From Democratic Consultation to User-employment: Shifting Institutional Embedding of Citizen Involvement in Health and Social Care

Abstract

Policies of citizen involvement in health and social care have given rise to a variety of organisational forms, which address citizens in different capacities and differ in their demands as to the representativeness, performance and competence of those involved. Apparently, the policies draw on different institutional logics. Based on extant studies, partly the author’s own research from Norway, this article sheds light on three purposefully selected cases of citizen involvement. Two models of democratic consultation encompass a dominant model of involvement in Norway (advisory bodies of service users) and a model more prevalent in UK (panels of the general public). These are both embedded within a logic of democracy. A third emergent model of involvement is one in which citizens with experience as service users are engaged as workers in service providing organisations. This model resembles an idea of coproduction. However, when involvement is organised as user-employment and paid work, the modelratherseemsrootedwithinthelogicofthemarket–thelabourmarketofserviceworkers. The rise of this model suggests a shift in institutional embedding of citizen involvement. The analysis of these models provides a framework of distinguishing dimensions between different models of involvement.