The snakes and ladders of user involvement:moving beyond Arnstein

For 35 years, Arnstein's ladder of citizen participation has been a touchstone for policy makers and practitioners promoting user involvement. This article critically assesses Arnstein's writing in relation to user involvement in health drawing on evidence from the United Kingdom, the Netherlands, Finland, Sweden and Canada. Arnstein's model, however, by solely emphasizing power, limits effective responses to the challenge of involving users in services and undermines the potential of the user involvement process. Such an emphasis on power assumes that it has a common basis for users, providers and policymakers and ignores the existence of different relevant forms of knowledge and expertise. It also fails to recognise that for some users, participation itself may be a goal. We propose a new model to replace the static image of a ladder and argue that for user involvement to improve health services it must acknowledge the value of the process and the diversity of knowledge and experience of both health professionals and lay people.

Divided care and the Third Way:user involvement in statutory and voluntary sector cancer services

In health care, as in much of the public sphere, the voluntary sector is playing an increasingly large role in the funding, provision and delivery of services and nowhere is this more apparent than in cancer care. Simultaneously the growth of privatisation, marketisation and consumerism has engendered a rise in the promotion of 'user involvement' in health care. These changes in the organisation and delivery of health care, in part inspired by the 'Third Way' and the promotion of public and citizen participation, are particularly apparent in the British National Health Service. This paper presents initial findings from a three-year study of user involvement in cancer services. Using both case study and survey data, we explore the variation in the definition, aims, usefulness and mechanisms for involving users in the evaluation and development of cancer services across three Health Authorities in South West England. The findings have important implications for understanding shifts in power, autonomy and responsibility between patients, carers, clinicians and health service managers. The absence of any common definition of user involvement or its purpose underlines the limited trust between the different actors in the system and highlights the potentially negative impact of a Third Way health service.

Exchanging knowledge on participation by EU health consumers and patients in research, quality and policy

Sponsored by ZonMw (The Netherlands Organisation for Health Research and Development) The Hague 11–12 April 2013

Public participation by appeal - insights from empirical evaluation in Finland

Environmental law increasingly provides for participatory rights, including appeal rights, to ensure informed, legitimate decision-making. Despite consensus around the general need for participatory rights, including strong ones such as a right to appeal, public participation in environmental decision-making is often criticised. The critics' main argument is that the negative side effects resulting particularly from the use of strong participatory rights outweigh their benefits. Recent regulatory trends arising from better regulation policy to make environmental decision-making more cost-efficient tend to pay special attention to such arguments despite limited empirical evidence. This article provides evidence using material-concerning appeals against pollution permits in Finland and suggests that judicial review is a necessary and effective process for both protecting citizens' rights and improving the quality of environmental protection. © The Author [2008]. Published by Oxford University Press. All rights reserved.

Citizens, consumers and stakeholders in European health policy

In this chapter we track emerging issues in public participation and involvement in European policymaking. We focus on the politics, legitimacy and accountability of different actors as well as exploring how European participation processes relate to globalization in general and global and regional governance in particular. Health policies tend to be understood as national or even local, yet they are often shaped and defined by regulatory decisions and policies that are determined globally and regionally.

Putting policy initiatives into practice:adopting an “honest broker” approach to adapting small businesses against flooding

Purpose: Amidst the current economic climate, which places many constraints on expensive flood defence schemes, the policy makers tend to favour schemes that are sympathetic to the needs of small and medium-sized enterprises (SMEs) and which promote empowering local communities based on their individual local contexts. Research has shown that although several initiatives are in place to create behavioural change among SMEs in undertaking adaptation approaches against flooding, they often tend to delay their responses by means of a "wait and see" attitude. The paper aims to discuss these issues. Design/methodology/approach: This paper argues that unless there are conscious efforts in the policy-making community to undertake explicit measures to engage with SMEs in a collaborative way, the uptake of adaptation measures will not be achieved as intended. With the use of the "honest broker" approach the paper provides a conceptual way forward of how a sense of collaboration can be instigated in an engagement process between the policy makers and SMEs, so that the scientific knowledge is translated in an appropriately rational way, which best meets the expectations of the SMEs. Findings: The paper proposes a conceptual model for engaging SMEs that will potentially increase the uptake of flood adaptation measures by SMEs. This could be a useful model with which to kick start a collaborative engagement process that could escalate to wider participation in other areas to improve impact of policy initiatives. Originality/value: The paper lays the conceptual foundation for a new theoretical base in the area, which will encourage more empirical investigations that will potentially enhance the practicality of some of the existing policies. © Emerald Group Publishing Limited.

User involvement in UK cancer services:bridging the policy gap

Recent UK government initiatives aim to increase user involvement in the National Health Service (NHS) in two ways: by encouraging service users to take an active role in making decisions about their own care; and by establishing opportunities for wider public participation in service development. The purpose of this study was to examine how UK cancer service users understand and relate to the concept of user involvement. The data were collected through in-depth interviews, which were analysed for content according to the principles of grounded theory. The results highlight the role of information and communication in effective user involvement. Perhaps more importantly, this study suggests that the concept of user involvement is unclear to many cancer service users. This paper argues the need for increased awareness and understanding of what user involvement is and how it can work.

Variation in the length of an undergraduate degree:participation and outcomes

Recent policy in England has advocated the introduction of fast-track degrees to provide an alternative, shorter route to a bachelor's degree. It has been argued that this will widen participation in higher education and increase labour market flexibility by providing an option in which undergraduates spend one fewer years out of the labour market. Critics have suggested that the outcomes from this new undergraduate option will be worse than those for students following the standard length of undergraduate degree (which is three years for most subjects studied at universities in England). This criticism is based on a belief that students on the shorter degrees will be encouraged to 'cram', having less opportunity for reflection that will foster a deep understanding. These arguments are evaluated using data which compare students following two and three year degrees in the same subjects at the same university. © 2012 Copyright Society for Research into Higher Education.