Established 2005 Registered Charity No. 1110656

Scottish Charity Register No. SC043760

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June – July 2024 : Reflections READ ONLINE


User involvement and consultation

May 18 2009
The relationship between the public sector - including the NHS - and the public is being redefined Under current legislation, why and how do service providers and policy makers keep their finger on the pulse about issues around, say, drugs and alcohol? One of the ways is user involvement. In the past, patients or service users were seen as passive recipients of treatment and expertise. However, due to changing public attitudes towards authority and expertise, and a more open and questioning society, social movements involving users began to develop. The relationship between the public sector - including the NHS - and the public was being redefined. Why involve people? Because you want to and because you must... You want to because it builds trust in services, and fosters local ownership of services and decision-making. It maximises service uptake and it generates new ideas. And on the must side is the legal framework for user involvement, including section 11 of the Health and Social Care Act, which talks about consultation in planning how to run these services, developing them and making decisions. Also included under the must section are the Human Rights Act (2000), the NHS Community Care Act (1990) and Best Value. Service users include people who have used or still use a service, groups with common issues, people who pay for services and others who may need them in the future. What is user involvement for? From the organisational perspective, it ensures that services reflect needs. It makes best use of scarce resources and increases accountability through "customer democracy". It builds trust and confidence by being a force for democratic renewal. "Participatory democracy" also makes decisions more legitimate and improves accountability. From the users' perspective, the development of person-centred services improves their self-confidence and self -esteem, and helps them regain a sense of control and empowerment. "Participatory democracy" also addresses the perceived power imbalance and improves users' ability to make constructive choices and judgements about services. User involvement, broadly speaking, encompasses information-giving, consultation and participation. But here comes the rub: how do we participate? Are we directly involved in decision-making groups? Will user groups have any say how budgets are spent, because current budgets don't reflect the importance of user participation. What is the target user group in any given borough? Will the process of choice lead to unfair decisions? Will the group be working in partnership with service providers to improve service delivery, or will tokenism prevail? Will user bodies be empowered to present a collective but anonymous voice, or will their status remain unclear? Will service users and service providers be reluctant to share information? Much of the burden of user involvement still needs to fall on the shoulders of service providers - the NHS, DATs, social services, the voluntary sector and housing departments, to name but a few. User involvement seems to be working, but only on the level that decision-makers agree they should seek the public's views when developing services. Participation, partnership and decision making is still in the hands of the service providers. They will seek the views of users and the public, but the final decisions will be made by the professional decision maker. If funding reflects the need for user involvement, then current policy and organisational imperatives are more about "service delivery" than about delivering a service, more about "user involvement" than involving the user.