User involvement in identifying health needs and shaping and evaluating services: is it being realised?

The rhetoric of user involvement has featured in health policy documents for over a decade. However, there is mixed evidence as to the extent to which it is being achieved. This paper explores what is meant by user involvement, proposing that it exists at a series of levels ranging from information giving to true empowerment. Examples are presented from two practice development projects. The first sought to develop multidisciplinary audit in primary care, attempting to involve users in defining health needs and determining services. Although the project co-ordinators were highly committed to user involvement this was only achieved to a limited extent. It was concluded that there was a resistance to user involvement grounded in the fear that such involvement would increase user expectations and add to the pressures of overworked primary care teams. The second project used interviews with service users to assess the effectiveness of a team building initiative. Users were found to be knowledgeable about practitioner roles and how to access the care they required. The overall conclusion is that there needs to be a shift from rhetoric to reality at governmental and practitioner level if true user involvement is to be achieved.