United We Stand? Partnership Working in Health and Social Care and the Role of Social Work in Services for Older People

The concepts of ‘partnership’ and ‘collaboration’have become amongst the most critical themes of ‘new’Labour’s social policy, particularly in respect of thedelivery of health and social care. Although the terms are rarelyprecisely defined and hence have become problematic to analyse,in most understandings successful partnerships rely upon goodsystems of inter-professional collaboration. Through revisitingthe extensive literature on the sociology of the professions,and the nature of inter-professional working, this paper willargue that effective collaborative working within health andsocial care is hard to achieve, particularly in the light ofthe vast differences in power and culture between various occupationalgroupings, and the inherently competitive nature of professionsjostling for territory in the same areas of activity. It suggeststhat these issues cannot be resolved unless they are properlyunderstood; a rhetorical appeal to the unmitigated benefitsof ‘partnership’ alone will not produce more effectivejoint working. In addition, it notes that an appropriate rolefor social work in the context of partnership working has yetto be defined and proposes specific tasks and values that distinguishthe social worker from other related professionals.     

For the Sake of their Health: Older Service Users' Requirements for Social Care to Facilitate Access to Social Networks Following Hospital Discharge

Facilitating older service users’ requirements for accessto or re-engagement in social networks following hospital dischargeis recognized in social care analysis and policy as criticallyimportant. This is because of the associated benefits for restoringphysical health and psychological well-being. However, it tendsto be a neglected dimension of current social care/intermediatecare. Our paper draws on a qualitative study of voluntary sectorhospital aftercare social rehabilitation projects in five UKlocalities, which focused on addressing this issue. Throughexamining older service users’ feedback and experience,our study confirms the health benefits of social care facilitatingaccess to social networks at this crucial juncture. By providingsensitive interpersonal interaction, advocacy and ‘educational’assistance, social care workers supported older service users’re-engagement in a variety of networks. These included friendship,recreational and family groups, health care treatment programmesand locality based contacts and organizations. As a result,material, interpersonal and health care resources were accessed,which contributed to restoring and sustaining physical healthand psychological well-being. The process of such social carealso emerged as critical. This included ensuring that objectivesreflected service users’ priorities; integrating ‘low-level’home care; offering befriending; and challenging the pre-settime frame of intermediate care.     

Risk, Mental Disorder and Social Work Practice: A Gendered Landscape

Whilst the importance of gender for social work practice, riskand mental health has been recognized theoretically for sometime, few attempts have been made to explore this area empirically.This paper presents findings from a mixed-methods study of socialwork practice in relation to mental health service users perceivedto be ‘high-risk’. Findings suggest, first, thatthe concept ‘high-risk’ was gendered because theprimary focus in social work practice was on the risks posedby male service users to others. Second, female social workersin the present study were found to have more female serviceusers from their caseloads who had been defined as ‘high-risk’compared with their male counterparts. The paper goes on toexplore this apparent congruence between female social workersand female service users and highlights how the management ofrisk could be considered gendered because it reflects a worker’s(perceived) capacity in cultural terms to ‘decode’the nature of the risks that their clients face as genderedsubjects. The paper demonstrates how the intersections betweenrisk, mental disorder and social work practice can thereforebe understood as a gendered landscape. It concludes by highlightingthe implications of these findings for social work practiceand research.     

Developing the NICE/SCIE Guidelines for Dementia Care: The Challenges of Enhancing the Evidence Base for Social and Health Care

Internationally, interest is developing in the challenges ofdeveloping evidence-based guidelines for social work practice.The paper reports on the process of establishing the UK’sfirst joint health and social care evidence-based practice guideline,which is in dementia care. The paper addresses the methodologicaland procedural challenges of reviewing, meta-analysing and synthesizingknowledge for health and social care given the contrasting historiesof the two sectors in relation to the emergence of evidence-basedpractice. Dementia care is a complex domain within which socialand clinical perspectives intersect, reinforcing the desirabilityof producing ‘joined up’ health and social carepractice guidelines that are relevant to integrated services.It is suggested that the exemplar of producing a joint healthand social care guideline for dementia may be a model for futuredevelopment of practice guidelines. Some of the main recommendationsare presented to illustrate the character of the joint guideline,lessons are drawn for future guideline development, and implicationsfor policy and practice implementation are considered.     

