Abstract

There has been an on-going policy interest in service user involvement in health and social
care services, based on the assumption that such interventions will have greater relevance
for users’ priorities and needs. The expectations of the breadth and depth of involvement
intended to be achieved by care organisations when developing new and innovative services,
can sometimes be overly optimistic. The Partnerships for Older People’s Projects (POPP)
was a Department of Health funded initiative to develop innovative prevention services for
older people within 29 local authority led pilot sites. Their activity resulted in 146 core
projects and involved partnerships between a total of 522 separate statutory and nonstatutory
social and health care organisations. One aim of the POPP national evaluation (NE)
was to provide analysis of the level of older people’s involvement in the pilot areas and
determine the barriers to such involvement. A five category typology depicting intensity and
areas of older people’s involvement was developed from an analysis of early project
documents. However, a dissonance was found between the expectations outlined within
these early documents and the reality of involvement. Several cross-cutting themes emerged
from our interviews and focus groups that highlighted the barriers to expected involvement.
These included: involvement strategies that had rarely been designed or determined by
those responsible for implementation; overly formal involvement structures; and the
‘crowding out’ of any ‘real’ involvement by externally dictated outcome expectations and the
need to evidence cost effectiveness of projects. The findings indicate that if expectations of
service user involvement are to be achieved by new care services, a clear understanding of
its purpose is required at the earliest stage of development, led by realistic expectations
about what is viable in practice.