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.     

The Supervision of Child Protection Work

Correspondence to Alan Rushton, Course Director, M.Sc. in Mental Health Social Work, Social Work Department, The Maudsley Hospital, 101 Denmark Hill, London, SE5 8AZ, UK Summary It has frequently been recommended that statutory child protectionservices in Great Britain need greater provision of specialistsupervision to support front line social workers. This qualitativestudy, based in social services departments in London, usedthe focus group method to explore the provision of supervisionby team managers in a very pressurized work environment. Thestudy highlights the difficulty of protecting adequate supervisiontime but shows how supervisors can use their skills to conductcase related discussion concerned with developing professionalskills. ‘Inquisitorial’ and ‘empathic-containing’functions are identified and an approach is proposed for combiningthem in training courses for child protection supervisors. Thepaper recommends that supervision training needs to be expanded,to be more precisely targeted, and that outcomes need to berigorously and appropriately assessed.     

Keyworkers Re-examined: Good practice, quality of care and empowerment in residential care of older people

Correspondence to Rosemary Bland, Department of Applied Social Science, University of Stirling, Stirling FK9 4LA, Scotland Summary Social work definitions of ‘good practice’ in residentialcare which were originally developed in work with children andyoung people have also been applied to residential settingsfor other user groups, including older people. However, anylink between such elements of practice and positive outcomesfor users has not always been demonstrated. The introductionof market principles and orientations into social welfare inthe 1980s re-defined the social work ‘client’ asa ‘consumer’ with the associated power to make choicesin the area of social care. The success with which such an approachcan be applied to services for people who are very often, notin a position to exercise much choice, is debatable. Alongsidethe notion of the ‘consumer’ or ‘user’of services has grown the ideology of ‘empowerment’of people who use social work services. Drawing on findingsfrom a recent study, this article explores the contributionof the keyworker role to good practice and the empowerment ofolder people living in residential homes. It concludes that,because their understanding of the concept and practice is largelyundeveloped, the role as currently interpreted is not consonantwith good practice and tends rather to reinforce the power ofstaff.     

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.     

The Social Worker as 'Bad Object'

Correspondence to Dr Marguerite Valentine, 56 Osbaldeston Road, London N16 7DR Summary A ‘bad object’ has been defined as an ‘objectwhom the subject hates or fears, who is experienced as malevolent.A bad object may be either an internal or an external object’(Rycroft, 1988, p. 100). This paper explores the circumstancesin which public fears and anxieties over child abuse becomeprojected into the social worker. It discusses how social workersintroject these feelings, become a ‘bad object’,and how social services departments have developed a numberof strategies which defend against feelings of blame and responsibility.The exploration is derived from my own experiences and observations,and applies Kleinian psychoanalytic theory to studies of institutionaldefences.     

Notes on Theory and Practice in Social Work: a Comparative View

Please address reprint requests to Robert van Krieken, Department of Social Work, University of Sydney, Sydney, New South Wales 2006, Australia. Summary There are still a number of problems surrounding the relationshipbetween theories of social work practice and that practice itself.This paper examines the factors underlying those problems andemphasises their roots in the failure to examine the diversityof social work theories and practices. We refer to one attemptto resolve the problems—the distinction between ‘practicetheory’ and ‘theory of practice’—pointout some difficulties with it and suggest an alternative, three-folddistinction within theorising: between (a) materialist socialtheory, (b) strategic practice theory and (c) working concepts. As an example of how those distinctions can be used, we thenbriefly discuss the work of Oskar Negt and its introductioninto the Dutch welfare context, as it was the issues raisedby that which stimulated the ideas in this paper. We concludeby arguing that only this kind of perspective on theorisingcan produce ideas which are of real use to progressive socialwork practitioners.     

The State of Welfare

Summary The word ‘welfare’ is difficult to define becauseit combines within it a range of ideologies and actions. Twoconclusions are drawn from this: first, that social servicesshould be regarded as contributors to, but not providers ofwelfare; second, that the study of social work and social administrationshould be concerned not only with the relationship of ‘service’to ‘need’ but also with societal movements and pressureswhich determine the emergence of both. The article reviews theprofessed values of the welfare state, particularly ‘socialequality’ and the problems associated with its achievement,namely public attitudes, and the discontinuity between intentionand practice in the welfare services. The implications for socialwork education and practice are considered.     