Social Work, New Public Management and the Language of 'Service User'

The purpose of this paper is to offer insight into the possibleconsequences of language developed at the political level byan authoritative body for the purpose of designing social policythat is then adapted as discourse in social care. The focusis on the UK government’s policy toward the language of‘service user’ in the context of New Public Management(NPM). It begins with a brief introduction on the importanceof language. Next, it outlines the move towards NPM and changesthat have facilitated the shift from ‘client’ to‘service user’, presenting some of the implicationsthese changes have had on social work in Britain. Finally, itdetails the possible detrimental effects of labelling language,and discusses research from other countries on preferred termsof reference for individuals who use health and social careservices.     

Cost and Stakeholder Views: A combined approach to evaluating services

Correspondence to Jackie Powell, Department of Social Work Studies, University of Southampton, Highfield, Southampton SO9 5NH Summary This paper focuses on the decision-making process at a strategiclevel in the context of implementing a ‘community care’policy for older people with mental health problems. It is basedon the findings of an evaluative study of the implementationof one district health authority's strategy for the decentralizationof its mental health services for older people. The study wasan attempt to develop an evaluative approach which acknowledgedthe importance of cost, but also the need to include the viewsof the several ‘interested parties’, not least thosewho used the service. The reconciliation of what might be seenas the conflicting interests of the wider public for a carefulutilization of resources with the individual's needs for anaccessible and responsive service represents a major challengefor planners, managers and practitioners within the public sector.This paper argues the need for dialogue as the basis for partnershipbetween those with a primarily financial focus to their workand those more intimately concerned with individual needs.     

Ambiguities in Decision Making: Social Work's Response to 'Glue-Sniffing' in Scotland

Correspondence to Dr Elizabeth Jagger, Social Science Department, Park Campus, 1, Park Drive, Caledonian University, Glasgow G3 6LP Summary This paper examines how social workers make decisions aboutwhich cases of ‘glue-sniffing’ require intervention,in the context of a government policy which construes the problemprimarily within the arena of parental responsibility. Usingdata from interviews with social workers and research on ‘glue-sniffing’,it shows that social workers were frequently reluctant to dealwith cases. It explains that this has to do with factors suchas organizational priorities, lack of resources and, in particular,the ambiguous status of ‘glue-sniffing’ within theirown professional discourse. It concludes that the complex interplayof these factors means that government policy is not translatedinto practice in any simplistic manner.     

Community Development, Partnership Governance and Dilemmas of Professionalization: Profiling and Assessing the Case of Ireland

Over the last two decades, Ireland has emerged as a paradigmaticcase of partnership governance. Underpinned by state-facilitatednational agreements that sought to maximize economic and socialdevelopment, ‘partnership’ was also held to includethe development of progressive social policies. The ‘communityand voluntary sector’ has been both the site and purportedvehicle for these progressive policies. In this context, communitydevelopment emerged as a discourse of social action that wasboth popular with what Donnelly-Cox and Jaffro (1999) have inthe Irish context called ‘second generation communitydevelopment’, i.e. the emergence of self-activated localcommunity groups informed by a social justice ethos, and tothe Irish state as a route to social inclusion for an arrayof marginalized social groups. Since the early 1990s, thesegroups have been the recipients of significantly increased statefunding. This resource has had a dramatic effect on the structureand nature of community development. In this paper, we outlineand assess the model of community development that has emergedin Ireland during this period. Based on empirical data arisingfrom a nationwide survey of community workers, we profile theextent of state funding; the consequent employment profile ofcommunity development workers and the impact on volunteerism;and the nature and consequence of community development’semerging relationship with the Irish state.     

Inter-agency Information Sharing in Health and Social Care Services: The Role of Professional Culture

This article uses a literature review to examine the ways inwhich professional culture might shape inter-organizationalexchange of personal information in a health and social carecontext. The aim is to explore a simplified model of possibleinformation-sharing behaviours (‘ideal’, ‘over-open’,‘over-cautious’ and ‘chaotic’) and tosuggest that patterns of information sharing may be influencedby a number of factors. It is proposed that these factors includenot only inter-professional differences in the approach takento information sharing but also the ways in which the professionsinterrelate.     

