User participation in developing services

September 5, 2007 in Adults, Disability

The past 10 years have seen more recognition and acceptance of the right of service users to participate in developing social care, especially given the new responsibilities that key government legislative and policy initiatives have placed on organisations to consult service users. As a result, service users are increasingly asked to take part in the planning, provision and evaluation of services. This has created interest in what works in participation and why.

Evidence

Whole-systems approaches have become a popular way of thinking about the steps that organisations need to take to achieve change. They involve identifying the various components of a system and assessing the nature of the links and relationships between each of them.

To make service user participation work organisations must change at every level, from senior management to front-line staff. It should become part of daily practice, not a one-off activity, and must take place at different levels of the organisation.

Wright and colleagues suggest that the different elements of participation can be brought together in a single framework, like a jigsaw puzzle. The pieces are as follows:

● Culture: The ethos of an organisation, shared by all staff and service users, demonstrating a commitment to participation.
● Practice: The ways of working, methods for involvement, skills and knowledge which enable children and young people to become involved.
● Structure: The planning, development and resourcing of participation evident in organisation’s infrastructures.
● Review: The monitoring and evaluation systems which enable an organisation to evidence change affected by participation.

The pieces, if they fit together well, have significant implications for practitioners.

Further information

● Beresford P, Shamash M, Forrest V, Turner M and Branfield F (2005), Developing Social Care: Service Users’ Vision for Adult Support, SCIE
● Carr S (2004), Has Service User Participation Made a Difference to Social Care Services? Social Care Institute for Excellence
● Department of Health/Public Services Productivity Panel (2000), Working in Partnership: Developing a Whole Systems Approach, HM Treasury
● Department of Health (2006), A Stronger Local Voice: A Framework for Creating a Local Voice in the Development of Health and Social Care Services: A Document for Information and Comment, DH
● Wright P, Turner C, Clay D and Mills H (2006), The Participation of Children and Young People in Developing Social Care, Social Care Institute for Excellence.
● Resource guide 07, Participation: Finding out What Difference it Makes
● Nasa Begum, Report 14, Doing it for Themselves: Participation and Black and Minority Ethnic Service Users

Practitioners’ messages
Culture ● Map the different levels at which participation occurs, from how service users are involved in daily decisions to strategic decision-making. This will help identify participation “champions” and areas that need improvement. ● Identify which attitudes lead to service users being excluded and develop ways of changing them. For example, involving service users in training staff. ● Agree on shared values and be honest about what is likely to result from participation. ● Make sure that there are mechanisms for accountability and admit when mistakes have been made or when there are problems with the service. ● Acknowledge the contribution made by service users. Structure ● Plan in advance, use accessible venues and make sure that service users have time to prepare for the meeting. ● Avoid exclusionary practices in meetings such as not sticking to time, or using jargon or abbreviations. ● Draw up a clear set of ground rules that operate across all levels of participation and which aim to create the right atmosphere for working together respectfully. ● Write documents in plain English and make them available in different formats and languages. Provide support for service users who need help reading complex or long documents. ● Agree agendas and notes of meetings in advance and give service users a chance to include items that they would like to discuss. ● Develop a clear policy for the reimbursement of service users which covers the costs of participation, transport and support costs. Provide cash payments on the day. Where payments are made by cheque, or by transfers to a bank account, make it clear how long it generally takes for the organisation to process them. Practice ● Good practice involves making sure that service users feel valued and welcomed. ● Use different and more imaginative approaches to help prevent service users feeling excluded and encourage them to become involved. ● Identify which groups of service users have been under-represented in participation and see what steps need to be taken to reach out to them. Review ● Use reviews to assess progress and provide evidence of the changes that have been made as a result of service user participation. ● Service users must be involved in the process. ● Reviews should be based on realistic goals. ● Set a clear timescale for measuring change. ● Identify whether changes are needed at individual or strategic levels. ● Develop a system for sharing the results within the whole organisation.

Practitioners’ messages

Culture

● Map the different levels at which participation occurs, from how service users are involved in daily decisions to strategic decision-making. This will help identify participation “champions” and areas that need improvement.
● Identify which attitudes lead to service users being excluded and develop ways of changing them. For example, involving service users in training staff.
● Agree on shared values and be honest about what is likely to result from participation.
● Make sure that there are mechanisms for accountability and admit when mistakes have been made or when there are problems with the service.
● Acknowledge the contribution made by service users.

Structure

● Plan in advance, use accessible venues and make sure that service users have time to prepare for the meeting.
● Avoid exclusionary practices in meetings such as not sticking to time, or using jargon or abbreviations.
● Draw up a clear set of ground rules that operate across all levels of participation and which aim to create the right atmosphere for working together respectfully.
● Write documents in plain English and make them available in different formats and languages. Provide support for service users who need help reading complex or long documents.
● Agree agendas and notes of meetings in advance and give service users a chance to include items that they would like to discuss.
● Develop a clear policy for the reimbursement of service users which covers the costs of participation, transport and support costs. Provide cash payments on the day. Where payments are made by cheque, or by transfers to a bank account, make it clear how long it generally takes for the organisation to process them.

Practice

● Good practice involves making sure that service users feel valued and welcomed.
● Use different and more imaginative approaches to help prevent service users feeling excluded and encourage them to become involved.
● Identify which groups of service users have been under-represented in participation and see what steps need to be taken to reach out to them.

Review

● Use reviews to assess progress and provide evidence of the changes that have been made as a result of service user participation.
● Service users must be involved in the process.
● Reviews should be based on realistic goals.
● Set a clear timescale for measuring change.
● Identify whether changes are needed at individual or strategic levels.
● Develop a system for sharing the results within the whole organisation.