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

Structure - Dealing with barriers to participation

Personal barriers

Service users can be supported in overcoming some of the barriers to individual participation in three main ways. These are through:

• training;
• policies aimed at minimising the costs to service users; and
• systems that are flexible enough to take account of the way in which a person’s circumstances or disability might influence his or her ability to participate.

Training for service users

Supporting service users through training is an example of capacity building whereby, as service users become more confident, their capacity for activity is increased. This has been a key feature in the development of user-controlled organizations (Postle & Beresford, 2007). However, investment in capacity building has remained low or poorly co-ordinated and this has been identified as a major reason why communities and service users remain excluded from systems for decision-making (Duncan & Thomas, 2000).

The practice survey identified the three following types of training for service users.

1. Campaigning and lobbying skills

Campaigning skills, and being able to put one’s views across effectively, are very important for service users, especially if they are taking part in formal settings, such as being a representative on a local authority strategy group. Although many service users are experienced campaigners, others are not. Training in campaigning and lobbying skills helps those without experience in this area.

2. Assertiveness training

Assertiveness training can be used to help service users become more confident at expressing their views.

3. Workplace skills

Training can be used to support service users who would like to become paid workers or volunteers. This includes training in counselling and presentation skills, project management and staff recruitment.

Offering training is especially important where service users are involved in specialist roles, such as teaching on social work education programmes (Duffy, 2006) or working as co-researchers (Miller et al., 2006; Smith, 2004; Walmsley, 2004).

Minimising the costs of participation to service users

Organisations can help overcome barriers to individual participation by developing clear and efficient systems for minimising the costs to service users of participation. This is about more than the actual monetary value because it demonstrates a commitment to equalising relationships between service users and professionals. An important starting point is having a policy for participation that makes things clear from the start and spells out what will be paid and how. This helps to prevent differences in the way that people are treated and reduces the difficulties that might be caused by informal arrangements when there are organisational or staff changes.

Linked with this, is the need to have a policy for paying support workers, and/or personal assistants, and reimbursing the expenses of volunteers if they are needed to help the person participate, or to cover replacement support costs for family carers.

It is vital to make sure that expenses are paid as quickly as possible, either by fast-tracking claims through the organisation or by bringing along cash to reimburse people on the day. Service users should be reminded in advance if they need to bring receipts or provide invoices.

Payment

• There is considerable variation in the way that organisations deal with the issue of payment and there are many examples of unfair treatment where individuals work for no payment alongside others who are being paid (Turner & Beresford, 2005). For example, service users and carers are increasingly involved in professional education but may receive only token payments for their involvement (Bamber & McKeown, 2003).
• The question of payment is an extremely complicated area and solutions will depend on the personal circumstances of individual service users. The Department of Health (2006a) has issued a guide on reimbursement for service users which outlines good practice in terms of paid involvement and gives an overview of the current regulations on permitted work for people on benefits.
• While some organisations offer payment in kind, such as complimentary copies of newsletters, reports, or other publications, a meal or refreshments, or the opportunity to take part in a conference, training or other activity, these may be defined as taxable benefits by the Inland Revenue and so this needs to be considered if payments in kind are to be made (Faulkner, 2004).
• The complexities of payment should not be used as an excuse to avoid supporting service users who want to move into paid employment as consultants, researchers, or advisors.

Devolving budgets to service user organisations

• Most of the organisations included in the Practice Examples had developed policies for reimbursing expenses and, to a lesser extent, support costs. Fewer organisations had devolved budgets to service users so they could control how the money was spent themselves.

Systems that are flexible

This can range from flexible employment policies to providing quiet areas for people to rest or take time out. Similarly, there should also be recognition that service users with conditions which have periods of remission, may have times when they would like to increase their involvement.