New Labour, Social Justice and Children: Political Calculation and the Deserving-Undeserving Schism

Correspondence to: Barry Goldson, Department of Sociology, Social Policy and Social Work Studies, The University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool L69 7ZA, UK. E-mail: b.goldson{at}liv.ac.uk Summary Within a context of national prosperity and relative economicstrength, poverty and inequality is rife in the UK. This paperconsiders the broad contours of such social injustice, beforesharpening the focus to examine the specificities of child poverty.The New Labour government has made an ‘historic pledge’to end child poverty within a generation. The paper traces thekey policy initiatives that are being directed to this end and,by drawing on the latest research evidence, it attempts to assesstheir early impact. Whilst it is acknowledged that the government'ssocial justice agenda has made some progress in ‘tackling’child poverty, it is further proposed that a more rigorous redistributiveapproach is required if substantial and sustainable improvementsare to be made. Furthermore, it is argued that the social justiceagenda is conditioned by wider political calculations, whichlimit its scope. In this way the imperative to be seen to be‘tough on crime’ has meant that policy responsesto children in trouble have taken a distinctive and increasinglypunitive form. By developing the argument that New Labour'selectoral ambitions have led it to re-engage with a specious‘deserving’ ‘undeserving’ conceptualdichotomy, the paper assesses the implications for the treatmentof child ‘offenders’ in particular, and the broadersocial justice project more generally.     

Mental Health and the Asian Communities: A Local Survey

Correspondence to Barbara Hatfield, Lecturer in Psychiatric Social work, Department of Psychiatry, 12th Floor, Mathematics Building, Manchester University, Oxford Road, Manchester M13 9PL Summary The survey of people from the Asian communities in ‘Milltown’included people who used mental health services, family membersof service users, and members of the Asian general public. Personaland social stresses of the group were explored, as were theirperceptions of the ‘causes’ of mental ill-healthand appropriate responses. Although most people saw family andsocial stress as central, a religious dimension was also prominent,in terms both of causes and treatment of mental ill-health.There was no evidence of rejection of mainstream services becauseof a choice on the part of Asian families or communities tobe self-servicing. A range of issues identified by respondentssurrounded the cultural acceptability of services in ‘Milltown’to Asian people. A lack of knowledge of service availabilitywas also apparent, with a heavy reliance upon GP services formental health care in the community. The findings of the surveyare compared with similar studies, where available, which focuson indigenous white British service users. Some findings arecommon; other issues are specific to this Asian group.     

Social Work in Accident and Emergency Departments: A Better Deal for Older Patients' Health?

Correspondence to Eileen McLeod, School of Health and Social Studies, University of Warwick, Coventry CV4 7AL, UK. Summary Well-established internationally, the current development ofsocial work in UK accident and emergency (A&E) departmentsis part of a conjoint health/social care policy drive to divertolder people from ‘unnecessary’ admission to acutehospital care on social grounds. However, from older serviceusers' standpoint, the prime criterion for assessing A&Esocial work is not its powers of diversion, but its contributionto optimum health and social care. Our account indicates thatA&E based social work can provide important benefits, includinghelp with negotiating the A&E environment and readier accessto social services. Nevertheless, continuing professional–serviceuser power imbalances, together with shortages in health andsocial care services, undermine its positive contribution bothwithin A&E and following discharge. Notably, under-resourcedcommunity based health and social care can lead to servicesimplemented through A&E, swiftly unravelling. This has seriousconsequences for older service users facing interlinked healthand social problems, and may be implicated in re-attendanceat A&E.     

Advocacy for Black and Minority Ethnic Communities: Understandings and Expectations

Recent policy has promoted ‘advocacy’ as a meansof promoting social justice for many disadvantaged groups. Yet‘advocacy’ is a contested concept, and the understandingsthat members of disadvantaged groups themselves have of advocacyhave rarely been explored. Previous research indicates thatunderstandings may vary considerably. Using empirical evidencefrom research conducted in Glasgow, Scotland, this paper examinesthe understandings and expectations of ‘advocacy’held by black and minority ethnic (BME) service providers andpotential service users. The BME service providers believedthat they were offering advocacy, and did so in the contextof a marginalized position for their services. The BME communitymembers supported the development of advocacy services, buttheir own marginalization was in many ways reinforced by servicesthey were already using. They had clear ideas about appropriateadvocacy services for their situation. These ideas were groundedin their current situation, and did not necessarily conformto dominant ideas about advocacy. In conclusion, the prospectsfor successful advocacy are assessed.     

Globalization and Social Work: International and Local Implications

Globalization can seem a remote process, related only to theeconomic and commercial world. However, it impacts (differentially)on the work opportunities and living conditions of populationsaround the world and has also influenced thinking about welfarepolicies, including through state provision. It thus has implicationsfor the practice and education of social and community workersin both affluent and poverty stricken states. In addition tosocial professionals who seek opportunities to work internationally,globalization is also affecting the practices of those who wouldpreviously have seen their work as essentially rooted in localconditions and community needs. This paper therefore gives someexamples of the ways in which local practice may have cross-borderand international dimensions, drawing on experiences in thechild-care field, particularly in the UK and European context.The author indicates how international social work courses areaiming to equip specialist international social workers, whilealso arguing for the development of educational programmes whichprepare ‘local’ social workers for practice in aninterdependent world.     

