Introduction

This chapter explores the implications of two competing discourses on participation: the consumerist discourse and one concerned with empowerment, democratisation and liberation. These discourses are situated in the context of their relationship to welfare provision and changes therein since the 1980s. Drawing on recent research, the chapter connects participation in political activity with the development of movements of people using health and social care services. It discusses the implications these may have for the nature of involvement and, indeed, of democracy. It therefore illustrates some of the more theoretical issues about the role of service users, and the knowledge they contribute to policy and practice processes that were raised in Chapter Four. This chapter also considers the changing role of care professionals in relation to forms of participation that can liberate and empower rather than construct people who use services or give care/support solely as consumers in a care market.

Context: the residualisation of state welfare provision in the UK

In 2005 a major new political discourse was initiated about welfare provision in the UK (see also Chapter Seventeen). Social care tends to be marginalised in political debates but this discussion emanated from the Prime Minister's Strategy Unit, bearing his formal imprint. Its initial focus was on disabled people but its influence is spreading across a range of service user groups (DH, 2005). This new discussion focuses on ‘individual budgets’, converting services to notional or actual entitlements that can be used flexibly to secure the range and types of support that an individual prefers. As the Prime Minister makes clear, the proposal to introduce individual budgets is at the heart of government thinking about ‘improving the life chances of disabled people’: