We need to talk about service user
involvement, says Nick Goldstein
ervice user involvement, in one form or another, has been around a long
time. An argument could be made that it’s been around since
Hippocrates carved healing out of theology, superstition and belief to
create modern medicine. He actually asked his patients to describe their
symptoms and how their treatment was going and used their feedback
to improve treatment, which sounds familiar.
Service user groups arrived in modern Britain with the forming of community
health councils in 1974. Their stated aim was to allow the ‘public’ to participate in
their own health and social care – and that public included service users.
The arrival of New Labour in 1997 marked the apogee of service user
involvement in Britain. One of the government’s first acts was to legislate for
greater public engagement in healthcare, so the NTA, PCTs et al all promoted,
encouraged and even funded service user groups. But even at its peak, service user
involvement often gave the impression of being an afterthought – something that
had become a legislative obligation and hence tolerated by service providers, rather
than a concept that was loved and appreciated.
A change of government in 2010 brought a change of agenda and the beginning
of the decline of service user involvement. The adoption of the recovery agenda
resulted in recovery-orientated services and recovery-focused service user groups,
8 | drinkanddrugsnews | June 2018
and their concentration on life post treatment meant that much of the emphasis on
improving treatment and policy was lost. It also resulted in funding cuts, making it
difficult to operate meaningful service user groups and furthering the disinterest in
service user groups and what they had to say.
This is where service user involvement languishes at present – as an
underfunded afterthought that only really exists to tick boxes. To be clear, service
user involvement is gravely ill. The question is, is the patient worth saving?
The question alone will be heresy to some, but maybe the time has come to
examine what service user involvement was supposed to be, what it actually
became, and what it should be. Its initial aim was to empower users to improve
their own health by involving them in partnerships with service providers, to
improve and monitor services. That’s actually two subtly different aims – and that
schism between the two aims is the root of the problem.
Firstly, there’s service user involvement as therapy for users. This could be
sarcastically referred to as the service user involvement of pony riding trips and opera
visits, but it would be short sighted or wilful blindness not to accept that it provides
vital support and structure to many service users who are already marginalised.
It’s the second aim that’s the problem. Service user involvement has, and