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state to individual responsibility. It is market based and works with the idea of service users as a customer/consumer who has a choice of services, they have a voice to say what they want and where they want to go (Beresfod and Croft, 1986; Winkler, 1987, as cited in Reader book, p. 22). For example parents being allowed to choose the school their child can attend, at one time children had to attend their local school but some schools were failing and to allow children equal opportunity the government has allowed parents to choose their school. The problem with this approach is that the choice really isn’t there as the schools parents want their children to go to are usually full so they end up having to send the child to the local school after all. This is a problem for all services where the government has allowed to service users to choose where they want to go. The areas that are failing continue to fail and the areas that were once successful are unable to cope with the overwhelming numbers of users demanding their services.
Consultation and involvement with service users has become a key component of legislation, policy and guidance in relation to service delivery and planning. The other view of participation is service users as citizens with equal rights. This approach has a direct impact on people’s lives, its main aim is to ensure that everyone is heard and what they say is acted upon. The government has consulted people with learning difficulties in drafting a white paper ‘Valuing People’ (Department of Health 2001b as cited in book 1 p. 29).
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These service users at one time would have been seen as victims and not consulted but with the United Nations human rights act everyone has the right
to be heard. They view this consultation process as being an important step forward in assessing the performance of Health and Social care agencies (Department of Health 2000b; Scottish Office 1999 as cited in book 1 p.29). The term citizenship is a helpful concept to enable wider consultation and involvement of the service users. In regarding the service user as equal there is a better chance that their voice is heard and acted on. The problem with this approach is that not all service users are willing to participate due to either lack of confidence, time restraints or a lack of faith in the system. This causes concern for providers who are required by central government to ensure that there is a satisfactory level of participation from a broad representation of the service users. There are also concerns that those who do participate are not truly representative of the typical service user. Another problem is that providers have to work within a set budget and have limited resources, the demands from service users put too much strain on the budget.
The managers of the providers need to liaise between government and service users. Practice led managers have the experience of working with the service users directly and can see where the service being offered is failing. They are in a better position to help and understand what the service user
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needs. Allowing service user participation has been useful to managers as they have found the feedback useful in measuring the quality of service being offered. It also helps highlight any problems or issues that need to be resolved. It also creates accountability for the service providers ensuring that they are providing a useful service.
These two approaches vary in the way that they allow participation of service users in decision making but they both have the same end goal and that is to improve the services that they provide. Consulting users about their expectations and what they need seems to be the best way forward as the services being provided are for the service users and who better than the users to know what they need or want. The problems that arise from this are the difference between what the government is willing to offer in resources and what the users want. The answer may lie in a combination between viewing service users as citizens and as consumers. Provider need to ensure that the feedback they obtain from service users is inclusive and they are able to distinguish between what service users and staff say about services (Connelly and Seden, Book 1 ch.2 p.37). Deciding what is useful and helpful in implementing quality of service is another issue that needs to be addressed as not everything that is suggested from the service users will be practical to implement due to resource restrictions. Service users want to be respected and have a voice in decisions. This is what the government wants but it has a long way to go before it is put into practice in every service. Prejudices and
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lack of participation from service users put the participation and service users as valued citizens at risk.
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References:
Beresford Peter and Suzy Croft (2003), Ch. 3 Involving Service users in Management: citizenship, access and support, The Managing Care Reader, Routeledge, London.
Birchall Johnston and Richard Simmons (2004), User Power, National Consumer Council, . [accessed 1/11/05]
Connelly Naomi and Janet Seden (2003), Chapter 2, What Service users say about services: the implications for managers, Book 1 Managing Care in Context ,Routledge, London.