Introduction

Discussion and developments relating to ‘the public service consumer’ have been constants of growing significance since the late 1970s. This chapter focuses on this issue from the perspectives of people as long-term users of health and social care services. This large group, which includes older and disabled people, mental health service users, people with learning difficulties and others, is one for whom the discourse about the consumer in public services has major ramifications. Yet this discourse is not one in which they can be said to have played a central part, albeit, as we shall see, that they have been enlisted as actors within it.

A key aim of this chapter is to explore both their responses to public service consumerism and the frameworks which they have employed in developing both their own individual and collective identities and actions in relation to public policy and services. I have described this contribution as from a ‘service user’ perspective because this is a crucial part of my perspective as the author. There is no suggestion that this is the only view that might be offered from a service user's perspective, although the discussion does draw on a wide range of service users’ views and discussions.

The role of social policy

A key concern of recent social policy, both in the UK and more generally, has been to develop a changed, more active relationship with welfare users. Yet, so far, social policy texts have had relatively little to say about welfare users. They have paid little (in some cases, no) attention to their perspectives and discourses. In some cases, though, these discourses are far advanced, for example in the case of the disabled people's movement. There is now a range of movements associated with welfare service users, including those of older people, mental health service users/survivors, people with learning difficulties, people living with HIV/AIDS.

Yet, if we take a range of widely used social policy textbooks, discussion of and references to service users, their movements and their critiques are generally very limited or non-existent. It was not until 2008 that the UK Social Policy Association specifically addressed the issue of welfare service users in its student's companion (Beresford, 2008).