Citizen Consumers? Using Public Services is Not Like Shopping

The government’s new white paper on health seems to suggest that patients should be offered more choice. However, visiting the doctor or phoning the police is simply not like shopping, according to people questioned for a new study funded by the Economic and Social Research Council (ESRC), which found that most of us reject the trend towards treating everyone as ‘consumers’.

We see public services as different from the market-place and value their ‘publicness’, according to the project led by Professor John Clarke of the Open University, Milton Keynes.

The study – part of the joint ESRC and Arts and Humanities Research Council’s Cultures of Consumption programme – gathered the views of people in two urban areas – one in the North-West and the other in the South-East. It involved managers, front line staff and users of health, police and social care services in both places.

Professor Clarke said:“The idea that people expect to be treated as consumers by public services has become a central theme in public service reform under New Labour.

Our research explored what people who provide and use public services thought about this idea, and the changes it is bringing about.

“We found that people have many relationships with public services. They are citizens, experts, taxpayers and voters as well as users, and they see themselves as part of wider bodies – as members of the public or local communities.

“When people approach health, police or social agencies, they do not always know what they want. They hope to meet staff who will respect them and help them make important decisions.”

According to the report, more than half of staff and those using the services saw the relationship as being members of the local community or the wider public. Around one third regarded people as service users.

While many preferred terms such as service user or patient, fewer than one in five thought of them as consumers or customers.

The findings support the idea that people are becoming more assertive in their relationships with public services – less deferential and more willing to express their needs and to challenge providers. And they illustrate the many ways in which service providers are responding to this shift, helping users know more about decisions, and to be involved.

Professor Clarke said: “Our findings show that both providers and users consistently view public services as different from commercial transactions, insisting that the process is ‘not like shopping’.

“This phrase was used repeatedly in the interviews. It captures the view of the people we met that public services are, and should be, centred on ongoing, personal relationships, rather than being anonymous, one-off transactions.”

The report argues that this does not mean people are uncritical. Many want improvements but have mixed views about whether consumerism and consumer choice can deliver better services.

When it came to the prospect of more choice, users were more positive than providers about likely benefits, with the police staff expressing the greatest concern about its impact. However, users also worried that increased choice and voice for users would give an advantage to those best able to work the system, or with the loudest voices.

They wanted to deal with skilled people they could trust, and for services to provide reliable and high quality assistance, attention and support at points of crisis or difficulty in their lives.