Taking Care of Later Life: A Matter of Justice?

Correspondence to: Julia Johnson, Senior Lecturer, School of Health and Social Welfare, The Open University, Walton Hall, Milton Keynes MK7 6AA, UK. E-mail: j.s.johnson{at}open.ac.uk Summary This paper reviews current policies and practices regardingthe provision of long-term care for older people. In particularit focuses on three aspects which are central to social workand care management: current developments in residential andnursing home care; charging for care; and the shifting boundarybetween health and social care. It argues that, in all respects,these policies and the ways in which they are being implementedare incompatible with the notion of social justice. Over thelast fifty years, the older generation has invested heavilyin the welfare state and continues to make a significant contributionto it. The security and well-being of those in need of long-termcare is, however, being threatened by the marketization andcommodification of care provision.     

Dying and Bereavement, Spirituality and Social Work in a Market Economy of Welfare

Correspondence to Margaret Lloyd, School of Social Work, University of Manchester, Oxford Road, Manchester M13 9PL Summary This paper examines the contribution of social work practiceto the care of people who are dying or bereaved. It considerscurrent challenges to traditional practice arising from societaland organizational change, reaffirming the importance of thesocial work role but arguing that, in order to face those challenges,social workers must broaden their perspective to incorporatea spiritual dimension. The paper draws on a research study conductedby the author.     

Nearest and Dearest? The Neglect of Lesbians in Caring Relationships

Correspondence to Jill Manthorpe, Social Care Workforce Research Unit, King's College London, 150 Stamford St, London SE1. E-mail: jill.manthorpe{at}kcl.ac.uk Summary The article argues that caring within lesbian relationshipshas been ignored in social and health care studies and practice.It critiques the dominance of caring debates by relationshipsbetween parents and children and partnerships, but with theunspoken presumption that those involved are heterosexual. Thepaper concludes that social workers should engage with lesbiancarers in supporting individuals and networks. It draws outa range of implications for policy, practice and research agendas.     

Informal Care in Asian and Afro/Caribbean Communities: A Literature Review

Correspondence to Karl Atkin, Social Policy Research Unit, University of York, Heslington, York YO1 5DD. Summary The multi-racial nature of British society can no longer beignored by those responsible for planning and implementing socialcare policy, particularly since community care is presentlyat a crossroads. Informal care provides a useful starting pointfrom which to introduce the notion of race into social caredebates. The paper, by reviewing a mix of empirical studiesand policy debates emerging from the literature on informalcare and black communities, examines the experience of informalcare within black communities. By discussing topics such asthe demography of care, the nature of informal care, and serviceprovision to black carers, it gives coherence to a fragmentedliterature and illustrates gaps in present understanding.     

Informal, Voluntary and Statutory Services: The Complex Relationship

Summary The argument of this paper is that equitable social care caneventuate only with the acceptance of a greater role for publicsector services. In debates about the development of socialcare, politicians in industrial societies who stress the virtuesof family care are either unaware of the costs to families ofproviding that care, or are cynically expecting a major shiftin social provision and social resources, with the result thatthose least able to provide adequately will find greater burdensthrust upon them. Responses to the exclusions experienced bypeople in the 1980s will require greater state interventionbecause families may have the willingness, but not the capacityto provide the high level care required by dependent relativesand because the voluntary sector is too diffuse and diverseto plan, develop and deliver the bulk of the services.     

Group Homes for the Mentally Handicapped--an Examination of the Effects of Group Interactions

Summary The past decade has witnessed a move towards increased communityresidential care for the mentally handicapped, essentially involvingan expansion of hostels and group homes. The latter has beenviewed as a serious alternative only for the more able members:those sufficient in a modicum of independence and behaviouralskills. The present paper explores the importance of group interactionaldynamics within the framework of providing residential carein ordinary houses for groups of up to five mentally handicappedadults. The use of group theory perspectives concentrates onthe potential of individuals to achieve effective social skillsthat contribute to adequate group harmony. The findings illustratethe potential of meeting the needs of the less able within grouphome settings through an emphasis on assessment of total groupneeds rather than on an aggregate of individuals comprisingthe group. These are discussed within the contest of currentefforts both at policy and provider level to expand care withinthe community.     

Foster and Residential Children's Perceptions of Their Social Environments

University of Oxford, Department of Social and Administrative Studies, Barnett House, Wellington Square, Oxford OXI 2ER. Summary This paper compares foster and residential children's perceptionsof their social environments (placements). The exercise formedpart of a larger examination of care practice in special fosterhomes and Children's Homes. The application of a combinationof quantitative and qualitative techniques showed that the fosterchildren's perceptions of their placements generally comparedfavourably with those of the residential children.     

