Are all consumers the same? Choice in health, social care and education in England and elsewhere

Abstract

The reliance on consumer choice to drive improvements in public services is at the centre of policy debates in the UK and elsewhere. However, the discourse of consumerism occurs in the midst of a quagmire as to whether users of public services can legitimately be considered as customers, citizens or co-producers, while the existing evidence on how far they assume the role of public service consumers is largely ignored. This article discusses research on users' attitudes to choice in health, education and social services in the UK, the European Union and the USA. Provision of public services is rarely about acquiring products for pure consumption, but more about providers and users jointly addressing essential social and human needs. The author argues for an alternative conception of public service provision going beyond the limitations of consumerism, although some users are more likely to choose certain public services over others (for example schools rather than health services). However, the evidence presented disproves the view that users of public services will act as discerning consumers in the market-place.

Acknowledgements

I would like to thank Alan Boyd whose diligent help in designing methodology and reviewing evidence on social care has been invaluable and Professor Paul Adler for helpful comments on the earlier version of this article. Support from the National Institute for Health Research (Department of Health) grant which made this research possible is also gratefully acknowledged. The views expressed and any remaining errors are the author's alone and do not in any way represent the funding agency.