Challenging Medical Power? Citizen and User Involvement within the English NHS

The profession of medicine in England has been variously challenged and changed by the growth of Public and Patient Involvement (PPI) in its various forms. Initially, and especially at the turn of millennium the emphasis was on a deliberative democratic model of citizen and user involvement. With the neo-liberal turn of New Public Management (NPM) in the following decade the emphasis switched to a consumerist approach (patient choice). This version challenged the power of the profession more immediately and directly. Currently, the emphasis has again changed, this time to co-production. This reflects an attempt at more consensual approach to managerial-professional power relations and a move away from (but not a rejection of) consumerism and NPM and the emergence of a New Public Governance (NPG). This, perhaps idealistically, seeks the hybridisation of doctors, patients and maybe even managers too.

The paper will review the extent of citizen involvement across the NHS and the professional bodies in service delivery and health research governance. In examining the power play involved, I will be assessing whether the involvement reflects an empowerment or manipulation the parties involved. For while not the only factor, citizen and more especially user involvement has played a crucial part in the reconfiguration of the power relations between the medical profession, managers and the state, as well as the public. In this paper I will draw on a Foucauldian analysis of power informed by an Actor Network Theory analysis.