The Single Assessment Process in Primary Care: Older People's Accounts of the Process

Recent government policies have been active in addressing socialinclusion and active participation of older people in many aspectsof societal life. Independence and well-being animate thesedevelopments and are evident in the emphasis on person-centredservices within the single assessment process for older people(Department of Health, 2002b). Drawing on a feasibility study of the Single Assessment Processas a ‘case-finding’ approach, this paper presentsfindings drawn from older people’s accounts of this experience.These accounts indicate the potential of the process for identifying‘low-level’ need, whilst raising issues of accessto formal services and resource constraint; also they underlinethe importance of understanding how older people seek ways ofmanaging their own health and well-being, whilst continuingto contribute to the social cohesion of society by providingsupport to their peers and to younger generations. Interdependence, it is suggested, rather than dependence shouldunderlie any approach to assessing older people’s needs,if we are to appreciate and build upon the complexity of olderpeople’s strategies for actively managing their lives.     

Helping Older People in Residential Care Remain Full Citizens

New Labour’s project of modernization has involved thepromotion of interlocking ideas about active citizenship andnew modes of democratic engagement combining to produce whathas described as ‘participative governance’. Concernsabout legitimacy, a ‘democratic deficit’ and theneed to shift power and responsibility to the ‘citizen’have led to the emergence of a range of new deliberative foraand democratic processes. This has led to debates about howto ensure that social diversity can be represented in the decision-makingprocess. A challenge has been how to engage with the issuesof an ageing population and represent older people in all theirdiversity. In recent years, there have been growing calls toextend advocacy rights to older people living in residentialcare. Mostly, this has been to ensure that as consumers, theyhave a fuller say in how their service is run. Older care homeresidents are service users but, as persons, should not be reducedto this role only; they are also citizens in the broadest senseand should not be cut adrift from debates at the national, localand community levels on issues that concern them. This paperexamines how the moves to bring older people into deliberativedemocratic processes have tended to focus on those in their‘Third Age’. Those in institutional settings, beingin the ‘Fourth Age’, occupy a much more marginalposition. This effective disenfranchisement is yet another reasonwhy, for many, the move into residential care—a difficulttransition for a variety of reasons—becomes regarded asthe ‘last refuge’. It contributes to the sense ofloss of identity, lowering of self-esteem and a reduced senseof personhood. This article accepts that there should be moreeffective involvement of care home residents in decision makingabout their personal care. However, there are dangers in adoptinga too narrowly consumerist approach. This can reinforce a reductionistview of care home residents simply as ‘service users’—aform of ‘othering’ in itself. As citizens and membersof a wider community, they should be included in consultationsabout any community and wider political debates that affectthem. Such a proposal implies a widening and deepening of advocacyservices available to this group. As most older people in residentialcare are there following the intervention of a social care professional,then ensuring that they have access to advocacy must surelybe a key task. This paper argues that this is frustrated bythe lack of suitable services. Without a significant investmentby the Government in independent advocacy services, not onlyis the social work task with one of social care’s coreclient groups rendered impossible, but the Government cannotdeliver on its own agenda of empowerment, active citizenshipand inclusion.     

Beyond Social Constructionism: Critical Realism and Social Work

Summary Theories within the social and psychological sciences continueto shape social work practice. However, recent debates withinthese sciences on the shortcomings of ‘social constructionism’,and the attempt to overcome them through a critical realistposition, have so far failed to capture social work's attention.This paper provides a critical overview of these theoreticaldebates, highlighting the shortcomings of social constructionismfor social work. The critical realist challenge to social constructionism,as articulated by the British philosopher Roy Bhaskar, is consideredand its relevance to social work formulated in terms of a returnto ‘depth’ in practice.     

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.     

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.     

'Low Key Practices' in Social Work. Towards a Socio-historical Method

Summary In this article a ‘socio-historical’ method of analysisand intervention in social work will be developed, illustratedby an example drawn from social work with families, the programknown in France as Action Educative en Milieu Ouvert. Our purposeis to support and encourage what we call ‘low key practices’,which refers to practices in which social workers within theexisting structures of so-called ‘individual social work’attempt to explain the social struggle taking place in the situationsthey are dealing with.     

Social Networks and Social Service Workers

Correspondence to Peter Sharkey, School of Law, Social Work and Social Policy, Liverpool Polytechnic, 98 Mount Pleasant, Liverpool, L3 5UZ. Summary ‘Networks’ is a word often used in the discussionof social work practice and within social services departments.It was a word which was central to the Barclay Report (1982)and important within the more recently published Griffiths Report(1988) on community care. It is a word also known to sociologistsand anthropologists through the development of ‘networkanalysis’. There is, however, a fairly wide gap betweenits use within social work and its use within social science.This article tries to explore this gap and the ways in whichsocial science ideas might have some use and relevance to socialservice workers. It does this by using some illustrative datafrom a study done of the personal networks of thirty elderlypeople who were all clients of a social service district office.     

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.     

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.     

