9. Traditionally, government bodies have involved users of public services through consulting directly with users or with their representatives about the services received. We are concerned in this Report with forms of user involvement that go beyond consultation—what we term 'user-driven' public services. We shall, however, briefly consider the rationale for user consultation and the experience of it in practice, before going on to examine the implications of user-driven public services.

User consultation

10. Public involvement in policy development, including consultation with citizens and people that use public services, is a necessary part of a healthy democracy. Good consultation can also improve the content of policies and the quality of service provision, as the Government acknowledged in its 2007 paper Effective Consultation.[9] Consultation with people that use public services is particularly important because many users, understandably, have strong views about the services they receive—especially where those services significantly affect the quality of their lives. As Liz Stone of Mencap told us, "…for a lot of people with learning disability they want to be very active in the whole design and delivery of service because it is about them; it is about you; it is about your life".[10]

11. Unfortunately, much of the evidence we received on user consultation indicated a significant amount of cynicism—on both sides—about the effectiveness of actual consultations. From the Government's point of view, there can be a danger that the same people are heard from repeatedly—the 'usual suspects' syndrome. From the user perspective, there is often scepticism among people being consulted about whether what they say is really taken into account. (A prominent example was the Government's 2006 consultation on nuclear power, which the High Court ruled was "manifestly inadequate" as a consultation.[11]) This is especially so if people suspect that key decisions have already been taken, as the national service user network Shaping Our Lives and the Hansard Society suggested to us:

…many people were concerned about tokenistic user involvement and taking part in consultations in which they do not feel that they are being listened to, which consequently means action/change does not result from their involvement.[12]

It is best not to sponsor consultation where decisions have already been made. Engagement needs to be authentic. False engagement—consultation for the sake of persuasion—leads to more disillusionment not less.[13]

12. Pat McFadden MP accepted that the onus fell on government bodies to be clear about the purpose and boundaries of consultation, so that people's expectations were not unrealistic:

Cynicism can be produced because of a lack of clarity about what is actually on the table here when we consult and I think it is legitimate for a government to say, "Look, we've made up our minds to do A, B or C but we want to consult you about how we do it"…I think my response to this would be to hope that government would be clear about what exactly was being consulted about, what is open for debate, what is not already decided and what is.[14]

13. New initiatives on user consultation and engagement have emerged in recent years, including those that have been enabled by developments in information and communication technology. Innovations such as ministerial blogs, online consultations and web forums extend the channels through which government engages with citizens.[15] The Government has also shown a renewed interest in citizens' juries and other deliberative consultations (for example, the deliberative events with young people, parents and others that fed into the development of The Children's Plan[16]). In the Governance of Britain Green Paper, the Government proposed a duty to consult on major decisions through mechanisms such as citizens' juries.[17] Depending on how they are constituted, deliberative mechanisms can enable people to make informed contributions to decision making and can enhance democratic engagement. Like other forms of consultation, however, this depends on whether the Government is genuinely committed to listening to and learning from the people it engages in deliberation.

14. We are pleased to see the Government's initiatives for improving the effectiveness of consultations and for extending their reach. We support the underlying principle that government bodies need to make systematic efforts to collate and learn from the views of citizens and people using public services. Furthermore, government bodies must do this in good faith: consultations should make plain what they are trying to do, and this understanding should be clearly communicated to the people being consulted.

15. We now consider forms of user involvement in public services that embody a deeper level of engagement on the part of service users: user-driven public services.

User-driven public services

16. User-driven services are those that actively involve the people using them in service design and delivery. They entail drawing upon the expertise, views and perspectives of service users to complement the skills and input of service professionals. User-driven services go beyond user consultation or user representation. As we have seen, consultation serves an important function in eliciting people's views about the services they are getting, but it can be a one-way process—there is no guarantee that services will actually change as a result. By contrast, the idea of user-driven services involves public service staff and users working together to determine what services are provided and how.

17. The Minister for the Cabinet Office, Ed Miliband MP, has described it in this way:

…responsive public services look not just at needs but also at strengths and abilities. Public services must respond to and mobilise the expertise, ideas, time, and willpower of people using them. What I call the "letterbox model"—where the service was just delivered to the user—doesn't see us as participants who can shape our own lives.[18]

18. This is echoed by Sophia Parker of Demos, who told us:

[It] is very much a way of understanding how you achieve some of the outcomes we are talking about, recognising that if you want to create a society of life long learners, if you want to create a healthy population, that is not something that can be delivered by some institutional public service. It needs to engage all of us and motivate all of us not to smoke, to eat healthily and so on.[19]

19. Under the general heading of 'user-driven services', we consider what is termed 'co-production' in public services—the notion that service users work with service practitioners and professionals to 'co-produce' desired outcomes such as good health or safe communities. We also examine 'user-directed' services, where service users are able to control or direct (often by financial means) the services they receive. 'User-driven services' is a useful catch-all term to cover the different forms of deeper user involvement in public services. The core underpinning idea is the same, however: that successful public services will both enable and engage the people they are designed to serve.

