Philosophy of The Big Society

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Thursday, 4 December 2008

Service User Involvement - Are things really any different in other parts of the UK?

Received this article (from an Ulster Newspaper):

Mental Health Services: Innovation Without Change
28th November 2008

The provision and delivery of mental health services in Northern Ireland has not improved with devolution, according to University of Ulster academic Professor Deirdre Heenan.

Speaking at her inaugural professorial lecture at the Magee campus this week, Professor Heenan, who is Professor of Social Policy, suggested that despite the rhetoric, service users still have no real influence over the decision-making process.

`Devolution and Social Policy: More say for the Citizens of Northern Ireland?' looked at the provision of mental health services in the context of devolved administration in Northern Ireland to illustrate how the government's avowed commitment to service user involvement had translated into reality.

Professor Heenan said that while devolution was warmly welcomed – as it was widely believed that it would bring government to the people, putting them in control of their own affairs, – the reality for users of mental health services in Northern Ireland was very different.

"One of the first major decisions of the newly devolved government in 2002 was the Review of Public Administration (RPA). In the broader policy context of modernising public services, the RPA was to ensure help that services were to be driven by, planned for, and responsive to, the needs of patients," she said.

As part of the RPA, Northern Ireland's health and social services have been reorganised but Professor Heenan suggested that this radical rationalisation and centralisation of service delivery may actually have an adverse affect on the responsiveness of services.

She says that whilst there is a consensus that user involvement is desirable, it can be problematic.

"The nature and extent of involvement varies enormously. At one end of the spectrum is the token involvement when a few service users might be asked to comment on or react to an agenda, project or document which has already been developed. The other end is characterised by an ideology in which clients' expertise and knowledge is valued.

Pointing out that involving service users did not necessarily mean that their contribution is valued or used constructively, Professor Heenan continued: "It is possible to argue that user involvement is a sham, something which can be held up as representative of authenticity and reality but something which has no real influence over decision-making. It can be employed by managers to illustrate that they are in touch with users. The ideology of user involvement is a way of illustrating management's empathy and demonstrating that they are actually on the side of the user.

"The story told is back in the `bad old' days, users had no say and were simply told by professionals what to do. Now users are told they can be involved and influence the design and delivery of services. This is in fact a myth because all the decisions about how users are involved are controlled by professionals on the one hand and government and welfare bureaucracy on the other hand. The latter have control over finance which is crucial in all these situations.

Professor Heenan concluded that although devolution should have improved user participation and helped make services more patient centred, in key areas of social policy, quangos have been replaced by super quangos, largely unaccountable, remote and non-responsive.

"User participation is a key theme in policy and strategy development but the nature and extent of this participation is controlled by professionals and for many is synonymous with consultation where the outcomes also controlled by policy makers. The example of mental health demonstrates the difficulties associated with meaningful engagement.

Despite examples of new ways of working based on users experiential insights of distress, professionals and policy makers remain extremely resistant. It is this resistance based on the desire to retain power, status and security that needs addressing in depth if there is to be equality based partnership that could lead to fundamental transformations in services. Without these fundamental changes, service users will remain comparatively powerless and `Innovation without change will continue'.


  1. every word of this article is true of how my trust SLAM pretends in the most cynical way to 'involve' service users!!!!
    margaret j

  2. Ahahahahaha. I'm from Northern Ireland and I can tell you now that their mental health services are across the board fecking awful. This is from my mum's experience, my dad's, mine and just about everyone I talked to. They're incredibly underfunded and it's very postcode lottery. And they have next to no crisis services.
    If they want to change, then they need to stop with specious guff like this!

  3. Service user involvement, pah!

  4. So I sent the article to my local Trust and they said it was "interesting"

    From: Ferran, Jim
    Date: 28/11/2008 13:04:03
    To: Jeremy Bryce
    Subject: RE: It is possible to argue that user involvement is a sham

    Interesting!! Thank you.


    Jim Ferran

    Service Improvement Manager

    Level 2 Laganside House

    Lagan Valley Hospital


    BT28 1JP

    028 92 665141 x2281

    P Save Paper - Do you really need to print this e-mail?

    From: Jeremy Bryce []
    Sent: 28 November 2008 12:58
    To: Ferran, Jim
    Subject: Fw: It is possible to argue that user involvement is a sham

    Mental Health Services: Innovation Without Change
    28th November 2008


    Error! Filename not specified.Emai

  5. Jim Ferrari's response is at best unprofessional and at worst downright provocative.

    So much for service user involvment!!!

  6. "Jim Ferrari's response is at best unprofessional and at worst downright provocative."

    Ha Ha Ha wan't to meet him in person !! His former position with the Trust was as a psychiatric nurse. It amazes me that so many former psych nurses become moderate to senior managers with this Trust. Must be something to do with in-built lack of ethics.

  7. Evening folks

    Margaret, SLAM weren't they given Beacon Status at some point? Another one of those times when I go "DOH!".

    Senean, Must confess to not knowing much about the goings on in NI but I think services in England are patchy (some seriously so). I hear Essex seems to be the place to get the best level of care. BLPT (The MH Trust that serves Bedfordshire) are in the bottom 20% in regards to national standards. I think the Healthcare Commission was being kind to them!!!

    Lareve....couldn't put it better than that.

    Jeremy, Good on you for trying to get some sense out of a bureaucrat. You are lucky you didn't get the "We are passionate about patient care" bollocks. Cos it is all lip service!

    Juno and anon

    I don't have a beef with nurses becoming managers. I have a beef with nurses becoming puppets for the system.

    Now going to get off my soapbox and update my bloglist. I am sick of the self questioning and going to add Senean to it and apologies if that offends those who, for reasons of time, I don't add. Is not personal is just there are so many blogs out there, I don't get chance to read half of them and that means I am missing out on quite a bit.

    TTFN x

  8. I left Northern Ireland 14 years ago. One of the main reasons to relocate (to England) was the crap services available for my severely autistic son. I see that things haven't changed much!

    Btw, you did fine on the radio :0)

  9. Hi Robert

    I hope your son is getting better care where you are now.

    Thanks for feedback from radio programme although I won't be doing one again.

    I want other people's voices to be heard (and for sure they will sound a lot better than mine). :>)

    Take care

  10. I'm surprised you allow comments on here from Jeremy Bryce of all people.

    Bryce has targeted anti Seroxat campaigners in the UK and America with a series of posts both in UK Survivors [A Yahoo Group] and with a dopleganger blog he has created where he targets Seroxat lawyers, campaigners and psychiatrists that have spoken out against Seroxat and SSRis.

    Don't believe me? Ask him!

  11. Mental Health Campaigner Jeremy Bryce, targets Seroxat Campaigner with vile posts on UK Survivors.