Care Management and Professional Autonomy: The Impact of Community Care Legislation on Social Work with Older People

Correspondene to Mark Lymbery, Centre for Social Work, School of Sociology and Social Policy, University of Nottingham, University Park, Nottingham NG7 2RD, UK. e-mail: Mark_Lymbery{at}nottingham.ac.uk Summary The 1990 National Health Service and Community Care Act appearedto herald a new dawn for social work with older people, whichhad previously been a relatively neglected and undervalued areaof social work practice. The legislation proposed a new rolefor social workers as ‘case managers’, with considerableautonomy and flexibility about the way in which the ‘casemanager’ responded to need. By the time community carepolicy was implemented, the role of ‘case manager’had been transformed into that of ‘care manager’,with a focus which emphasized procedural and managerial requirementsrather than a more flexible professional practice. This paper explores the extent to which this shift has substantivelyaltered the nature of social work practice with older people.It outlines key theories of professions and their applicabilityto social work, and critically analyses the impact of the ‘newmanagerialism’ within social services departments. Thepaper also examines the nature of social workers' practice witholder people following the impact of community care legislation,and concludes that the impact on the social work professionhas been to locate an increasing control of practice with socialwork managers, with potentially serious consequences for thecontinuation of a distinctive social work role in relation toservices for older people.     

Adolescents in Care and their Social Workers: A Research Note

Summary There has recently been an increasing concern that young people,and especially those in residential care, should be encouragedto express their views, and that the views expressed shouldbe used in improving the care which they receive. The publicationof the Who Cares? booklet (Page and Clarke¹), and the emergenceof ‘Who Cares’ groups and the ‘Voice of theChild in Care’ organisation, is evidence of this concern.In sympathy with these developments has been a study of adolescents'perceptions of social workers, and a part of this research hasincluded a pilot study of the views of adolescents living intwo family group homes.     

Older People and Access to Care

Correspondence to Denise Tanner, School of Health and Social Sciences, Coventry University, Priory Street, Coventry CV1 5FB, UK. E-mail: d.tanner{at}coventry.ac.uk Summary At the heart of a number of New Labour health and social policyinitiatives are stated concerns with supporting independence,preventing deterioration and extending access to services. Thisarticle examines the potential impact of these initiatives,including Prevention Grants (Department of Health, 2000b), theNational Service Framework for Older People (Department of Health,2001a), the Fair Access to Care Services Guidance (Departmentof Health, 2002a), and the Single Assessment Process (Departmentof Health, 2002b), on older people with ‘low level’needs who have increasingly been excluded from services targetedat those in high risk categories. Key standpoints for this analysisare research findings indicating what older people themselveswant from preventive services. Central messages, consistentwith those from other service user ‘groups’, arethe need for support services that enable older people to continueto exercise choice and control over their lives. New preventivemeasures are evaluated in the light of these findings and foundwanting. It is argued that recent policy initiatives are likelyto do little to widen access to support services for those withlow intensity needs, and, moreover, that the processes involvedin identifying those at future high risk will detract from ratherthan enhance citizenship. A more diffuse approach to preventionis advocated, based on mutuality, community development, andcapacity-building.     

Irish Social Workers in Britain and the Politics of (Mis) Recognition

The article focuses on the perceptions of Irish social workersworking in ‘children and families’ settings in Britain.These respondents cannot be seen as representative of all Irishsocial workers in Britain, yet they do provide insights intofive significant themes: the approach to ‘race’and ethnicity in social work education; Irish identities inBritain; racism and stereotyping; children and families whoare Irish Travellers; and an agenda for the future. The discussionconsiders some of the issues raised in the context of what hasbeen referred to as the ‘politics of recognition’.     

Mapping Child-Care Social Work in the Final Years of the Twentieth Century: A Critical Response to the 'Looking After Children' System

Correspondence to Paul Michael Garrett, c/o, British Journal of Social Work, University of Warwick, Coventry, CV4 7AL Summary This paper explores aspects of the Looking After Children: GoodParenting: Good Outcomes system (LAC) (Parker et at., 1991).It is suggested that the scheme, to be used with children andyoung people who are ‘looked after’ by local authorities,needs to be subjected to greater critical scrutiny. The paperseeks, therefore, to situate the LAC system in a social andpolitical context and highlights how it also relates to thedominant operational modalities of social work interventionin the late 1990s. In addition, the paper explores how ‘troublesome’children and ideas centred on ‘parenting’ featurein the LAC discourse. The discussion concludes with an examinationof Action and Assessment Records (Ward, 1995b), the centrepieceof the LAC system.     

Investigation or Initial Assessment of Child Concerns? The Impact of the Refocusing Initiative on Social Work Practice

This paper is based on a qualitative research study of socialworkers’ and parents’ experiences of attempts to‘refocus’ child protection practice in England sincethe late 1990s. A review of the research base for the refocusinginitiative is presented, leading to an exploration of one ofthe key changes arising from the initiative: the move away frominvestigations in ‘borderline’ cases towards lessintrusive initial assessments. Methods involved qualitativeinterviews with parents and social workers in twenty-three casesdrawn from two local authorities. The main conclusions are thatinitial assessments, as developed through the refocusing initiativeand the Framework for the Assessment of Children in Need andtheir Families (Department of Health, 2000), provide a formof practice that offers benefits in terms of balancing childprotection and child welfare approaches, and in terms of relationshipswith parents.     

