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Active CitizenshipWhat Could it Achieve and How?$
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Bernard Crick and Andrew Lockyer

Print publication date: 2010

Print ISBN-13: 9780748638666

Published to Edinburgh Scholarship Online: September 2012

DOI: 10.3366/edinburgh/9780748638666.001.0001

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PRINTED FROM EDINBURGH SCHOLARSHIP ONLINE (www.edinburgh.universitypressscholarship.com). (c) Copyright Edinburgh University Press, 2022. All Rights Reserved. An individual user may print out a PDF of a single chapter of a monograph in ESO for personal use.date: 22 May 2022

Power and Public Services: for Customers or Citizens?

Power and Public Services: for Customers or Citizens?

(p.57) 4 Power and Public Services: for Customers or Citizens?
Active Citizenship

David Donnison

Edinburgh University Press

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

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