Citizens, users or consumers: the voice of the public and its influence on improving performance

Policy is important not only because it sets parameters for rules and resources in public services, but also because of the way it positions service professionals and the public in particular roles in relation to one another (Propper 1995; Deacon and Mann 1999; Hoggett 2001; Greener 2002). The roles of professionals will change significantly whether they are meant to be providing a service that treats individual users as consumers of their service in a market relationship, or whether they are meant to be providing professional expertise to more passive clients in monopoly-like provision (Greener and Powell, in press). Equally, constituting the public in relatively passive or active roles in relation to public services changes the nature of the public's relationship to them, and adds or takes away mechanisms by which the public may be able to drive improvement. If I am able to exit from a public provider and move to another if I don't like the service I am receiving, or choose between services, then that will provide a different basis for interacting with that service than if I am expected to negotiate improvement with the public professional I am unhappy with, or campaign with others for the improvement of local services when I find them unsatisfactory (Hirschman 1970). The positioning of public service users in relation to services and to their professionals presents a number of possibilities from the public being constituted extremely actively, where they are given a significant role in improving services, to relative passivity, where mechanisms other than user voice or public engagement have to be found (Le Grand 1997).