SCIE Practice guide 11: The participation of adult service users, including older people, in developing social care

Practice - Types of participation

Different people want to participate in different ways and there is widespread agreement that successful service user participation is based upon having varied and flexible approaches that allow this to happen (Collins, 2004; Truman & Raine, 2002; Waldman, 2005).

Consultation meetings

• Consultation through meetings, questionnaires and focus groups is probably the most frequently used model of participation, although it is most criticised by service users because there are concerns that consultation meetings may operate according to a fixed agenda and there is no guarantee that people’s views will actually be used to change a service (Carter & Beresford, 2000).

Ways in which organisations have tried to improve the quality of consultation meetings include:

• having meetings in which there is a formal system for accounting for decisions that have been taken and an opportunity for discussion and planning for the future;

• using different ways of collecting information, such as focus groups and questionnaires, in addition to formal meetings; and

• meeting at different times and in different venues

• The choice of venue is something that can make meetings simultaneously more inclusive for some groups and exclusive for others. For example, meetings in pubs can reach people who would not want to travel to 'official’ locations such as the town hall, but would exclude others who would not go to pubs on religious or moral grounds. This means that it is important consider carefully the choice of venue.

Forums

• Forums for specific service groups, such as national and local older people’s forums or local and regional forums for people with learning disabilities, may avoid some of the difficulties about power raised by consultations because they are run by service users for service users.
• Forums are more democratic in that they have a recognisable 'voice’ and they have been able to effect changes to services, despite barriers persisting for some people. (Barnes, 2005; Carter & Beresford, 2000).

Campaigning organisations

• Campaigning organisations range from large national to small grassroots organisations.
• Larger organisations are sometimes seen as coalitions for service users, rather than of service users, although they can offer a less time consuming way of becoming involved, while creating a sense of solidarity and shared interests among their memberships. In addition, service users are able to increase their levels of involvement by becoming volunteers, paid workers or trustees. (Carter & Beresford, 2000).

Advocacy

• There are different models of advocacy services (Rapaport et al., 2005) but each share similarities in that they all aim to speak on behalf of another person or, in the case of self advocacy groups, to speak on behalf of themselves and fellow members.
• There are disagreements about what is meant by advocacy and the understandings and expectations of people who use advocacy services may not be the same as the service providers (Bowes & Sim, 2006; Forbat & Atkinson, 2005).
• While advocacy services are available in most parts of the country, not all service users have equal access to advocacy services. For example, advocacy services for people with dementia (Cantley et al., 2003) or people with communication difficulties (Lewington & Clipson, 2003) are less developed than those for people with learning difficulties or mental health service users.

Service user led groups or networks

• Participation led by service user controlled groups or networks has the advantage of being more firmly rooted in the actual aspirations and preferences of service users but has often faced barriers in terms of funding (Beresford et al., 2006; Carter & Beresford, 2000).
• Consulting directly with service user led groups or networks, or asking them to undertake consultations on behalf of another organisation, has greater credibility with service users (Banongo et al., 2007) and leads to better quality results because of their greater experience and expertise in identifying what is important to service users (Evans & Carmichael, 2002; Fisher, 2002).

Individual involvement on a daily basis

It is easy to forget that, for many people, the most meaningful participation is being able to take more control over their everyday lives.