The ‘User’: Friend, foe or fetish?: A critical exploration of user involvement in health and social care

Abstract

‘User Involvement’ has become the new mantra in Public Services with professionals constantly being reminded that ‘user knows best’. The pur pose of this paper is to ask where the preoccupation with ‘the User’ comes from and to pose some questions about what ‘User Involvement’ actually means. Within our paper we see three issues as central within this. The first is a consideration of the historical antecedents of the discourse of ‘User Involvement’, focusing in on the struggles over British welfare that took place around the late 1970s–early 1980s. This forms the context from which we seek to understand and critique the New Labour project in relation to the massive expansion of regulatory frame works. We argue that, far from enabling the delivery of high quality integrated services that truly reflect the interests of current and future users, these policies represent the further commodification of basic human needs and welfare. Finally, it has become apparent the current ‘User’ discourse has assumed contradictory manifestations, in particular the emergence of groupings of ‘professional users’ who participate in the formation of state policy as ‘expert consultants’. We conclude by arguing for an approach in which user perspectives are neither privileged nor subjugated, but are situated in a process of creative critical dialogue with professionals, which is linked to the development of a concept of welfare driven by emancipatory rather than regulatory imperatives.