Towards a Model for Co-working in Family Conciliation

Correspondence to Thelma Fisher, Tutor in Social Work, School of Humanities and Social Sciences, University of Bath, Claverton Down, Bath, Avon BA2 7AY. Summary This article surveys the present state of co-working in thepractice of those independent family conciliation services affiliatedto the National Family Conciliation Council. It proposes thata model of co-working is needed that is specifically tailoredto conciliation practice. It sets out progress towards such a model in a particular agency—theSwindon Family Conciliation Service. It develops a theoreticalbase for this model from the concepts of ‘content’and ‘process’ which it links with the ‘underlying’and ‘substantive’ issues brought up by separatingand divorcing couples for resolution. It draws these ideas fromwritings about divorce experience and negotiation procedures. It then presents a particular case, with an extract from anactual interview in which the model is used, and introducesa diagrammatic format for analysing conciliation processes interms of the model proposed.     

The Other Italian Experiment: Neighbourhood Social Work in the Health and Social Services

Summary Following recent legislation, most social workers in Italy arenow responsible for giving a service to the population of agiven geographical area rather than to any particular categoryof client. The findings suggest that there is some experimentationwith regard to the organisation and composition of neighbourhoodteams and that the trend, not without problems, is towards socialworkers becoming the ‘gatekeepers’ to financialand other resources in the Social Service Sector for the localpopulation.     

'No Irish Need Apply': Social Work in Britain and the History and Politics of Exclusionary Paradigms and Practices

Correspondence to Paul Michael Garrett, Centre for Social Work, School of Sociology and Social Policy, University of Nottingham, University Park, Nottingham NG7 2RD, UK. E-mail: paul.garrett{at}nottingham.ac.uk Summary In Britain, Irish people have continually been excluded fromthe discourse of anti-discriminatory social work theory. Themain reason for this centres on the dominant tendency to exclusivelycentre on ‘race’ and visible difference. Recentpolicy documents in relation to social work with children andfamilies illustrate the fact that Irish people are omitted indiscussions seeking to promote culturally appropriate services.Conceptually this approach is founded on implicit ideas aboutBritish identity and erroneously suggests that white ethnicitiesare homogeneous, unified and clearly demarcated from a (new)black presence. Historically, ideas associated with ‘theproblem family’ can be related to the racialization ofIrish people. Archival research examining responses to unmarriedmothers travelling to Britain to have ‘illegitimate’babies adopted also highlights how Irish women have been subjectto exclusionary social care practices. Whilst rejecting an essentialistconceptualization of ‘Irishness’, the article goeson to suggest that the mainstream and hegemonic discourse on‘race’ needs to take specific account of Irish peopleand other minority ethnicities not identifying as ‘black’,particularly during a period of globalization and new migrationinto Britain by refugees and asylum seekers.     

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’.     

Risk and Supervision: Social Work Responses to Referred User Problems

Correspondence to Peter Burke, Department of Social Work, University of Hull, Hull HU6 7RX Summary This study examines social work responses to users followingcase allocation of the initial referral. The aim of the studyis to demonstrate the need for supervision of social workersdealing with cases which have in common an inherent quality,described as ‘risk’. The study also links referralsto other practice responses identified as ‘service delivery’and ‘advisory’ work. The relationship between theseparticular responses is tested against the outcome decisionreached on case closure. All referrals were allocated betweentwo fieldwork teams over a one-year period and a total of 312referred cases was allocated within the categories mentioned.Findings are indicative that more ‘risk’ type referrals,however defined, are resolved with additional supervisory inputthan without, and that lower status workers favoured ‘middleground’ decisions of outcome when compared to their seniorcolleagues. A consideration resulting from this research isthat agency definitions of risk are different to the type ofrisk which requires crisis intervention. The question of riskto the user or to the agency requires the workers concernedto be able to discriminate between such cases. The implicationfor team training is that supervisory input should clarify thenature of risk, if any, and the task required of the workerfollowing case referral. The matching of skills which wouldultimately be the objective of this type of research cannotbe finally determined until a more comprehensive set of parametersfor practice is identified. This study shows that the responsecategories used demonstrate some basic supervisory needs ofthe worker.     

