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Involving service users in every stage of staff selection not only makes good recruitment sense, it can also help fine-tune service delivery, writes Peter Beresford. And it doesn't have to stop there either.

User involvement in staff selection is a particularly powerful force for progress in a welfare world where "paying the piper" means calling the tune. The Durham example, which is featured on page 32, is interesting for two reasons. First, because it involves young people - a group which more often receives brickbats than bouquets - in the care system. And second because it concerns the appointment of senior staff - and without things changing at the top, they will be that much harder to change at the bottom.

As with all things in "user involvement", however, the involvement of health and social care service users in staff selection and recruitment needs to be approached systematically and coherently - enthusiasm is not enough. Effective guidelines building on service users' experience are overdue.

I have spoken to people with learning difficulties who have sat on appointment panels, expressed clear preferences and then seen someone else's (unwelcome) candidate appointed. Other service users on panels have reported never being told who was actually appointed. There are also examples of good practice to build on, but tokenism has been a long-standing problem in this area.

To overcome this, we need to follow the rules of good practice for all equal opportunities staff recruitment. Service users need to be involved from the start in identifying employment needs and drawing up job and candidate specifications. Their role should be clearly set out and agreed. And they should also play an equal part in the shortlisting and final selection of any support or training they want.

But why stop there? Service users should also be involved in defining and reviewing performance and, crucially, in the promotion processes. Furthermore, all groups of service users should be involved.

Already attention is starting to focus on how groups who face particular exclusions, such as black and ethnic minority service users, people without verbal communication, with dementia or with multiple or "profound" impairments can contribute to recruiting people with "the right stuff". All this is likely to turn on its head traditional understandings of what service users really want and need from service workers.

This has already happened, of course, in the best known and most effective example of service users selecting staff - direct payments schemes - where they recruit and employ their own personal assistants and support workers.

A growing range of service users are now starting to gain access to these. We know that direct payments work best and can be most inclusive where support is available from service users' organisations.

But later this year it will be mandatory to offer many service users the option of direct payments and we can expect a new phase in the development of service user-led staff selection. There is another issue to address here. Involving service users in staff selection has to be a step forward but it also raises the much bigger issue of ensuring that people with experience as service users themselves have equal opportunities to be recruited to and promoted in the workforce.

So far this generally has not been the case in health and social care services. More often than not, having an impairment or experience of using mental health services has been viewed negatively. Service user workers highlight the frequent failure of their organisations and managers to be supportive of their "difference".

This must change. Direct experience of social care services should be valued and should be built into job and candidate specifications. Service users' concerns about "glass ceilings" and their ghettoisation must also be challenged.¹

The Disability Discrimination Act 1995, now extended to cover education and backed up by the Disability Rights Commission, could make a real difference here. User-controlled services are offering examples of good practice in employing and promoting service users, although their often limited and insecure funding makes it hard for them to offer an acceptable career structure.

We'll be getting there in mainstream services when people with experience as service users - not least experience of the care system - are not only appointing but are being recruited as senior managers, as well as playing their full and equal part in every other kind of role in health and social care.  

¹ Colin Gell ed, Valuing Experience, Institute for Applied Health and Social Policy, King's College London, 2001

Peter Beresford is professor of social policy at Brunel University and is active in the psychiatric system survivor movement.