The participation of adult service users, including older people, in developing social care

Culture - Power dynamics

Until we have secure financial footing, we will not be able to help bring about changes. We always have to chase the money and cut our cloth to fit. And now with all the non-service user organisations tendering against us it is likely we will be forever the poor relation begging at the door. That hardly results in good participation practice. (Service user)

Service users are in an unequal position with social care organisations (Barnes et al., 1999; Rummery & Glendinning, 2000). Additionally, they may experience what are termed 'multiple oppressions’ through being a service user and being a member of a minority group on the basis of ethnicity, gender, sexuality, age or people with HIV/AIDS (Butt et al., 2005; Carr, 2004; National AIDS Trust, 2006). These existing power imbalances are often reproduced when social care organisations involve service users.

  1. The process of participation may itself be exclusionary if it is undertaken on the basis of an acceptance of a disempowered identity. For example, descriptions of particular types of service user, such as 'socially excluded’, are stigmatising and may actually deter people from participating (Newman, 2002).
  2. Some participatory structures may reproduce ways of operating that are exclusive rather than inclusive, for example, by having very formal agendas and rules of debate (Barnes, 2005).
  3. Social care organisations may retain power by defining who is a 'legitimate’ or 'representative’ participant (Beresford & Campbell, 1994; Millward, 2005), for example by controlling who is invited to consultation events and meetings.

This third point has become an increasingly important topic of debate. As social care organisations become increasingly concerned about representativeness, it has been suggested that this is less about extending involvement but more about organisations wanting to define who is representative.

You start off as a raw service user and as you become better at saying what you want to say, you get excluded from the list of who to invite because they call you a 'professional older person’. I have been at meetings and they have listened to what I’ve said but you know that they’re going to tick a box saying, 'Have you consulted with service users?’ when they have only talked to me.  My voice is valid but I don’t represent everyone else as well. (Service user)

Harrison and Mort (1998) identified how some officials used the views of service users to give legitimacy to their own opinions when they were faced with another group of officials with whom they disagreed. In these circumstances, they would highlight the legitimacy of service users, a process they (the officials) described as 'playing the user card’. Conversely, where they disagreed with the opinions of service users, they started to question service users’ legitimacy, dismissing them as extremists or unrepresentative.