Social Policy and Society

Themed Section on Choice or voice

Withering the Citizen, Managing the Consumer: Complaints in Healthcare Settings

Judith Allsopa1 and Kathryn Jonesa2

a1 Professor of Health Policy, Faculty of Health and Social Care, University of Lincoln E-mail:

a2 Senior Research Fellow, Department of Public Policy, De Montfort University, Leicester


This paper considers concepts of citizenship and consumerism in light of complaints about healthcare, which have risen since the early1990s, due to a greater willingness by the healthcare user to complain, and also the reforms in complaint systems. The narrow legal model for dealing with complaints has been replaced by a managerial model based on corporate sector practice that views complaint handling as a way of retaining customers and organisational learning. The managerial model has proved difficult to embed into the English NHS and has been superposed with a centralised regulatory system that aims to manage performance while also being responsible for reviewing, complaints and being responsive to complainants. It is argued that this may have positive consequences in terms of improving healthcare quality but more negatively, the promotion of consumerism within complaints processes has led to a loss of the right to due process and public accountability.