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

Key messages

Service user participation has become an increasingly important part of social care. Organisations need to consider how well they are doing in this area and where improvements need to be made.
The guide shows how this can be done by using a whole systems approach examining culture, structure, practice, and review (Wright et al., 2006).

Participation is more than developing a policy and implementing it. It is about ensuring that all members of an organisation are committed to participation and recognising that it will involve sharing power with service users.
Cultural changes need to occur throughout an organisation.
Staff may need training and support in developing a more participatory culture.
Attention needs to be paid to formal and informal ways of supporting service users.

Participation can be hindered by structural barriers, such as formal meetings or a lack of technological support. Organisations need to consider how they can avoid practices that may make people feel excluded, and how they can build up capacity among service users and service user organisations.
Many barriers can be removed by good planning.
Making changes to the system, not simply looking at how to support an individual, is generally a better way of removing barriers.

A welcoming and friendly approach is an essential ingredient to good participation.
Avoid using just one model of participation. This increases the likelihood that some service users are excluded. Specific strategies may be needed to ensure that the voices of people who are 'seldom heard’, such as service users from Black and minority ethnic groups, and service users with communication difficulties are included.

More attention should be paid to reviewing the effects of participation. Although many organisations lack the resources and some of the skills needed to review their practice, using systems to review participation increases accountability both to funders and to service users and helps in developing a more outcome-focused approach to participation.
The lack of emphasis on review means that we still have limited ways of identifying changes that have resulted from service user participation.
We also need to know more about how participation is undertaken effectively for all service users, including those who are 'seldom heard’.