Understanding trust and confidence: two paradigms and their significance for health and social care.

Trusting agents characteristically anticipate beneficial outcomes, under conditions of uncertainty, in their engagement with others. However, debates about trust incorporate different interpretations of risk, uncertainty, calculation, affect, morality and motivation in explaining when trust is appropriate and how it operates. This article argues that discussions about trust have produced a concept without coherent boundaries and with little operational value. Two paradigms are identified, which distinguish the characteristics of trust and confidence. It is argued that a reliance on confidence in human affairs makes trust redundant and that this has undesirable moral consequences. Discussion is illustrated by the UK Government's 'modernisation' policy in health and social care, which privileges confidence in systems over trust in moral agents.