Depressed Mothers' Experience of Partnership in Child and Family Care

Summary Partnership is a key dimension of social work practice in childand family care, reflecting the significance attached to workingwith parents. While, however, considerable attention has beenfocused on the role of the social worker in encouraging partnership,rather less attention has been focused on the capacity of themothers to engage in partnership. Depression, known to affecta considerable proportion of mothers in this client group, is,because of its debilitating psychological effects, of considerablepotential significance, yet its effect on partnership has notbeen examined. This article focuses on exactly this issue. Findingsshow that depression has highly significant relationships witha number of facets of partnership. It shows also that partnershipmorale and quality of consultation mediate between depressionand, respectively, participation in decision making and involvementin decision implementation—action by the mother to helpresolve the situation. Depression and partnership are, furthermore,related in a complex way to the authority role invoked in casesof children ‘at risk’. The data indicate that theelements of low self-esteem, vulnerability to criticism, andself-blame are key factors in the mother's capacity to workin partnership. Social work practice must take these into account,requiring very high degrees of sensitivity and skill in workingwith mothers. Indeed, unlocking these pernicious cognitionsmay frequently require specialist techniques, such as the useof cognitive behaviour therapy. Overall, being ‘socialworker for the child’ means also being ‘social workerfor the parents (in particular the mother)’, who may wellrequire high levels of encouragement.     

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.     

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.     

A Critical Perspective on Quality within the Personal Social Services: Prospects and Concerns

Correspondence to David Watson, Glasgow Caledonian University, Room W109a, Hamish Wood Building, City Campus, 70 Cowcaddens Road, Glasgow G4 OBA, UK. Email: d.watson{at}gcal.ac.uk Summary This paper considers the development of ‘quality’within the personal social services over the last decade. Inparticular, it locates ‘quality’ within a managerialdiscourse, which de-politicizes and minimizes the critical aspectsof the concept in order to increase organizational scrutinyand control through the use and development of performance measurement.It is in this critical context that the prospects and concernsfor recent policy initiatives such as the Labour Government's‘Modernising Social Services’ are considered. Itis the contention of the paper that the critical and empoweringaspects of recent policy developments and quality approacheswill be minimized, as they are subsumed into activities whichare presented as technical and value-free. Further, that unlessthis process is critically questioned and challenged by managersand other stakeholders ‘quality’ and its developmentwill lead to greater proceduralization, increasing bureaucracyand ultimately commodification of the work processes.     

Implementing Community Social Work from a Social Services Department: Some Issues

Summary The proposal in the Barclay Report on the role and tasks ofsocial workers for ‘community social work’ as astrategy for social services departments is assessed The writerargues that the voluntary sector has significant roles and prioritiesoutside the social services, that government priorities forencouraging the voluntary sector emphasise other areas of workand that involving voluntary groups in official initiativesmay be seen as going against the independence of some groups.The motivation of groups and individuals in the voluntary sectorwill be important, but various research and practice shows thatindividuals, informal groups and mutual aid groups may be difficultto involve in a substantial programme. The climate of opinionin the field of volunteering and the social background of clients'neighbours may provoke hostility. Experience of community worksuggests that official initiatives may lead to resistance andconflict rather than involvement, and there may be ethical problemswith compulsion.     

Reforming Professional Training and Protecting Vulnerable Adults from Abuse: A Thematic Analysis of the New Social Work Degree's Prescribed Curriculum

Correspondence to Phil Slater, School of Health and Social Sciences, Middlesex University, Queensway, Enfield EN3 4SF, UK. E-mail: p.slater{at}mdx.ac.uk Summary This paper analyses the Prescribed Curriculum of the new Degreein Social Work in relation to the Department of Health themeof ‘protecting vulnerable adults from abuse’. Areview of post-war social policy first establishes the significanceof these terms, both individually and in varying combinations.Subsequently, the phrase as a whole provides the focus for acontent analysis of the three constituents of the PrescribedCurriculum, namely, the Secretary of State’s Requirementsfor Social Work Training, the employment-focussed National OccupationalStandards for Social Work, and the academically oriented BenchmarkStatement for Social Work. With the exception of ‘abuse’,the key terms are all registered, albeit unevenly. This presenceis subsequently enhanced via strategic considerations of ‘logicalimportance’ and ‘organising rubrics’. Finally,terminological variants of ‘abuse’ are traced, withparticular regard to the emerging language of ‘rights’.     

Conceptualizing Community Social Work--a Response to Alan York

Summary This note takes further the task of conceptualizing communitysocial work begun by Alan York in his paper for the June 1984edition of this Journal. York's approach is criticised firstlyfor unhelpfully conflating ‘community work’ and‘community social work’ and, secondly, for developinga schema unable to satisfactorily theorise the range of communitywork approaches currently to be found within social work. Buildingupon York's suggestion that ‘dichotomous formulations’provide an appropriate way forward for analysing community practice,three, distinct, dichotomies are elaborated, and recommendedas a basis for locating and comparing current approaches tocommunity social work.