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.     

Young People, Risk Taking and Risk Making: Some Thoughts for Social Work

Policy makers, professionals and the public have become increasinglyconcerned with identifying and managing young people who arenot only troubled or at risk, but troubling or risky. Socialwork, however, has been relatively silent on the subject. Insocial work practice, young people have become largely ‘someoneelse’s problem’; in the academy, relatively littlecritical attention has been given to their risk taking, or tothe way we ‘make’ or construct it. This paper takesan exploratory rather than systematically comprehensive journey,across a range of discursive terrains, to open up the debate.Examining current concerns with youth and risk, it exploressome of the social and psychological theory bases whereby youthis constructed as a risky business. Drawing on empirical researchfrom several disciplines, it examines patterns and dynamicsof young people’s risk taking, and explores concepts ofrisk culture and cultural learning, identity capital and Bourdieu’snotion of ‘habitus’, to frame these. The discussionhighlights the need for critically reflective social work tounderstand the complex interplay of identity and agency, structure,culture and context that underpins young people’s risktaking. It encourages us to scrutinize our judgements of whatis acceptable or unacceptable riskiness, what within and whatbeyond the pale.     

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.     

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.     

Unemployment, Age, Gender and Regional Suicide in England and Wales 1974-90: A Harbinger of Increased Suicide for the 1990s?

Correspondence to Prof. Colin Pritchard, Department of Social Work Studies, University of Southampton, Highfield, Southampton SO9 SNH. Summary The Department of Health's Health of the Nation aims at a substantialreduction in suicide; this is a ‘vote of confidence’in the effectiveness of the community psychiatric and healthservices. However, it will be shown that a number of socioeconomicchanges have occurred which may lead to increased suicide; forexample British male suicide rose in the 1980s, significantlyassociated with unemployment. Though female suicide fell substantiallyover the period, across the regions suicide rates for both menand women were worse amongst the ‘work age’ bands,16–44 years, than the older groups. In respect to therelatively poorer rates amongst younger women, this may be linkedto unemployment and their unfulfilled job expectations. If thesuicide targets are not met, it is feared that the ‘failure’will laid at the door of the community and health services.     

Global Social Justice for Older People: The Case for an International Convention on the Rights of Older People

Older people are beginning to represent a large proportion ofthe general population and have become a major area for socialprogramming in many parts of the world. However, neglect orviolation of older people’s rights is common. Until recently,there has been a surprising lack of advocacy on the part ofnon-governmental organizations (NGOs) and human rights activistsfor a legally effective international convention on the rightsof older people, as compared with other vulnerable groups suchas children and women. This paper argues that the introductionof an international convention on the rights of older peopleis long overdue. Such an international convention should containcomprehensive and legally binding provisions which would requireratifying states to promote older people’s rights. Itshould be reinforced by a strong monitoring system that wouldinvolve key members of the international community. This paperoutlines the arguments in favor of the creation of a transnationalhuman rights agreement for older people and proposes that internationalNGOs and human rights advocates should work toward creatingsuch a convention.     

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.     

Research Note: Managing the Financial Assets of Older People: Balancing Independence and Protection

Family involvement in managing the financial assets of olderpeople is an area of policy and practice importance. This importancerelates to the complexity of older people’s assets, systemsof paying for care and concerns around substitute decision-makingand financial abuse. Although a common task of informal care,little is known about older people’s experiences and wishesin relation to asset management. This paper reports on a qualitativestudy of the experiences and perspectives of thirty-four olderpeople receiving such assistance. It identifies three scenariosthat promote or inhibit independence in this context and drawsout the challenges for this emerging area of practice with olderadults and their families.     

Critical Commentary: Who Decides Now? Protecting and Empowering Vulnerable Adults Who Lose the Capacity to Make Decisions for Themselves

The implementation of the 2005 Mental Capacity Act in Englandand Wales heralds a new era for social work practitioners andresearchers. Protecting and empowering vulnerable adults—animportant element of adult-care social work—relies ona legal framework that attempts to balance adults’ rightswith the desire to protect them. The new Act is part of thatframework, addressing the fundamental issue of when and howdecisions can be made on behalf of people who lose decision-makingabilities (‘capacity’). The Act encompasses themeaning of incapacity and best interests, advance directivesconcerning treatment, managing people’s affairs and makingdecisions for them, overseeing the delegation process, and research.In explaining how the Act addresses some of these challenges,the article alerts practitioners and researchers to the keyareas in which the Act will make a major impact.     

