Social changes are creating new challenges for the way in which public services work.

Doctors tell of how in the past patients would defer to their diagnosis, take the pills prescribed, and be on their way. Nowadays, a GP is more likely to meet a patient who tells them that: “I felt under the weather, Googled it, and I think that I have this ailment and I want to be treated in this way.”

The story reflects a fundamental shift in citizens’ attitudes to public services. Several factors are important. First, we are richer than ever before. Second, we expect more from our public services than we used to. Third, we are better informed – two thirds of us now have internet access at home. This means that information that was once the preserve of experts is now on the web (although, of course, not all of this information is reliable). On top of this, society has changed – we are less deferential to authority.

A recent report published by the Social Market Foundation described this transformation as the rise of the assertive citizen. That people are more willing to assert their rights, and less keen to defer to authority is liberating; yet there are downsides too, such as when assertiveness strays into aggressiveness or selfish individualism. After talking to patients, doctors, nurses, schoolchildren, parents and teachers, the report argued that public services should adapt to capture the positive aspects of these changes.

Two areas are particularly relevant. First, the introduction of greater choice into the public services seems to be an appropriate response to assertive citizens expecting more flexibility in their services. There is real scepticism from service users who hear politicians talk about choice but then find it is not available at a local level – policymakers must be careful to recognise this gap. Greater choice also raises new challenges in providing fair services. Choice and decent advice must be available to all, not just those who assert their demands the loudest.

Second, the report examined how to improve the relationship between service users and professionals, such as doctors and teachers. Citizens have a responsibility to channel their assertiveness in a positive way, and government must encourage them to do so. Students should be educated about their rights and responsibilities during citizenship classes. There is also a need for more advice to be given to other service users.

Professionals also need better training on how to deal with assertive citizens. Teachers, in particular, are given help to deal with overly assertive children, but little on how to deal with assertive parents. In health, professionals are given more help, but here again the relationship has changed. Healthcare professionals must act as advisers offering guidance and support. There are 15.4 million people in England with a long-term health condition. For these patients, lifestyle choices can be as crucial to their health as prescriptions. The doctor becomes the guide to how to achieve better health.

In these ways users’ assertiveness can be a driver for better outcomes in the public services and as such should be embraced.

— Dr Simon Griffiths is a senior research fellow at the Social Market Foundation and co-author of Assertive Citizens: New Relationships in the Public Services. www.smf.co.uk

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