Why “Service User”?

Words sometimes gather special meanings, like post it notes stuck all over them. A word like ‘soldier’, for instance, can have ‘tough’, ‘hard’, ‘disciplined’, ‘fighter’, ‘patriotic‘ and maybe ‘fearsome’ stuck all aver it.

The words ‘patient’ and ‘client’ are such words. To be a patient is to have things done to one; to have things prescribed for ; to be passively accepting of what one is told; to be condescended to; to be patronised; to be at the wrong end of an imbalance of power. To be a client has similar but slightly different labels.

The phrase ‘People who use services’ has none of these labels and accompanying expectations. Neither does the term ‘Service User’. Indeed it implies expectations of ‘expertise by experience’ and equal partnership in service planning and development and delivery.

So, in a practical example, a ‘patient’ seeing a medical consultant, for instance, can be (as commonly happens) talked down to, can have whatever they might say about their own condition phoo phood by the consultant and can have requests turned down by the consultant. The ‘service user’, on the other hand will go into the consultant meeting with full expectations of making an equal contribution to the assessment and problem solving and will take an assertive part in the process, not allowing any consultant arrogance or condescension.

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One of the largest and most difficult issues Service User and Carer Involvement has to face is tokenism:

Tokenism in service user and carer involvement is -----------------

When a public body such as a NHS trust, a local authority or the police, engage and involve service users in petty and superficial activities while setting up tacit barriers to ensure they have no real and serious influence over service delivery or organisational policy. In this way, those organisations can just tick boxes to say they have met their statutory duty to involve service users and carers. Here are some other definitions:

• “Tokenism refers to a policy or practice of limited inclusion of members of a minority group, usually creating a false appearance of inclusive practices, intentional or not.” (Wikipedia)

• “The making of a perfunctory or symbolic effort to do a particular thing, especially by recruiting a small number of people from under-represented groups to give the appearance of sexual or racial equality within a workforce.” (Compact Oxford English Dictionary).

• “The practice of making only a token effort or doing no more than the minimum, esp. in order to comply with a law.”(Collins Essential English Dictionary)

• “Tokenism sits on the continuum from neglect and under provision at one end, to inappropriate provision and hostility at the other. A lack of resources can lead to neglect and under provision. Thoughtlessness, ignorance or antagonism can cause inappropriate provision and hostility. Tokenism is an insufficient attempt to resolve these problems. It is an institutional disregard for people's real needs and does little to tackle neglect, hostility and outright discrimination.” (Inclusive inclusion. ‘Challenging tokenism’, Dr Dory Reeves)

Combined Voices

One of the serious weaknesses of true service user and carer involvement is the fragmentation of our voices. There is a plethora of good internet forums catering for service users, carers and all kinds of disability - all mainly speaking out in like terms in the campaigns for adequate care and treatment. But they are scattered around on the net - divided - Imagine how authoritative those voices could become if they were united.

Well, it is happening. The last few years has seen a positively growing development of concerted voices and I have listed three of the bodies who are becoming increasingly succesful at making the service use voice heard. The following links will take you to their external websites: