Representativeness, legitimacy and power in public involvement in health-care management

Public participation in health-service management is an increasingly prominent policy internationally. Frequently, though, academic studies have found it marginalized by health professionals who, keen to retain control over decision-making, undermine the legitimacy of involved members of the public, in particular by questioning their representativeness. This paper examines this negotiation of representative legitimacy between staff and involved users by drawing on a qualitative study of service-user involvement in pilot cancer-genetics services recently introduced in England, using interviews, participant observation and documentary analysis. In contrast to the findings of much of the literature, health professionals identified some degree of representative legitimacy in the contributions made by users. However, the ways in which staff and users constructed representativeness diverged significantly. Where staff valued the identities of users as biomedical and lay subjects, users themselves described the legitimacy of their contribution in more expansive terms of knowledge and citizenship. My analysis seeks to show how disputes over representativeness relate not just to a struggle for power according to contrasting group interests, but also to a substantive divergence in understanding of the nature of representativeness in the context of state-orchestrated efforts to increase public participation. This divergence might suggest problems with the enactment of such aspirations in practice; alternatively, however, contestation of representative legitimacy might be understood as reflecting ambiguities in policy-level objectives for participation, which secure implementation by accommodating the divergent constructions of those charged with putting initiatives into practice.

The Productive use of Failure to Generate Witnesses from Divergent Proof Attempts for Coinduction

Coinduction is a proof rule. It is the dual of induction. It allows reasoning about non--well--founded structures such as lazy lists or streams and is of particular use for reasoning about equivalences. A central difficulty in the automation of coinductive proof is the choice of a relation (called a bisimulation). We present an automation of coinductive theorem proving. This automation is based on the idea of proof planning. Proof planning constructs the higher level steps in a proof, using knowledge of the general structure of a family of proofs and exploiting this knowledge to control the proof search. Part of proof planning involves the use of failure information to modify the plan by the use of a proof critic which exploits the information gained from the failed proof attempt. Our approach to the problem was to develop a strategy that makes an initial simple guess at a bisimulation and then uses generalisation techniques, motivated by a critic, to refine this guess, so that a larger class of coinductive problems can be automatically verified. The implementation of this strategy has focused on the use of coinduction to prove the equivalence of programs in a small lazy functional language which is similar to Haskell. We have developed a proof plan for coinduction and a critic associated with this proof plan. These have been implemented in CoClam, an extended version of Clam with encouraging results. The planner has been successfully tested on a number of theorems.