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 fo r 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 involvemen t, proposing that it exists at a series of levels ranging from information giving to true empowerment. Examples are presented from two practice develo pment projects. The first sought to develop multidisciplinary audit in prim ary care, attempting to involve users in defining health needs and determin ing services. Although the project co-ordinators were highly committed to u ser involvement this was only achieved to a limited extent. It was conclude d 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. Us ers were found to be knowledgeable about practitioner roles and how to acce ss 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.