Euthanasia: Israeli Social Workers' Experiences, Attitudes and Meanings

Correspondence to Dr Ronit D. Leichtentritt, Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel. E-mail: ronitl{at}post.tau.ac.il Summary Sixteen social workers in Israel were interviewed about theirexperiences with and attitudes towards various forms of euthanasia,as well as the meanings they ascribe to them. Using phenomenologicalanalysis, seven themes were identified, emphasizing individual,interpersonal, organizational, social and therapeutic considerations,and suggesting a holistic and integrative structure of the phenomenon.The themes were arrived at by identifying distinctions and similaritiesbetween different forms of euthanasia. Two themes suggestingsimilarities were revealed: ‘diminishing the value oflife’ and ‘a call for help’. Three themeswere found to distinguish between passive euthanasia (withholdingand withdrawing life-sustaining treatment) and active forms(active euthanasia and assisted suicide): ‘legality’,‘social acceptance’ and ‘concern for the sickand dying’. The last two themes distinguished betweenwithholding treatment and assisted suicide, on the one hand,and withdrawing treatment and active euthanasia, on the other:‘the involvement of others as executor’ and ‘thepublicity of the act’. Further research and training isrequired to better inform social workers in this ethical area.Given their unique position, social workers should activelyparticipate in legal, social and therapeutic discussions concerningend-of-life decisions, for the benefit of clients, their familiesand health-care providers.     

Social Work Responses to New Labour' in Continental European Countries

Summary The re-emergence of a majority of centre-left governments incountries of the European Union was associated with the hopethat, after the neo-liberal attempts at its marginalizationand de-institutionalization, social work could regain a morevalued position in society. There are indeed indications thatthe growth of the profession continues and that social workis returning to a more explicit and official role in nationalsocial policies. However, this tends to be associated with anexpectation that social work would play its part in ‘activating’the recipients of welfare benefits in the context of the NewLeft project of shifting from social rights to social obligations.The practical and political effects of this new agenda are,however, modified greatly by the prevailing ‘welfare cultures’as well as the professional and academic discourses. This paperexplores the dilemmas and opportunities for the social professionsin Europe associated with the ‘pull’ to become incorporatedinto these new social policy agendas.     

Outline of a Critical Best Practice Perspective on Social Work and Social Care

Correspondence to Harry Ferguson, Faculty of Health and Social Care, University of the West of England, Blackberry Hill, Stapleton, Bristol BS16 1DD. E-mail: harry.ferguson{at}uwe.ac.uk Summary This article seeks to lay the foundations for a new, more positiveperspective on critical practice, research and learning in socialwork and social care. A ‘critical best practice perspective’seeks to move the literature beyond a ‘deficit approach’where the focus is on what does not get done (well), to createa perspective where learning occurs in terms of best practicewhich is set out as a model for developing systems and practicecompetencies. This requires a focus on the actual critical practicesthat are ‘best’ demonstrating the very practicethrough which positive outcomes were achieved. A detailed case-studyis offered drawn from a large scale research study which typifieshow a critical best practice perspective can provide for learningin key areas such as how to engage service users, advocate ontheir behalf, promote protection, establish empowering relationshipsand conduct longer-term therapeutic work in an antioppressivemanner. The research method uses critical theory as an interpretativeframework for reaching an operational definition of 'excellence’and what is ‘best’, which is drawn from the perspectivesof the range of stakeholders who construct practice. This requiresa broadening of the concept of evidence-based practice to includequalitative research methods and the experience of professionals,service users and the production of ‘practice-based evidence’.     

'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.     

Yes Minister: Reviewing the 'Looking After Children' Experience and Identifying the Messages for Social Work Research

Correspondence to Paul Michael Garrett, Centre for Social Work, School of Sociology and Social Policy, University Park, Nottingham NG7 2RD, UK. E-mail: paul.garrett{at}nottingham.ac.uk Summary The heavily promoted Looking After Children: Good Parenting,Good Outcomes (LAC) project continues to exert a powerful influenceon social work in the UK and elsewhere. Despite the repeatedassertions that the documentation associated with LAC is embeddedin ‘objective’ research, this not sustainable onaccount of the failure of the researchers to interrogate theirown normative assumptions and judgements. Specific criticismscan also be levelled at the ‘community study’ connectedto the evolution of the Action and Assessment Records (AARs)which are the key part of the scheme. The system should alsobe viewed in the context of wider pre-occupations about ‘outcomes’.In addition, the project needs to be politically situated andthe researchers' relationship with the Department of Healthshould be more fully explored. In conclusion, it is suggestedthat the LAC experience contains important ‘messages’for the future of social work research.