Are we too focused on service user involvement in care services?
I know that is a controversial question but make no apologies for it because I think it is a debate worth having because while we focus on that we may be missing some of the essential ingredients to truly personalised care and support provision.
The idea of service user involvement is a natural extension of the theory of Social Role Valorization (or normalisation or an ‘ordinary life’ which ever term you choose to use). The idea behind this is that all people with disabilities should have the same conditions in life as are offered to the general public and that they should have the same should have the same opportunities in housing, education, health and freedom of choice. It does not mean that we should try to make everyone ‘normal’ but it does mean the same conditions of life should allowed to occur.
So why could we be too focused on service user involvement? Let’s take two areas where it is touted as a good thing for users to be involved in, recruitment and supervision.
The aim is to create an ordinary life, the same as the general population but at what point do the general public get involved in the recruitment and supervision of people in the services that they use? When was the last time you were given the opportunity to sit in on the recruitment process of your bank, your G.P. or your local NHS Trust or, indeed, have the opportunity to sit in a supervision session at your local council, supermarket or energy supplier?
The fact of the matter is we are all service users in one way or another, the principle difference being the majority do not use care services but if people are to be given the opportunity of an ordinary life then, surely, care services (in this sense) should be treated the same as any other service.
This is where the true difference occurs and where social care fails in providing the opportunity for an ordinary life. What do the general population do if they are really unhappy with a service they receive? Simple, they change the suppliers if they are able to or, if not (as in NHS services), they will challenge the quality of the service.
What many service users lack is the opportunity of freedom of choice in the service they receive and it is the denial of freedom of choice that needs to be addressed.
How much choice to service users get in the social worker ‘allocated’ to them to assist them in sorting out their care package? An unfair question because we would not expect any other service to give us the choice yet if we were unhappy we would be able to move to a different provider, something not available to care service users or we would be able to make a specific request about the type of person we wanted to help us – how many service users are given that choice?
And what about the choice of actual care services? Is there a real choice or are service users again ‘allocated’ the approved local authority contractor? Given that we are talking about vulnerable adults, is there really an adequate mechanism for challenging the quality of the service and a choice of care provider available?
Service users should be involved in their care but rather than the somewhat tokenistic concept of involvement in recruitment, supervisions etc. the real involvement should be in the choice of services they receive in order that they can have the ordinary life opportunities available to the rest of us.