1.5 Moving forward?
So far you have read about the development of consultation with service users. Why, then, do service users and their organisations experience a struggle to be heard? What barriers are they encountering?
Service providers may structure consultation around service needs rather than service users' interests. For example, consultation at the planning, delivery and monitoring stages of a new day centre might be informative to service providers as well as a good example of service user involvement at all stages. Conversely, service users might consider that another day centre – no matter how well developed – is not what would best meet their needs.
Another area of contention is the rationale on which service provision is based. Many services stem from paternalistic concepts of ‘looking after’ less advantaged people. Some disabled people reject notions of vulnerability and personal disadvantage and many people find getting the help they need difficult enough. On the other hand, vulnerability and ‘being looked after’ can be more positive concepts where children are concerned (but children also want their strengths recognised and to have a voice in what happens to them). How ‘care’ is defined and the way social problems are defined and prioritised will affect responses to consultations. Medical or individual service models assume that ‘the problem’ resides in the individual rather than in the attitudes, structures and environments that create barriers to ‘ordinary’ life.
Are the service planners prepared to listen to such messages? One thing is clear: action of some kind must follow consultation. An area for development may well be more user-controlled services:
If those who need support in order to live in the community are to exercise choices and have control over how that support is provided then two things need to happen: their preferences about the support they receive have to be expressed and action has to follow based on the expression of these preferences.
(Lindow and Morris, 1995, p. 5)
To respond to the results of consultations, managers need to meet a range of challenges posed by their own organisations as well as service users, and to deal effectively with any tensions that may arise.
Social care organisations need to be inclusive in getting feedback from service users and distinguish between what service users and carers say about services.
Service users want to be respected as individuals and to have a voice in decisions.
Discrimination can be reinforced by consulting only the people who receive services.
Service users can play a central role in monitoring and evaluating the quality and effectiveness of services, including relationships with social workers and service providers.
Action must follow consultations with service users.