Power and Public Services: for Customers or Citizens?

David Donnison

in Active Citizenship

Published by Edinburgh University Press

Published in print September 2010 | ISBN: 9780748638666
Published online September 2012 | e-ISBN: 9780748671939 | DOI:
Power and Public Services: for Customers or Citizens?

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This chapter explores the changing balance of power since World War II between elites and citizens in respect of the health professions. The chapter offers a personal account of the decline of deference in British society before arguing that an excessive focus on individualistic, market-orientated values undermines the ethos of public services. It explains how the introduction of market values, including both the profit motive and the concept of consumer choice, into the provision of public services reinforces inequality; the ‘inverse care law’ operates — meaning the poorest and sickest get the least good service because they are least able to agitate for their rights. This applies to services beyond health. The provision of independent advocacy as introduced by Scottish Mental Health legislation is a particular help to protect the vulnerable against professional discretion and neglect, but individual advocacy cannot be a general solution to making public-service professions ‘more effective, more accountable and more humane’. Concerted collective action by those with direct experience of services, acting as citizens rather than as customers offers the potential for revitalising our public services.

Keywords: public services; balance of power; elites; citizens; health professions; market values; inequality; inverse care law; advocacy; customers

Chapter.  6310 words. 

Subjects: UK Politics

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