momentum since 1997 as a central component of New Labour’s NHS moderni-
Recent PPI policies have been criticized for their rhetorical content, patchy
implementation, and lack of clarity about underlying objectives. Many commen-
tators believe that the ‘patient’ and ‘public’ dimensions of PPI pull in di¡erent
While the ¢rst aspect focuses on micro-level decisions a¡ecting
patients’ treatments and self-care, the second concerns the role of the public in
in£uencing service development and the allocation of resources. It is evident that
the issues th at matter most to patients may not be of paramount importance for
citizens conceived as tax payers or representatives of local communities.
sion between these aspects of policy is further re£ected in contrasting rationales.
While patient involvement is seen as contributingto the more responsive adapta-
tion of services and facilities to service-users’ needs, public involvement is com-
monly justi¢ed as a means of improving accountability for public services and
reversing declining public con¢dence in traditional forms of political representa-
In the New Labour era, the di¡erent strands of PPI have become associated
with competing conceptions of involvement.The traditional emphasis on collec-
tive representation and ‘voice’ is being displaced by a new preoccupation with
consumer ‘choice’ and the ability to exit unsatisfactory market relationships.
Despite the attempt made by some policy makers to reconcile these elements, for
example th rough the not ion of the ‘citizen co nsumer,’
the tension remains. Most
recently, government pronouncements have suggested that user choice should
properly be seen as an alternative to citizen voice, implying that increased choice is
needed precisely because voice has failed as a mechanismof involvement.
4 R. Klein and B.New,Two Cheers for Democracy (London: Kings Fund, 1998).
5 I. Greener,‘The Three Moments of New Labour’s Health Policy Discourse’ (2004) 32 Policy &
Politics 303; R. Forster and J. Gabe,‘Voice or Choice? Patient and Public Involvement in the
National Health Service in England under New Labour’ (2008) 38 InternationalJournal of Health
6 D. Florin and J. Dixon, ‘Public Involvement in Health Care’ (2006) 328 BMJ 159; A. Coulter,
‘Patient Engagement: Why is it Important?’, in E. Andersson, J. Tritter and R. Wilson (eds.),
Healthy Democracy: The Future of Involvement in Health and Social Care (Warwick: Involve and the
NHS National Centre forInvolvement, 2006).
7 Memorandumto the House of Commons Select Committee on Health, Inquiry i ntoPublic and
PatientInvolvement in the NHS,10 January(London: Picker Institute, 2007).
8 House of Commons Health Committee, Patientand PublicInvolvement in the NHS,ThirdReport of
Session 2006^07, HC 278^1; see also M. Barnes, J. Newman, and H. Sullivan, Power,Participation
and Political Renewal: Case Studiesin Public Participation (Bristol: Policy Press,2007), 23^25.
9 A.Thompson, ‘The Meaning of PatientInvolvement and Participationi n Healthcare Consulta-
tion: A Taxonomy’ (2007) 64 Social Scienceand Medicine 1297. On the question of the extent to
which‘choice’i svalued by patients and the public, see J. Barnett J. Ogden and E. Daniells,‘The
Value of Choice: AQualitative Study’ (2008) 58 BritishJournal ofGeneral Practice 609; M. Calnan
and R. Rowe,‘Trust, Accountability and Choice’(2008) 10 Health,Risk and Society 201..Although
surveys haveshown that the idea of patient choice of hospital is popular with the public at large,
when patients are askedwhat is most important to them as individuals, choice of treatmentloca-
tion ranks relativelylowon the scale of priorities ^ N. Richards and A. Coulter,Is t he NHS Becom-
ing More Patient-Centred? Trends from the National Surveys of NHS Patients in England 2002^07
(London: Picker Institute,20 07).
10 J. Clarke, J. Newman, N.Smith, E. Vidler and L.Westmarland, Creating Citizen-Consumers: Chan-
ging Politics and ChangingPublic Services(London: Paul Chapman Publishing, 2007);C. Needham,
Citizen-Consumers: NewLabour’sMarketplaceDemocracy. (London: CatalystForum, 2003).
New Labour’s PPI Reforms
248 r2009 The Authors. Journal Compilation r2009 The Modern Law ReviewLimited.
(2009) 72(2) 247^2 71