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Drawing on the findings of a major review on service user participation in the social care system of England and Wales, this paper explores some of the challenging dynamics that are emerging as service users begin to take up strategic power in social care organizations. Analysis of the current situation suggests that such participation is challenging the very fabric of the institutions in which it is taking place, exposing problems with the political, strategic and structural elements of established non-user organizations. On many levels traditional power relations are being unsettled. The conceptual clash between citizenship and consumerism is being exposed as participation becomes more widespread and sites of resistance are revealed. The associated issues of power, conflict and democracy are discussed with reference to the work of the political philosopher Chantal Mouffe.
Sarah Carr (2007) studied this question.