ABSTRACT
This chapter looks at user responsiveness in the new National Health Service (NHS) after 1997. It applies Hirschman's framework of exit and voice both to health policy and to the mechanisms set up by such policy, draws from two separate studies carried out at National Primary Care Research & Development Centre (NPCRDC), University of Manchester between 2000 and 2004. NHS policies for promoting user responsiveness emphasise democratic accountability, rights of citizenship, partnership, empowerment and choice and changing Primary Care Trusts (PCTs) organisational culture accordingly. Buckland and Gorin found there to be limited consumer involvement in the NHS R&D Regional Programmes and the Commission for Health Improvement (CHI) had not found any examples of excellence in voice mechanisms for the public in any of the NHS organisations it reviewed to 2003. The chapter examines the governance arrangements of nine PCTs and their relationship to user responsiveness, modernisation and accountability.