Informal Networks of Care: Issues Raised by Barclay

Summary In calling for the creation of ‘community social work’,the Barclay Report argues that social workers should aim todevelop informal caring networks. This entails exploiting anindividual's informal social contacts, such as kin, friends,and neighbours, to provide care. This paper firstly examinesthe assumptions and thinking behind the concept of informalcaring networks. It then assesses the feasibility of using differentinformal relations in care provision by analysing the normativepatterning and exchange content underlying them. It concludesthat strategies like Barclay's are unlikely to be successfulbecause they entail a transformation of these relationshipsthat is incompatible with their normal organisation.     

The Background of Children who enter Local Authority Care

Andrew Bebbington, PSSRU, Cornwallis Building, The University, Canterbury, Kent, CT2 7NF. Summary The family backgrounds of 2500 children admitted to care inEngland were investigated, to quantify the association betweenindicators of material and social deprivation and entry to care.These indicators are more closely associated than in Packman'snational survey of 1962. Broken family is the most significantfactor, though there are several alternative explanations forthis, which have quite different policy implications. When allowanceis made for other social factors, children from particular ethnicminorities do not seem specially vulnerable, though childrenof mixed race are. The study confirms that many children whocome into care after an offence have experienced similar deprivationsto non-offenders. There remain great variations between authoritiesin children's routes into care, but less so in the circumstancesof the children themselves.     

The Post- and the Anti-: Analysing Change and Changing Analyses in Social Work

Correspondence to Dr Liz Lloyd, School for Policy Studies, University of Bristol, 7 Priory Road, Bristol BS8 1UA Summary This article considers some of the issues raised by criticsof postmodern analyses of social work. It analyses the waysin which social services departments have changed to a ‘post-fordist’organizational form and considers the implications for equalitypolicies and anti-oppressive practice. It challenges the viewthat preserving a more professional approach to social workoffers greater opportunities for anti-oppressive practice thanthe more deprofessionalized approach currently being developedand argues that social workers committed to the principles ofanti-oppressive practice can develop new tactics appropriateto the changing organizational context It also argues that postmodernistanalyses offer new insights into experiences of power, oppressionand inequality. In particular, it stresses the importance ofunderstanding the linkages between broader, political and economictrends and the experiences of individual social workers andservice users. Drawing on research in Avon Social Services, it considers theways in which race equality strategies in community care continueto reduce issues of race and racism to culture and identity.Reflecting critically on anti-oppressive and anti-racist actionit argues that the limitations placed on anti-oppressive practiceunder the postfordist context of community care are unlikelyto differ greatly from those felt under previous organizationalregimes.     

Compulsory Persuasion: A Problem for Correctional Social Work

Summary Social work risks being misused as a technique for controllingundesirable behaviour, regardless of clients' expectations orchoices. This approach to social work involves certain underlyingassumptions about human nature which raise considerable ethicaland practical difficulties. Recent trends in the probation andafter care service are considered, together with some researchstudies of the effectiveness of social work in reducing offendingbehaviour. From these it is argued that social work servicesfor offenders are more likely to be effective when the emphasisis on helping with perceived problems and difficulties ratherthan on crime prevention.     

Adopted Children in Care

Correspondence to David Howe, School of Economic and Social Studies, University of East Anglia, Norwich NR4 7TJ. Summary Four local authority social services departments were surveyedto determine the number of adopted children who were currentlyin their care. The biographical characteristics of these childrenand the reasons for them entering care are reported. The adoptivedimension is discussed as a possibly relevant factor in theassessment and treatment of these children and their families.It is concluded that appropriate practice in this field requiresspecialist skills and understanding.     

The Beckford Report: A Critical Appraisal

Correspondence to Nigel Parton, Department of Behavioural Sciences, The Polytechnic, Queensgate Huddersfield HDI 3DH. Summary This paper provides a critical analysis of the Beckford Reportand its implications for social work and the personal socialservices. Four interrelated themes are explored: the relationshipbetween social work practice, statutory responsibilities andthe law; the attitudes of social workers towards children andfamilies; the social work skills required; and the assumptionsthat are made about child abuse and the role of social workers.This is then related to recent research findings in the areaof policies and decision making in child care. It concludesby arguing that the report is in great danger of misdirectingour attentions from the major issues concerned with social workwith children at risk.     

Aspects of Social Work on a Cancer Research and Treatment Unit in a London Teaching Hospital

Summary With the rapid growth of technology and science in society today,an increasingly large number of people are becoming patientsin specialized research and treatment units. The reorganizationof social work support to the health service is upon us, andgreat care must be taken to ensure that this important groupof clients will receive the social work help it needs. The paper is based on work in a cancer unit in a London teachinghospital and seeks to illustrate ways in which the work is specialized     

On Patient Satisfaction in Cerebral Palsy Care

Correspondence to Professor W. G. Kernohan, Room 12J08, University of Ulster, Newtownabbey BT37 0QB Summary The value of managing teamwork in health care is well recognized.Yet, for a variety of reasons, it often fails to provide thedegree of support required. To investigate the capacity forall-round service provision in Northern Ireland, a survey wascarried out to obtain both quantitative and qualitative dataon the degree of social and health care support for familieswith a child affected by cerebral palsy, one of the most seriousorthopaedic disorders. Results suggest that, while clinicalmedical care is generally good, the role of social support inhealthcare management seems poorly defined, fragmented and variable.     

