Community participation and citizenship in British health care planning: narratives of power and involvement in the changing welfare state

This article considers changing conceptions of local citizenship with particular reference to the idea of 'community participation' in the planning of state health care within Britain. The aim is to gauge the extent to which a political rhetoric of community participation in the 1990s constituted an attempt to redefine the relationship between health authorities (responsible for planning and prioritising services) and local communities. Data from an investigation encompassing 75 interviews is used to chart the manner in which health authority managers have re-articulated and given substance to the rhetoric of participation. The analysis appears to confirm a 'democratic deficit' with regard to decisionmaking in health care planning but there is a significant qualification. A process of 'professionalisation' and the growth of 'active management' (rather than 'active citizenship') may in part be off-setting the democratic deficit. This process is however highly contingent upon developments in health service policy and organisation.