For many citizens, their relationship with the state is experienced primarily through their experiences of using services provided by or through government. The potential of increased public participation will be judged by many participants by its capacity to generate services that are of better quality, more responsive, culturally appropriate and designed in ways that reflect their lives and circumstances rather than the preferences and interests of service providers. The significance of public services to the lives of most citizens, particularly at times and in circumstances when personal resources may be low, or when they have no option other than to receive services, accounts for the power of the consumerist discourse and its expression in the Thatcherite ‘reforms’ of the public sector during the late 1980s and 1990s. But the way in which people use public services also explains many of the inadequacies of consumerist developments in terms of ‘empowering’ individual service users or generating services that are collectively experienced as more responsive to the needs and circumstances of their users (see, for example, Barnes and Prior, 1995; Barnes and Walker, 1996).

In this chapter we consider five initiatives, which, in different ways, illustrate how citizens and service users are taking part in action intended to shape and change public services. They demonstrate ways in which a consumerist ideology is inadequate in accounting for why people get involved in such initiatives, or in understanding the relationship between citizens and officials and the nature of the dialogue that develops between them. We reflect on such motivations and relationships as well as locating the initiatives more precisely within the policy discourses discussed in Chapter Two. The five examples are:

• • a community health forum involved in developing a community-run health centre;

• • a social services user group seeking to influence the design and delivery of social care services for adults;

• • a patient participation group in a GP surgery;

• • a group aiming to secure the free provision of religious circumcision services for Muslim men by the NHS;

• • a multi-ethnic group convened by an NHS trust to contribute to ensuring the provision of more appropriate services sensitive to the needs of different ethnic groups within the city.