'Anti-Oppressiveness': Critical Comments on a Discourse and its Context

This paper identifies and aims to explain an apparent dissonancebetween the dominance in Britain of ‘anti-oppressive’social work discourse and the socio-political context surroundingits use; a context often claimed to feature excessive regulationand control. Pursuing this, some politically radical aims associatedwith ‘anti-oppressiveness’ are spelt out, and thedifficulty of achieving these in an unconducive climate is discussed.Then, a distinction made by Robert Merton between ‘latent’and ‘manifest’ functions is used to suggest thatthe manifest radicalism of ‘anti-oppressive’ discoursecan helpfully be distinguished from some latent largely unrecognisedconsequences of its use – not consequences with politicallyradical impact, but with a social meaning congruent with a climateof control. It is concluded that the ‘success’ ofanti-oppressive discourse might well be viewed as requiringmore of the kind of critical analysis that the discourse itselfwas supposed to espouse.     

The State of Care Management in Learning Disability and Mental Health Services 12 Years into Community Care

This paper reports on the organization of care management froma longitudinal study of community care for people resettledfrom long-stay learning disability and psychiatric hospitals.The findings from a 12-year follow-up of care management arrangementsin 12 learning disability and eight mental health study siteservices are described. The diversity of care management arrangementsfound at earlier points in the evaluation remained evident.Also, many of the former ‘care in the community’service users were excluded from mainstream care managementarrangements in their localities. The difficulty of developingperson-centred arrangements in learning disability and the lackof integration of the Care Programme Approach and care managementwere evident. The findings and observations are placed in thewider policy and practice context, with suggestions for takingcare management forward nationally and locally.     

Accounting for Ethical Difficulties in Social Welfare Work: Issues, Problems and Dilemmas

This paper is a preliminary exploration of social welfare practitioners’accounts of ‘ethically difficult situations’. Itdescribes variations in the ethical vocabulary and form of theseaccounts. Analysis of practitioners’ own accounts (asopposed to ‘textbook’ cases) draws attention tothe ways they construct events, actions and qualities of characteras ethically significant and highlights the qualitative distinctivenessof ethical dilemmas, where seemingly irresolvable choices leavea residue of moral loss, regret or guilt.     

The Victorian Ethical Foundations of Social Work in England--Continuity and Contradiction

Correspondence to Bill Forsythe, Dean of Academic Partnerships, 261, Northcote House, University of Exeter, Exeter EX4 4QJ, UK. E-mail: W.J.Forsythe{at}exeter.ac.uk Summary In this article we argue that during the Victorian era certainethical foundations of best practice were identified and werecentral to the work of particular individuals. We also arguethat there was a strongly discriminatory moralistic basis tosocial policy and mainstream charitable intervention that militatedagainst these ethical foundations. We suggest that this contradictionis replicated in New Labour's ‘Third Way’ and thatwe need to heed the tradition of social inclusion espoused bysome of the Victorian practitioners discussed if we genuinelymean to put into practice the ideas of social worth and communityespoused by New Labour rather than return to the Victorian distinctionbetween the ‘respectable’ or ‘deserving’poor and the ‘pauper’.     

Swimming with Dolphins: The Assessment Framework, New Labour and New Tools for Social Work with Children and Families

Correspondence to Dr Paul Michael Garrett, School of Sociology and Social Policy, University of Nottingham, University Park, Nottingham NG7 2RD, UK. E-mail: paul.garrett{at}nottingham.ac.uk Summary Local authorities, in England, implemented the Framework forthe Assessment of Children in Need and their Families in April2001. The Framework is the first ‘official’ standardassessment model intended for use in the initial assessmentof all ‘children in need’ under Part 111, section17 of the 1989 Children Act. This new ‘conceptual map’needs to be understood in terms of previous policy documentsand earlier technologies of intervention related to child protectionand, more broadly, child welfare. However, it also needs tobe more expansively perceived, fixed and located as it relatesto other elements in New Labour's political ‘project’.The Framework's preoccupation with an ecological approach toassessments and with questionnaires and scales are likely tohave major implications for social work practice and for micro-engagementswith children and families.