Review

Customer rights OK?

Whose standards?
Charlotte Williamson
Open University Press, 1992

At last, a book that acknowledges the confusion surrounding the new management-speak of consumerism! Williamson, as a social scientist with a long-standing involvement in the NHS, promotes a theory that helps us understand the role of patients in relation to the health professions as a basis for quality standards.

She begins by attributing the origins of consumerism to a combination of scepticism, a public perception of poor quality care, and ‘intense concern’ of groups of patients or relatives. This is stated with scant regard to the emerging demands for involvement as a result of increasing information and education and also ignores the rise of consumerism in other sectors, particularly manufacturing.

Where Williamson does make an important distinction for the public sector is in identifying interests as the key, which allows us to understand why some people are able to accept professional dominance when their interests are met.

She distinguishes between individual consumers and consumerists, their champions against professional dominance. Her model is one where dominant interests can be seen to be synergistic, or not, with repressed interests which may be apparent, oppressed or suppressed.

The style is clear and well-referenced, with some interesting attempts to link her ideas on consumerism to parallel political movements such as feminism. Her notion that consumerism is part of the wider political demands of the left against structural disadvantage begs many questions - which remain unanswered - about the rise of market-led initiatives around charters and ‘rights’ now forcefully employed by the new right protagonists of public choice.

This book provides a valuable contribution to the debate and it should be useful for researchers needing a framework for empirical investigations, for professional wanting to understand why there may be a difference between their views of their practice and those of the public, and for policy-makers who have embraced the ideals of consumerism, but often have simplistic ideas of customers choosing among products in a health care supermarket.