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).