Service user involvement in the NHS in England: genuine user participation or a dogma-driven folly?

This paper will catalogue and debate the recent policies that seek to extend the role of health Service Users in England. For operational purposes, the term 'Service User' refers collectively to individual patients and also to the public at large.

The provision of principal features of user involvement are twofold. First, it concerns more personalized services to individuals. Second, it represents recognition that the 60 million potential users of health services have a rightful role in determining the design of service development and delivery.

The paper will review the conceptual and ideological basis for current policy in relation to users. For a while, involvement policies began as benign benevolence, users now find themselves as the means to distributing resources in a way that was originally unintended.

The dilemmas raised by these policies for both users and providers will be explored and analysed.

The challenge for managers resides in the empirical evidence. This indicates despite undoubted improvements in the service as a whole, data suggests that at the operational level, care is still far from user centred. The task for policy makers and managers as far as user involvement is concerned, is to move from aspiration to reality.