A Child's Eye View: Dementia in Children's Literature

This paper explores accounts and understandings of dementiathat are encountered infrequently. Children’s views ofdementia are under-explored and yet children, too, must be beinginfluenced by the growing public knowledge of dementia as anamed disease, particularly of old age. The first section notesthat many children will encounter dementia among family members,their grandparents and great-grandparents in particular. Thesecond section considers fictionalized accounts of dementia.These are assuming greater exposure, not so much in the professionalwelfare domain, but as a plot or character device in contemporaryfiction. This paper combines these two areas by discussing anumber of publications written for young people where dementiais a central issue, motif or characteristic. These include dementia-relatedmaterial targeted at a children’s readership. This isfollowed by development of themes arising from analysis of threenovels written for young people, emanating from Canada, Australiaand the UK. The paper ends with a series of discussion pointsfor social-work practitioners, educationalists and voluntary-sectorsupport or self-help groups working in dementia care and inolder people’s services.     

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.     

How to be Modern: New Labour's Neoliberal Modernity and the Change for Children programme

In England the New Labour administration is seeking to embeda ‘transformational reform agenda’ within children’sservice. Social workers, among others appear, however, to bewary of the agenda which is now rhetorically rooted in the EveryChild Matters: Change for Children programme (CfC). The mainsocial work practice elements of this programme are associatedwith the introduction of a Children’s Index, a multidisciplinaryCommon Assessment Framework and the role of Lead Professional.In terms of the promotion of this programme, the governmenthas maintained that the focal aim is to create a ‘modern’children’s workforce. However, the entire ‘transformationalagenda’ can be interpreted as reflecting New Labour’sneoliberal modernity. This is particularly apparent in the termsof the ideas associated with ‘flexibility’ whichare so central to the CfC programme.     

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.     

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.     

'Lifeworld', 'System' and Family Group Conferences: Habermas's Contribution to Discourse in Child Protection

Habermas’s critical social theory has been challengedon a range of fronts. However, the authors see merit in hismediation thesis as set out in the seminal text, Between Factsand Norms (1996). Adopting a pragmatist defence of the thesis,we review and demonstrate the effectiveness of what we believeis a coincidental expression of some of its main tenets—TheFamily Group Conference in Child Protection. Drawing furtheron Habermas’s work, we then proceed to re-work aspectsof the conference’s core processes, thereby accentuatingthe possibility of empowering dialogue between its key participants:the families (who embody the ‘lifeworld’) and thesocial work professionals (who represent the ‘system’).In the final section, we argue that moral practice in childprotection must be safeguarded by communicational proceduresthat explicitly address issues relating to the use of powerand the need for ‘recognition’ between subjects.     

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.     

Responding to Youth Crime in Scotland

Correspondence to Bill Whyte, Director, Criminal Justice Social Work Development Centre for Scotland, School of Social and Political Studies, University of Edinburgh, Flat 1FR, 31 Buccleuch Place, Edinburgh EH8 9LJ. E-mail: B.Whyte{at}ed.ac.uk Summary Scotland’s Children’s Hearings deal with young peoplewho offend within an integrated system dealing also with youngpeople in need of care and protection, on the assumption thatthe difficulties of both groups have similar roots in multiplesocial disadvantage and social adversity (Whyte, 1998a). A government-fundedstudy, one of the first since the system’s inception in1971, was commissioned to examine the social characteristicsof over 1,000 children and young people referred for offenceand nonoffence reasons. This paper describes the characteristicsof 465 of the young people who were referred specifically foroffending. It provides the first ‘official’ datain twenty-five years on young people in the system. The studyfound that most of those referred for offending had characteristicsstrikingly similar to those referred for nonoffence reasons,as predicted when the system was first established, and similarto those present in the general literature on young offendersfrom other jurisdictions. The study poses fundamental questionstaken up by the Scottish Executive’s review of youth crimeon how best to design systems and develop social interventionsthat can address offending and social disadvantage in an integratedway.     

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’.     

'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.     

Keeping Social Work Honest: Evaluating as Profession and Practice

Correspondence to Ian Shaw, School of Social and Administrative Studies, University of Wales Cardiff, 50 Park Place, Cardiff CF1 3AT Summary The central argument of this paper is that social work needsa radical alternative to existing options for evaluating practice.Social workers at present are offered three choices. They areinvited to choose between applying research, conducting researchor adopting specific forms of empirical research-based practice(for example Everitt et al., 1992; Thyer. 1993; Fuller and Petch,1995). We touch briefly on reasons why we believe none of these optionsprovides an adequate grounding for social work, referring especiallyto the growing call for social work to find new purpose throughan empirical, research-based practice. If alternative approachesare to be persuasive, they must be fashioned from the materialsof a new approach to research on social work practice—‘one that is exploratory rather than confirmatory, buildinga model of evaluation from the practitioners' own accounts ratherthan superimposing an ideal model’ (Elks and Kirkhart,1993, p. 555). The major part of this paper is taken up withevidence from research of this kind. The model of evaluatingin practice with which we conclude the paper is simultaneouslytrue to social workers' accounts of their practice, while offeringa critical starting point for evaluating and refashioning thatpractice.