Where has all the care management gone? The challenge of Parkinson's disease to the health and social care interface

Summary The delivery of health and social care has undergone massivechange in the UK in the 1990s. A key factor in the drive forreform was the failure of joint working arrangements betweenhealth and social services and the need to provide integratedcare for people who have overlapping health and social careneeds. This article draws on a research study investigatingthe community care provided to people with Parkinson's diseasein the wake of the 1990 National Health Service and CommunityCare Act. As a chronic progressive disease predominantly affectingolder people, the management of Parkinson's provides an exemplarof some of the key features of supporting people with continuingcare needs. This study found serious deficits in the assessmentand meeting of need, arising from weaknesses at the health andsocial care interface. The article concludes by consideringan approach which resources and supports the service user/carerin managing their own care pathway.     

Child Placement Policy: Some European Comparisions

Summary There is consensus among European countries that the first aimof a social policy for families should be to enable childrento remain in their own homes. However, in all countries somechildren require placement apart from their parents, but thereis no agreement as to the best mode of care for these children.Some countries rely entirely on residential care, others almostentirely on family placements in the community. The articlecompares Sweden (high fostering) with Belgium (low fostering),and England and Wales, which is midway between the two, andsuggests that some European models are relevant to English practice.     

Reconciling Cash and Care: Home Care Charges and Benefit Checks in Social Services

Correspondence to Pete Alcock, Health and Community Studies, Sheffield Hallam University, Collegiate Cresent, Sheffield S10 2BP Summary This article contains the report of a small research projecton the development of welfare rights checks for home care clientsin social services departments. Welfare rights take-up activityhas become an important feature of provision by local authoritysocial services departments, frequently targeted on particulargroups of clients known to experience problems in claiming fullbenefit entitlement. Users of home care services are such aclient group. Take-up work with home care clients is also, however,a product of the impact of community care policy changes andof financial pressures on local authority social services. Thesehave resulted in the introduction of charges for home care servicesby many authorities, and the use of rebates from such chargesto protect low income service users. Welfare rights work hasthus become an important feature of the reconciliation of thesenew charging policies with the continued service needs of poorhome care clients. The research examined a successful take-upinitiative, linked to home care charges, in Sheffield and contrastedthis with similar activities in other authorities throughoutthe UK. The conclusion is reached that levels of non-take-upof social security benefits are particularly low amongst homecare clients and that benefit checks can secure significantadditional income for them, which may also have the indirecteffect of increasing the income to social services departmentsfrom the charges for home care services.     

Contract Management and Community Care: A Negotiated Process

Correspondence to Jackie Powell, Department of Social Work Studies, University of Southampton, Highfield, Southampton, SO17 1BJ, UK. Summary Drawing on a wider study of community care arrangements forvisually impaired people in England and Wales, this paper exploresthe implementation of contractual arrangements as part of thedeveloping formalization of partnerships between local authoritysocial services departments and voluntary organizations. Itargues the importance of conceiving contract management as acomplex set of social processes involving a diversity of interestsand inequalities of power, where skills in negotiation are centralto promoting greater participation in community care policyand practice. It concludes with a brief discussion of the relevanceof social work to the implementation of this key area of contemporarycommunity care arrangements.     

Working in the Social Services: Job Satisfaction, Stress and Violence

Correspondence to Professor Jan Pahl, Department of Social and Public Policy and Social Work, Darwin College, University of Kent at Canterbury, Canterbury CT2 7NY. Summary A major survey of the social services workforce (Balloch etal., forthcoming), carried out in the Research Unit at the NationalInstitute for Social Work, has produced new data about sourcesof job satisfaction and about the incidence of stress and violence.The survey took place in five different local authorities inEngland, and interviews were carried out with 1276 individuals,selected from four groups of staff: managers, social work staff,home care workers and residential staff. The results suggestedthat those who work in the statutory, social services do experiencemore stress and violence than workers in other parts of thehealth and welfare services. However, different jobs presenteddifferent hazards. In general, home care workers were the mostsatisfied with their jobs, and were also the group least likelyto be stressed or to experience violence in the course of theirwork. By contrast, residential workers, especially those withmanagement responsibilities, were most at risk of both violenceand stress. Men were more likely than women to experience violence,while other groups with a higher than average risk of stressincluded younger members of staff, and managers and social workstaff responsible for elderly people.