This paper argues that a health consumer movement has developed in the United Kingdom over the last decade. Drawing on two empirical studies of groups that promote and/or represent the interests of patients, users and carers, it argues that groups formed by people with personal experience of a condition are now more widespread. Feelings of pain and loss can lead to the identification of others in a similar position, and to the formation of groups and action in the political sphere. Research shows that groups share a common discourse and follow similar participative practices, and there is extensive networking. Informal and formal alliances have formed to pursue joint action and indicate a wider health consumer movement. As governments have also increased the opportunities for participation, this has the potential for patients and carers to shape services in ways more responsive to their needs.

This paper reports on the findings of three empirical studies, conducted by the authors, of how doctors respond to complaints about medical care. We found that doctors respond to complaints with a range of negative emotions, and interpreted complaints as a 'challenge' to their competence and expertise as professionals, not as issues troubling the complainant or as legitimate grievances. The interview data show that the way in which doctors talked about complaints and accounted for them drew on their understandings of their work world. We suggest that this helped them maintain a sense of control, and argue that this not only sustains individual security but also reinforces professional identity and serves the interests of professional politics. However, we conclude that this reaction to complaints goes against the spirit of resolving complaints to the satisfaction of the complainant which is currently the aim of systems for quality assurance.

The paper examines 110 complaints about general practitioners adjudicated by a health authority. This was a 10 percent subset of complaints received. Complainants' letters were analyzed in order to identify the issues complained about, who complained, what they wanted and how they structured their accounts. The most common single cause of complaint was the lack of a home visit but a third involved issues of diagnosis and treatment. Most people complained to get an investigation rather than for personal redress. Very few considered suing. Doctors, in their response to complaints adopted a number of defence strategies. In a minority of cases they stepped outside the bounds of professional behavior. In the light of impending changes in complaints systems in the U.K., it is argued that a forum for the expression of conflicting accounts remains.

This paper examines the neglected area of health support work in the United Kingdom in the context of recent social policy and studies of professionalisation. A variety of socioeconomic trends have led policy makers to give greater consideration to this section of the healthcare workforce. Professional regulatory issues and recent reviews in the health field have provided the leverage to alter existing healthcare boundaries, as well as to enhance public protection. Drawing on commissioned research, it is argued that health support workers are not only an important area of study in their own right, but also raise interesting questions about the broader process of health policy making and professionalisation.

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