Involving the service user in shaping services continues to be an important activity within government policy. Drawing from the K303 materials critically discuss the issues, challenges and benefits in involving the service user to shape and develop services.
Health and social care services strive to maintain, increase people’s wellbeing and provide the best care practice to individuals and the community. However, discrepancies arise because generalisations about what people need and how services should operate is still an everyday issue that affects the provision of services. People’s circumstances and opinions differ from one another despite having similar needs on the surface. Therefore, different kinds of support are expected. That is the main reason why people need to become participants in designing and shaping care services. When it comes to user’s involvement, policies have shaped the way social services are delivered as they represent an essential framework to the implementation of consistent and quality practices. As a result, it is utmost for frontline managers and healthcare professionals to adhere to them. However, this process is not straight forward and difficulties emerge (Book 1, pp. 27-28). This essay will explore the issues, challenges and benefits of engaging service users in shaping and developing services. In order to do this, I will attempt to define the terms policy and service user involvement. Subsequently, I will identify the barriers faced by managers; discuss ways to overcome these challenges. And finally, the benefits of service user involvement will be identified.
Policy and Practice
Policy can be defined as a plan of action adopted by a person, group or government (Collins Language, 2011). In the history of health and social care, service providers have been influenced by the legacy of paternalism that developed in Victorian times. However, it was only until the 1970 s when emphasis on participation and service user involvement took placed. Through the years, the growing significance of service user involvement helped to eradicate the paternalist approach previously adopted by the government and service providers. Thus, generating a partnership-based approach. Service user involvement or participation is listening to what people say about the services to have an impact on the way they are delivered. This has also become a key feature of government policies (Book1, p.28). In the course materials, Jane Rees made reference to this statement by emphasizing that ensuring genuine service user involvement was fundamental to her managing role at Redcar and Cleveland MIND (K303, DVD1, Band 2). It is also important to mention that service user involvement derives from two approaches –consumerist and democratic. The first approach refers to service users as customers and consumers of welfare much as they are consumers of other products. This approach, mainly developed by the state, aims to improve efficiency, economy and effectiveness of organisations and services. By drawing on the ideas and experience of service users, it is possible to improve management and decision making (Leggett et al, 1999, quoted in Course Reader, p.22). On the other hand, the democratic/citizenship approach is related to people as citizens as it was developed by users of health and social care services. This model has to do with enabling people to have more input over what happens to them in order to bring about direct change in their lives through both collective and individual action (Priestly, 1999, quoted in Course Reader, p. 22).
Why is it important to adhere to policies? And what are the consequences of not adhering to them? Recognition of the importance of service user involvement is at a higher level. Service user’s view are becoming accepted by the government as an important element of evidenced based practice and a critical component when assessing the performance of health and social care agencies (DoH2000b; Scottish Office,1999, quoted in Book1, p.29). User involvement or participation is a complex, heavily politicised and value-based activity that can be related to basic ideas of best practice. At the same time, the experience developed by organisations, service users and supportive providers provides a source of principles for good practice. Although they do not guarantee success they do impact those who ignore them (Course Reader, p 24). It could be mentioned that one of the outcomes of not adhering to policies is the move away from considering the service user’s satisfaction. When an organisation does not take into account the views of the service user’s it will find itself open to criticism and it is likely to be told to make changes (Stallard, 2011).
For example, ignoring the views of service users who are involved in services again their wishes such as adults sectioned under the Mental Health Act 1983 (DoH, 2007) or the right of young people and children to be consulted about their views under the Children Act 1989 (DoH 2001c, quoted in Book1, p.41) could prevent valuable understanding regarding the fairness and equality of the service user’s involvement process. Also, difficulties when measuring and monitoring the quality of the services offered can be encountered when organisations and managers do not adhere to policies. Consequently, this could lead to the miss of any practice that needs to be highlighted or resolved. Moreover, not adhering to policies prevents social care organisations from being inclusive and developing a partnership with people who use the services. This has a direct effect on carers and service users as their right to have a voice and express their individual view is denied (Book1, p.37).
Issues, challenges and benefits
Frontline staff and managers need to bear in mind that their daily job objective is to maintain a person’s well-being and quality of life. However, that is not an easy task. Taking into consideration that user involvement is paramount to develop good care practices; it is also possible to establish that many difficulties arise when this approach is put into practice. The first issue to be considered is the amount of time it takes to manage and apply the integration of service user’s views into all phases of the social care process and, not as a ‘one off’ consultation session. As an example, considering, listening and understanding children and young people’s views about their lives as well as other people who could help is a time consuming process where preparation is the key. Albeit, preparation requires time; therefore the process can result on management exercising pressure on staff to meet time deadlines. Thus, making the procedure more difficult for practitioners and service users (Book1, p. 37) Another matter that could affect the way the service is provided has to do with power dynamics.
