well-known postcode lottery. The rapid pace of change in genetic screening and other technologies, which local health-care systems respond to at different rates, can only increase local organisational variability.