Introduction

In Chapter 5 we sought to draw from our case study material some conclusions related to our conceptual themes of consumerism and citizenship. In this final chapter we draw together the main points which arise from the case studies in Chapters 3 and 4 as they apply to more practical issues. Where appropriate, reference is made to the more general findings of the larger study.

User views on the policy context: new management and community care

The aims of the two groups considered in some detail in this report (and indeed of the other four groups in our study) went beyond bringing about change in what were seen as inadequate, dependency-creating statutory services. Although changes in service planning and provision resulting from the 1990 Act had inevitably impinged on the groups and the way that they worked, they did not define the groups’ purposes. Thus they also focused on the legacy of prejudice, discrimination, exclusion and disempowerment which disabled people and people with mental health problems experience in all areas of their life. In the case of Group One, this related to the stigmatising nature of mental health problems, while Group Five had a more far-reaching view, based on a social model of disability.

Neither group felt that their relationships with local statutory agencies were bad, but Group One reported a more positive relationship with the NHS than with local authorities and Group Five vice versa. Neither group (nor any of the others in the study) criticised the principle of community care, but were critical of what they saw as failure to resource its successful implementation. In particular, restrictions on local government finance had also affected the funding of user groups. Moreover, the purchaser/provider split had resulted in a proliferation of bodies that user groups may wish to influence, meaning that decisions had to be made about priorities. Concern was expressed that these organisational changes had led user groups to become more reactive rather than proactive.

User groups’ objectives and strategies

Hirschman (1970) identified three broad models of the way in which actors might respond to dissatisfaction with an organisation: ‘exit’, ‘voice’ and ‘loyalty’. The user groups in our study employed all of these, together with a fourth, to which we refer as ‘rewriting the rules’ (see below).