"Ordinary people only": knowledge, representativeness and the publics of public participation in healthcare

Public involvement in healthcare is a prominent policy in countries across the economically developed world. A growing body of academic literature has focused on public participation, often presenting dichotomies between good and bad practice: between initiatives that offer empowerment and those constrained by consumerism, or between those which rely for recruitment on self-selecting members of the public, and those including a more broad-based, statistically representative group. In this paper I discuss the apparent tensions between differing rationales for participation, relating recent discussions about the nature of representation in public involvement to parallel writings about the contribution of laypeople’s expertise and experience. In the academic literature, there is, I suggest, a thin line between democratic justifications for involvement, suggesting a representative role for involved publics, and technocratic ideas about the potential ‘expert’ contributions of particular subgroups of the public. Analysing recent policy documents on participation in healthcare in England, I seek moreover to show how contemporary policy transcends both categories, demanding complex roles of involved publics which invoke various qualities seen as important in governing the interface between state and society. I relate this to social-theoretical perspectives on the relationship between governmental authority and citizens in late-modern society.

Narratives great and small: neighbourhood change, place and identity in Notting Hill

The area of Notting Hill in west London has been subject to much media coverage in recent years, which, along with substantial gentrification, has given rise to an image of the area as the epitome of fashionable London. This study investigates the views of those marginal to gentrification and mediated representation on their feelings about the local area, its image and their changing neighbourhoods. Many participants in the research resented some of the more recent changes in Notting Hill and the area's representation in the media. However, in contrast to expectations, most of the more working-class respondents involved in the research did not articulate much emotional attachment to the area. They were more concerned with what might be termed the material aspects of life in Notting Hill: convenience, facilities, safety and so on. In contrast, the more middle-class respondents frequently spoke of their regret of the changes to the area, such as the loss of independent shops, and the reduction in diversity. Paradoxically, the loss of working-class landscapes seems a relatively middle-class worry. The symbolically important landscapes described by working-class respondents were related to more immediate, material issues, in which gentrification was only a relatively minor concern. The definitive version is available at www.blackwell-synergy.com