20. Public services that put a central emphasis on involving people are still far from common. Moreover, user involvement is more relevant to those public services that people consume as personal, client-based services (such as health, education and housing) than those provided on a more collective basis (such as policing or fire and rescue). Some of the few practical examples of user-driven public services that we encountered in the course of our inquiry are described in the table below.

Examples of user-driven public services Health and social care: expert patients, individual budgets, and community care navigators The area of health and social care has seen many developments in user-focused services. This is particularly so in relation to patients with long-term conditions, who often become expert at managing their own conditions. Co-produced health services are based on developing the partnership between health professionals and patients in order to determine the best course of care. The expert patients programme enables patients with long-term chronic conditions to gain the skills needed to manage their conditions better on a day-to-day basis. Expert patients are also able to provide peer support, advice and information to others with the same condition.[20] Individual or personal budgets and direct payments entail giving patients financial control over the health and social care services they receive, so that they can direct the support or services they get. These sorts of financial mechanisms recognise that patients are often best placed to understand what they need and to make decisions about their own care accordingly. Under the 'Putting People First' initiative, the Government has stated that by 2011 it intends to make personal budgets available to all people receiving publicly funded adult social care.[21] Community care navigators (CCNs) are health service staff who have been specifically trained to engage with patients in community settings, in order to offer help and advice with their (usually long-term) conditions. We visited a CCNs project in Newham, east London, which worked with people locally to identify chronic illness at an early stage, increase knowledge of long-term health conditions and support self-management of conditions. Housing: tenant-led management Since 1994, council tenants in England have had the statutory right to manage their own properties. Under the right to manage, groups of tenants are able to form tenant management organisations (TMOs) to collectively manage their homes. TMOs undertake housing services such as rent and service charge collection, cleaning of communal areas and are responsible for repair and maintenance work. There are over 250 TMOs managing some 85,000 homes between them.[22] Education: personalised learning Personalised learning is, according to the Government, "high quality teaching that is responsive to the different ways students achieve their best".[23] It involves schools and teachers tailoring education to individual needs and aptitudes, in order to fulfil each pupil's potential. Under 'Assessment for Learning', a component of personalised learning, teachers work with pupils to identify educational needs and goals. Teachers and pupils can then agree on what needs to be done to promote progress towards those learning goals.

21. The Government's support for user-focused public services is evident in its promotion of the greater personalisation of services.[24] The Strategy Unit, in its recent survey of the future strategic challenges facing the country, noted that: "World class public services will only be achieved by actively engaging with citizens in achieving more personalised public service outcomes".[25] Personalised public services include many of the examples listed above, such as personalised learning in education, and personal budgets and direct payments in health and social care.

22. We have been interested in how greater personalisation links with what we have termed user-driven public services, given that both are directed at improving public service provision to the individual. We note, however, that personalised services are not quite the same as services that engage and empower people: a service can be individualised without actively involving the person concerned (e.g. a teacher tailoring an education plan for a pupil without reference to the pupil's or parent's wishes). We welcome the Government's support for public services that focus on service users. We believe that achieving high-quality, responsive public services requires empowering and engaging with service users as much as addressing their needs. We urge the Government to foster a public service culture of working with the people that use services in order to ensure that moves toward greater personalisation result in excellent public services.

10   Q 370 [Ms Stone] Back

11   R (Greenpeace Ltd) v Secretary of State for Trade and Industry [2007] EWHC 311 (Admin) Back

12   Ev 152 Back

13   Ev 139 Back

14   Q 432 Back

15   Ev 138; see also Hansard Society, Digital Dialogues: An independent review into the use of online technologies to enhance engagement between central government and the public. Second phase report, August 2006-August 2007, 2007, p 19 ff Back

16   Department for Children, Schools and Families, The Children's Plan: building brighter futures, Cm 7280, December 2007, pp 155-156 Back

17   Ministry of Justice, The Governance of Britain, Cm 7170, July 2007, p 49 Back

18   Speech by Ed Miliband to 5th annual Guardian public services summit, 7 February 2008 Back

19   Q 397 [Ms Parker] Back

20   Ev 170, 180 Back

21   Department of Health, Putting People First: A shared vision and commitment to the transformation of adult social care, December 2007, p 3 Back

22   Ev 278 Back

23   Department for Education and Skills, A National Conversation about Personalised Learning, 2004, p 6 Back

24   Strategy Unit, Building on Progress: Public Services, chapter 4 Back

25   Strategy Unit, Realising Britain's Potential: Future strategic challenges for Britain, Cabinet Office, February 2008, p 153 Back