Our earlier analysis of the policy context considered the very different meanings being ascribed to ‘user involvement’. Certain of the tensions within that start to become evident in the case studies of the two groups we have described. In Chapter 1 we also highlighted the importance of distinguishing the roles of ‘consumer’ and ‘citizen’ when considering changes in the nature of relationships between the state and those who use public services. Having looked in some detail at two examples of user self-organisation and the response of public service officials to this, we can reflect on what this can contribute to our understanding of the role of user self-organisation in empowering people as consumers, and in enabling excluded people to become ‘active citizens’.

Consumers and consumerism

User activists were very aware of the consumerist rhetoric which was enveloping health and social care services during the later part of the 1980s and into the 1990s. They also acknowledged the role this had played in creating an environment in which it was hard for officials to dismiss user views:

However, while the language of consumerism had been well learnt by many of those active in the groups we studied, not all were entirely comfortable with it.

The attack on public service bureaucracies which came from the Conservative government of the 1980s and 1990s was based, in part, in a belief that producer interests had become too powerful and needed to be curbed (Harrison, 1991). One way of doing this was to introduce competition between providers. Another was to separate out responsibilities for determining what services were needed (purchasing or commissioning) from the direct provision of services. While the former should continue to be the responsibility of public authorities (in this context local government and health authorities), the provision of services should be carried out by a range of different provider agencies, including those operating in the commercial, voluntary and public sectors.