Our relationship with the state has filled the pages of novels and tracts for the last two centuries, but there has been far less attention to the everyday experience of this relationship and how we should understand and improve it.

Are we consumers, citizens, clients, users, passengers, patients or prisoners of public services? Well, people make sense of this relationship in different ways. As one of the people interviewed in research in this book states, “they just call me John”. We should not be surprised that words are slippery if we are dealing with such a myriad of different public...

The figure of the consumer has been central to New Labour’s approach to modernising and reforming public services (Clarke, 2004; Clarke et al, 2007; Needham, 2007). However, both consumers and public services are problematic. First, it is possible to claim that government documents tend to see the ‘consumer’ in a narrow sense: the individual ‘consumer as chooser’ to use the term of Gabriel and Lang (2006). Choice is becoming the watchword of the ‘new’ public services (Le Grand, 2005, p 200). At the risk of some oversimplification (see later), commentators tend to associate choice or exit with economic consumers and...

‘The figure of the consumer’, Vidler and Clarke have written, ‘stands at the heart of New Labour’s approach to the reform and modernisation of public services.’ Consumerism, that is, ‘the commitment to organising services around a public understood as consumers of services’, emerged after 2000 as the central motif in the Blair government’s narrative, ‘a generic organizing principle for public service reform’ (Vidler and Clarke, 2005, pp 19, 20; see also Clarke et al, 2007). What were the main elements of New Labour’s consumer narrative? Why was it adopted and so vigorously propounded? To what extent did it amount to...

To disaggregate the ‘differentiated consumer’ of public services, it is important to consider how policy actors in central and local government talk about those who use key services: health, education, welfare, transport and policing. This chapter gives an interpretative account of public services in the UK, exploring how different words and narratives are used in government texts and the extent to which these vary between services and levels of government. Through measuring the frequency with which certain keywords appear it is possible to assess the emphasis that policy makers place on certain identities – such as citizen, taxpayer and customer...

As we have seen, ‘choice’ and ‘voice’ have become watchwords of current policy and provision in the public services. Current debates often focus on notions of ‘choice’. Alongside these debates, ‘voice’ is often acknowledged as being related and of certain value, although it has been claimed to be a less influential driver of change:

Evidence points to choice serving as an important incentive for promoting quality, efficiency and equity in public services – and in many cases more effectively than relying solely or largely upon alternative mechanisms such as ‘voice’. (Cabinet Office, 2005, p 3)

We argue here and elsewhere...

Arguably one of the most provocative theoretical accounts of consumer sovereignty was articulated more than half a century ago by the economist L.E. von Mises (quoted in Gonse, 1990). At the heart of his argument lay the notion that consumers are empowered through ‘catalytic, or indirect, power’, where markets operating free from political or sectoral interests ensured that organisations and professionals were responsive to the needs of consumers. However, Gonse (1990, p 138), articulating what has now become a familiar critique of this highly theoretical position, posed the question of whether this perspective could be:

convincing in the face of...

Conceptualising users of health services remains a contentious issue. On the one hand, some authors have claimed that ‘the essential problem with the healthcare industry is that it has been shielded from consumer control – by employers, insurers and the government’ (Herzlinger, 2002, in Spiers, 2003, p 6). On the other hand, however, writers such as Titmuss (1968) and Stacey (1976) argued that the consumer has no place in healthcare (see Clarke et al, 2007; Le Grand, 2007; Needham, 2007).

In practical terms, there has often been little evidence of NHS organisations adopting a patient-centred approach to the delivery of...

The consumer role in education is one that has historically existed prior to legislative reform. Parents have always had choices about ‘which school’ in terms of private or state school, religious or non-religious, and also choices about where they live and, by implication, where their children go to school. It is now almost 30 years since the introduction of legislative reforms promoting additional elements of choice in the UK education service. Following the reforms put in place during the 1980s, parents, pupils and users have been empowered to participate further in the selection of services. In addition to the consumer-oriented...

The position of social housing as a service that is slightly removed from other public services, the ‘wobbly pillar’ of the welfare state, is well known (Malpass, 2005).¹ As Kemeny (2006) notes, housing is different because vested market interests have a stronger historical stake than they do in areas such as health and education. The role of the private consumer is not as strange to housing as it is to the worlds of education or health: most people in the UK choose their own housing in the market.

The relationship is further complicated by the nature of housing choices. Jordan...

Policing has an uncomfortable relationship to the dominant model of public service reform because of its relationship to law and the exercise of legal authority by police officers. The chapter draws on empirical work in two English urban settings to consider how both police and public view the usefulness of the ideas of consumers and customers. The idea of communities as a collective customer or user is then considered, raising some questions about how communities are to be discovered and engaged in the business of policing, with links to anxieties about local accountability in the recent Flanagan Report on the...

Consumerism discourses within adult social care, and the corresponding development of mechanisms to facilitate consumer-type choices by service users, have arguably developed further and faster over recent years than in other public service sectors. In addition to the supply-side mechanisms and incentives put in place by successive government regimes, consumer-related developments in social care have also been energetically advocated by articulate users of social care services.

Voluntary and charitable organisations have always played an active role in the provision of social care. However, since the early 1990s successive governments have consistently promoted a market-based ‘mixed economy’ of social care services,...

Discussion and developments relating to ‘the public service consumer’ have been constants of growing significance since the late 1970s. This chapter focuses on this issue from the perspectives of people as long-term users of health and social care services. This large group, which includes older and disabled people, mental health service users, people with learning difficulties and others, is one for whom the discourse about the consumer in public services has major ramifications. Yet this discourse is not one in which they can be said to have played a central part, albeit, as we shall see, that they have been...

The neoliberalism of Margaret Thatcher and her successors has had a profound effect on conceptualisations of the relationship between those who provide health and social care services and those who use them. The reinvention of clients and patients as welfare consumers was intended as one way of subjecting public services to the assumed discipline of the market. If people behaved more like active consumers than passive clients, then, it was argued, this would force services to become more responsive. Politically, the Left was found wanting in terms of its capacity to resist the power of this consumerist rhetoric, not least...

In a recent study as part of the ESRC/AHRC ‘Cultures of Consumption’ programme, we asked public service users in social rented housing, social care and public leisure services to describe how they saw themselves and how they were seen by the providers of the services (Simmons et al, 2007a). We were trying to find out what labels they felt comfortable with and how they viewed the labels that were ‘stuck on them’ by the professionals. The variety of answers was startling, and it was often difficult to generalise from the findings.

One word that our respondents used often was ‘member’:...

A key focus for the contributors to this book was to think about the ‘differentiated consumer’ in public services and what it meant from their perspectives in relation to public services and consumption. Their contributions show that people are working with a wide range of understandings in this regard. In this chapter we will attempt to make sense of this by returning to some of the themes set out in the Introduction. First, we recognise that many different faces and mechanisms of consumerism exist. This helps us to identify who it is that presents themself when they use public services...