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Address for correspondence: Rosemary Rowe, School for Policy Studies, University of Bristol,
Priory Road, Bristol, BS TZ. E-mail: rosemary.rowe@bristol.ac.uk.
Public Participation in the New NHS:
No Closer to Citizen Control?
Rosemary Rowe and Michael Shepherd
Abstract
Over the last decade support for increasing public participation in decisions regarding the planning
and delivery of health services has become a familiar feature of the policy agenda for the UK
National Health Service. This paper reviews current Labour policy towards public participation
and reports on the response of primary care groups (PCGs) to recent Labour directives to make
patient and public involvement an integral part of the way they work, presenting the findings of a
survey conducted in one English health region. The experience of these PCGs suggests that, despite
the diverse backgrounds of board members, there is marked consensus between local and central
decision makers as to their understanding of public participation. Whilst academic debates have
tended to conceptualize participation in dualist terms as a form of consumerism or of citizenship,
the survey data suggest that in the context of local implementation public participation is framed
within a new public management perspective which values it as an aid to organizational learning.
The findings of this study highlight obstacles to securing effective public participation, including a
lack of substantive guidance regarding policy implementation that produces uncertainty amongst
local decision makers as to how best to proceed. The inherent limitations of public participation
within the new public management paradigm suggest that democratic renewal, one of the goals of
the government’s modernization agenda, is unlikely to be achieved.
Keywords
Participation; Consumerism; The NHS
Introduction
In the first years of the history of the NHS the health service has been
consistently held in high regard by the British public as one of the most
enduring and successful of state institutions. However, a series of managerial
and clinical scandals in the s has shaken public confidence in the system
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