Put simply, whether managers are ready to work in conjunction with service users instead of for them and to adopt a practice-led approach (Book1,p. 37). This means that practice could be seen as a joint product where the service users can contribute at all stages or as long as they wish to (Course Reader, p. 24). However, this may lead to power issues as managers or owners of private social care agencies might face difficulties in relation to the shift of power, resources and engaging service users successfully. On the other hand, service users may not wish to participate or are sceptical of manager’s motives (Book1, p. 37). It could also be argued that the shift of power could place the managers into a position where they feel have little power to empower people. As a result, service users may feel powerless in front of professionals and organisations and this could prevent them from willing to participate (SCIE, 2011). Other inconsistencies may be the concerns expressed by managers in regards to service user’s expectations as these could be unrealistic, unattainable and unsatisfactory which can result in difficulties to decide appropriate aims(Book1, pp. 37-38).On top of that, managers attitudes towards the service users competence in making decisions can affect the relationship between both parties.
Managers may fear saying the wrong thing, exposing the service user’s lack of knowledge or being encountered by with anger or criticism (Harding and Oldman, 1996; Morris, 1994, quoted in Book1, p. 38). Furthermore, it is also worth to mention that in the mainstream of service users involvement to decide ‘who to involve’ represents a dilemma as well. A manager might want to find a ‘representative’ service user. However, this imposes great difficulties due to several reasons such as the diversity of service users groups in terms of culture, race, sexuality and in some cases age (older people or young groups) and different disabilities. On top of that, minority groups, for instance, can feel marginalised as they may feel under or unrepresented in the participation process. It could also be mentioned that marginalisation can occur due to lack of knowledge about user participation too (SCIE, 2011).
As a result of participation challenges have emerged for both managers and service users. Firstly, elements such as time, support and financial costs represent a challenge for managers. To address these issues, it is necessary to recognise that it is imperative to allow sufficient time and support help to build trust between managers and service users. Support refers to the provision of any help, encouragement, skills and assistant (Course Reader, p.27) Moreover, minimising the costs of participation for service users by paying for their time and travelling expenses could be appropriate. A budget should be allocated to finance the costs of those service users who have a real commitment to participate (Course Reader, p. 26). Secondly, managers encounter challenges in regards to monitoring and evaluating techniques. For example, sending questionnaires to service users is a good way to get feedback. However, a problem is experienced when questionnaires are not returned.
A possible solution to this problem would be to ask the service users to fill the questionnaires at the end of a meeting, for example, to ensure they come back or to make a commitment to collect feedback. Thirdly, it is worth to mention that even when service groups reunite with professionals it doesn’t necessarily mean that there is proactive participation. In some cases, participants don’t contribute to the communication process. This could be triggered by services filing away reports about what people said. As people do not get to see the information they do not know what has been said by others or if any changes have been made. Consequently, they are reluctant to have an input as they may feel their opinions are not taken into account (Course Reader, p. 30).A course of action could be to write reports and provide feedback to user groups. These reports should inform what changes have been made in relation to the information given as well as an explanation to why changes have not been made (Course Reader, p. 30).
Participation provides exclusive advantages for managers, service users and carers. Among the benefits for managers is the acquisition of new knowledge and experience obtained from service user’s engagement. This knowledge could help managers to understand (or improve) the different methods for involving service users and carers in the individual decision making. Moreover, this could prove to be beneficial for the development of an organisation’s structure when it comes to making changes or improving services that are being delivered. The benefits for service users and carers can be associated not only to an individual level but to a community level as well. That is to say, service users and carers can benefit on a personal level by increasing confidence as they get to know their rights and how to access services. Service users can also take part in planning care that fulfills their individual needs. Moreover, carers might improve their skills and gain job satisfaction as they are delivering better tailored care. They can also develop the necessary skills, experience and knowledge regarding the importance of participation trough training (Course Reader, p. 44).
Health and social care services policies have changed through the years. Current policies emphasise on the implementation of consistent and quality practices through service user involvement. Nevertheless, as there is no single user’s view managers face a series of practical issues and challenges when implementing participation. To tackle these problems, managers must find methods to address these challenges effectively. By doing this, what is considered a challenge can be turned into a series of benefits as successful user involvement proves to be a useful tool to identify issues, make changes and improve the service provided.
Collins Language (2011) [online]
http://www.collinslanguage.com/results.aspx?context=3&reversed=False&action=define&homonym=1&text=policy (Accessed 3rd November, 2011)
Department of Health (2007) Mental Health Act 1983[online]
http://www.dh.gov.uk/en/publicationsandstadistics/legislation/Actsandbills/DH_4002034 (Accessed 17th November, 2011) Stallard, D. (5th November, 2011, 14:07) ‘Block 1Forum Activity’, forum message to K303 2011. The Open University (2003) K303, Managing Care in Context, DVD 1, Band 2 ‘A meeting of Minds’, Milton Keynes, The Open University. The Open University (2003) K303, Managing Care in Context, Chapter 2, ‘What service users say about services: the implications for managers’, Unit 2.1 ‘Introduction’, Milton Keynes, The Open University. The Open University (2003) K303, Managing Care in Context, Chapter 2.