1.3 Service users' views: What views?
Some views from our consultations are shown in Example 1, which has comments from people who have used mental health, physical disability, older people's and learning difficulty services, and Example 2, which has comments from the users of services for children, young people and families.
Example 1: Some views from users of adults' services
Treat people as people and not as a problem.
Social care managers have got to listen. If they don't listen they don't know what we're saying to them. They've got to listen because we've got to tell them what we want. It's not what managers want, it's what we want ourselves.
I think basically from a practical point of view they are having to ration because they don't have the resources to do everything for everybody. What I want to know is who chooses who gets what? We don't have a say in it; you don't have a say in it, do you? … People who are in the caring professions – and this includes the line managers – should be listening to the person. That's the first thing they should do, listen to them. Find out what's available and then negotiate with them. I'm not expecting just to say I want this, this and this. I am expecting them to negotiate with me and I'm still waiting.
The services kick in at the point of crisis. On the way back you've got places where you can be rehabilitated and gradually get back into society. But there should be places on the way down.
It's independence really, isn't it? It's the biggest thing of the whole situation. Although you need help on occasions, you don't need it all the time. You don't want it thrust down your throat.
Example 2: Some views from users of children's services
Whenever I phone to ask what's going on, they tell me that I'm too anxious and I should wait, but the fact that they never phone me doesn't help.
The problem is there is a totally uncoordinated approach to family life with this sort of problem and it's now going to cost them more to put it right … it's probably the system rather than the people.
Children are not able to influence decisions made about them. Adults who do not know them well often make decisions in large meetings.
Social services … they were really supportive. I mean, I had to go to court and everything and my social worker came through with me and stuff and supported me through that.
I met quite a few nice girls at the group as well. They went through the same kind of thing, so you know what you're all going through, so you all have respect for each other.
(Young woman, speaking about a support group)
Social services … at the start they were very good and then weeks and weeks went by and in the end we wrote a letter of complaint … because we wanted to know what was happening … she just didn't keep in touch and when we sent the letter of complaint she sent a letter of apology, so that was the only bit we were unhappy with … I think what they should do instead of swapping over to different people … they should keep the child with one person …
It's certainly been a fight and I wish the professionals would listen to you. You're the child's best advocate, you know their needs more than anyone and sometimes they override that and say ‘No, I'm the professional here’.
The messages from these two sets of views are that service users want:
to be treated with respect and as individuals
a voice in decisions about the range of services that should be available and which services they receive in particular circumstances
recognition that while services may be an important or even an essential part of their lives, services are not all of their lives
acknowledgement that they are reasonable people who understand about resources and other constraints but who think that is a reason for more attention to be paid to their views, not less
to see signs that the time spent in giving their views has influenced decisions.
Services are organised around specific categories and delivered by a range of qualified and unqualified, paid and unpaid workers. When service users talk about what is important to them as people, they are not as concerned with the profession of the person who provides the care, or the context in which that worker operates, as with the quality and appropriateness of the service (Rogers et al., 1993).
There is no shortage of sources of service users' views. At central government level, inspectorate reports include some exploration of service users' and carers' views (for example, Social Services Inspectorate, 2001 – this kind of work will be taken on by the Care Quality Commission in April 2009). The views of people who use services continue to be part of any assessment of how well services work.
Individual social services departments and voluntary sector and service user organisations have done much research, such as surveys and the use of advisory groups or working parties including service users. People who receive services have also been involved in designing and carrying out training, monitoring and evaluation of those services.
Service users and potential service users from black and ethnic minority communities face additional barriers to involvement and consultation because the service providers lack effective communication skills, understanding or commitment (Bowes and Dar, 2000; Hatton et al., 1998; Joseph Rowntree Foundation, 1998; Taylor, 1999). Thus, if discrimination has led to services not being offered in the first place, consultation may reinforce this discrimination by asking only those people who have received the service.
Research studies have played a major role in finding out the views of children and their families about the services they have experienced. Overviews of the researchers' findings, drawing on several large studies, include summaries of views about what was available and the way in which the service was offered. For example, the following main points are from The Children Act Now, a review of 24 substantial studies into aspects of the implementation of the Children Act 1989.
Children value five main qualities in professionals: reliability, practical help, support, time to listen and respond, seeing children's lives in the round.
The techniques of research can be helpfully used to improve direct work with children.
A child-centred service demands that adults listen to how children would like services organised and act upon children's views.
(Department of Health, 2001, p. 95)