Book contents
- Frontmatter
- Contents
- List of figures and tables
- Acknowledgements
- Notes on contributors
- Foreword
- one Introduction: managing the ‘unmanageable consumer’
- two The consumer and New Labour: the consumer as king?
- three Narratives of public service delivery in the UK: comparing central and local government
- four Understanding the ‘differentiated consumer’ in public services
- five Differentiating consumers in professional services: information, empowerment and the emergence of the fragmented consumer
- six The healthcare consumer
- seven The consumer in education
- eight The consumer and social housing
- nine The people’s police? Citizens, consumers and communities
- ten The consumer in social care
- eleven Differentiated consumers? A differentiated view from a service user perspective
- twelve Authoritative consumers or experts by experience? User groups in health and social care
- thirteen The public service consumer as member
- fourteen Conclusion: the consumer in public services
- Index
six - The healthcare consumer
Published online by Cambridge University Press: 22 January 2022
- Frontmatter
- Contents
- List of figures and tables
- Acknowledgements
- Notes on contributors
- Foreword
- one Introduction: managing the ‘unmanageable consumer’
- two The consumer and New Labour: the consumer as king?
- three Narratives of public service delivery in the UK: comparing central and local government
- four Understanding the ‘differentiated consumer’ in public services
- five Differentiating consumers in professional services: information, empowerment and the emergence of the fragmented consumer
- six The healthcare consumer
- seven The consumer in education
- eight The consumer and social housing
- nine The people’s police? Citizens, consumers and communities
- ten The consumer in social care
- eleven Differentiated consumers? A differentiated view from a service user perspective
- twelve Authoritative consumers or experts by experience? User groups in health and social care
- thirteen The public service consumer as member
- fourteen Conclusion: the consumer in public services
- Index
Summary
Introduction
Conceptualising users of health services remains a contentious issue. On the one hand, some authors have claimed that ‘the essential problem with the healthcare industry is that it has been shielded from consumer control – by employers, insurers and the government’ (Herzlinger, 2002, in Spiers, 2003, p 6). On the other hand, however, writers such as Titmuss (1968) and Stacey (1976) argued that the consumer has no place in healthcare (see Clarke et al, 2007; Le Grand, 2007; Needham, 2007).
In practical terms, there has often been little evidence of NHS organisations adopting a patient-centred approach to the delivery of care. Sir Patrick Nairne, a former Permanent Secretary at the Department for Health and Social Services (DHSS), noted in 1988 that no public service thought less about the public (in Smee, 2005, p 133). In this sense, both the critique of Herzlinger and the concerns of Titmuss can claim that there is evidence to support their perspectives; consumerism has not often been very apparent in healthcare, regardless of whether particular commentators regard it as a good thing or not.
This chapter focuses on the consumer of healthcare. It first briefly examines the terms of ‘client’, ‘citizen’ and ‘consumer’ that were introduced in Chapter One with respect to healthcare. It then examines the ‘consumer’ in the NHS, before discussing the mechanisms of healthcare consumption and the different faces of health consumerism.
Citizens, consumers and clients in healthcare
The term most familiar to those using healthcare services is the ‘patient’, and Coulter (2002, p 7) argues that none of its alternatives is entirely satisfactory. There is no word that everyone may comfortably use to describe the individual receiver of health or social care. However, the terms ‘patient’, ‘client’, ‘customer’, ‘consumer’ and ‘user’ are all used, and each has different implications (Hogg, 1999, p 2) even if ‘patient’ is still regarded as a good label by staff and users (Clarke et al, 2007, pp 126–8) and is still widely used in policy documents (Needham, 2007).
Client
Most associated with the term ‘patient’ is the client role. Clients are often located in the context of professionalism. Talcott Parsons’ ‘sick role’ sums up the relationship between professional and client: the professional has expert knowledge and the passive client should be compliant (see, eg, Sheaff, 2005, pp 90–1).
- Type
- Chapter
- Information
- The Consumer in Public ServicesChoice, Values and Difference, pp. 99 - 118Publisher: Bristol University PressPrint publication year: 2009