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.     

Implementing Care Management: Issues in Relation to the New Community Care

Correspondence to Professor Jane Lewis, All Souls College, Oxford OX1 4AL Summary The official guidance on the new policy of community care emphasizedcare management as the means of securing needs-led services,together with user empowerment and choice. This paper uses datafrom eighteen months intensive fieldwork in five local authorities,first, to examine the very different interpretations of caremanagement in these authorities; secondly, to examine two majorsources of difficulty in the implementation of care managementsystems—the simultaneous development of purchaser/providersplits, and the tension between needs and resources—and,finally, to draw some conclusions about the implications ofcare management for social workers.     

Evaluating Social Work and Medical Practice with Black and Ethnic Minority Groups Using the Clinical Audit Model

Correspondence to Kish Bhatti-Sinclair, Department of Social Work Studies, University of Southampton, Highfield, Southampton SO17 1BJ, UK. Summary This paper is based on the External Audit-Ethnically SensitivePractice (EA-ESP) project which was undertaken within six primaryand secondary health care settings. This project is used asan example of how the clinical audit model can be used to monitorand review health and social work practice in the UK. The paperexamines quality, compares approaches to evaluation, and suggeststhat audit can be a useful tool for agencies in obtaining userand staff views on many areas of practice but in particularon equal opportunities, anti-racism and anti-oppression. Attentionis drawn to audit within broader evaluative and review approachesalready employed by social work academics and practitioners.The issue of quality and how it can be measured is consideredthrough an analytical comparison with approaches which employaction research and other evaluative means in the process ofreview. Audit is explored in the context of a growing need for the developmentof monitoring and review systems which provide evidence to supportand develop professionalism within social work. External auditis explored and compared to internal audit. Finally, the needfor the development of quality services in anti-racist and anti-oppressivework is highlighted and it is suggested that audit can be acost-effective and efficient way of achieving this.     

Regulation or fragmentation? Directions for Social Work under New Labour

Summary This article reviews the modernizing agenda of New Labour forsocial work which has been articulated in the various changesfor social work and social care announced in the ‘QualityStrategy’. Focusing predominantly on arrangements foreducation and training, the article argues that, rather thanpresenting a coherent strategy, the structures and proceduresare fragmented and unco-ordinated at many levels. A major weaknessis that New Labour has failed to clarify where it places socialwork in the structures of a ‘modernized’ welfarestate.     

Participants or Recipients--Disabled People's Involvement in a European Programme

Correspondence to Jackie Powell, Department of Social Work Studies, University of Southampton, Highfield, Southampton S017 1BJ Summary Drawing on an evaluative study of UK participation in a Europeandisability programme (HELlOS I), this paper explores the extentto which and the ways in which disabled people were-or werenot-involved in the programme as active participants ratherthan passive recipients, at local, national and European levels.The findings presented here draw attention to the differentperspectives of the programme's various stakeholders and arediscussed in relation to two broader themes. The first of thesethemes is the involvement of disabled people themselves in anyprogramme aiming to promote the full participation of disabledpeople in society. The second is the role and value of formalizednetworks as a means of promoting information exchange and learning,as a prerequisite for promoting change in individuals (thatis in day-to-day practice) and change in organizations (thatis service developments). These two themes are pertinent tocurrent developments in social work, with its explicit attentionto anti-discriminatoiy practice and its strong tradition ofvaluing the learning gained from experience.     

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.     

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.     

A Consumer Study of Young People's Views on their Educational Social Worker: Engagement as a Measure of an Effective Relationship

Correspondence to Colin Pritchard, Mental Health Group, University of Southampton, Royal South Hants Hospital, Brintons Terrace, Southampton, SO14 0YG, UK. Summary This, the first ever consumer study of education social workers(ESWs), uses qualitative material and quantitative analysisby examining the views of 110 users of a county ESW service.Most pupils belonged to families with long-standing disadvantage;e.g. 53 per cent had unemployed fathers; over 70 per cent hadparents with disturbed personal and social relationships, 39per cent had a single parent; 30 per cent plus had mental healthproblems; and 10 per cent of parents had been in care as children,i.e. more than ten times the national average. The young people also had considerable disruption in their lives:for example 78 per cent frequently missed school; over 50 percent had school and peer difficulties; 30 per cent offended;over 30 per cent experienced bullying; 5 per cent were the subjectof child protection enquiries, 10 per cent had previously beenin care and 2 per cent had had an incident of ‘attemptedsuicide’ (50 times the national rate). They averaged sixmajor difficulties each. Despite these antecedents, 91 per cent of the young people demonstratedan ‘engaged’ relationship with their social worktrained ESW, with many examples of practical psychosocial helpbeing received. The concept of ‘engaged’ was statisticallyvalidated in the comparison of views between the ‘engaged’and ‘non-engaged’ research participants. The resultsindicate the value and effectiveness of a supportive rapport/relationshipas a vehicle to reach and to be of practical assistance to disturbedand disturbing young people.     

Specialism, Genericism and Others: Does it Make a Difference? A Study of Social Work Services to Elderly People

Correspondence should be addressed to Roger Fuller, Social Work Research Centre, University of Stirling, Stirling, FK9 4LA Summary A previous paper published in this journal (Fuller and Petch,1991) described a preliminary feasibility study designed toinvestigate the effects of organizing social work teams alongspecialist or generic lines. The main study which developedfrom this work is here reported. The study, using modified casereview forms, compares the way samples of referrals of elderlypeople (n=1232) were dealt with at initial assessment and forup to a year subsequently by 15 social work teams of contrastingorganizational approach. The latter include specialist and genericteams, and comparisons are also drawn with teams adopting aself-styled community social work approach. Although the organizationalagenda has moved on since the study began, the issues are ofcontinuing relevance for the implementation of community care,particularly in view of its growing focus on specialist services.While not arguing that there is any one optimal model of teamorganization, the paper sets out some of the measurable consequencesof opting for the various models; in particular, it emergesthat the strengths of specialization are more clearly apparentin certain aspects of their engage ment with clients than inothers and at certain stages of that engagement than at others.     

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.     

A Role for Anyone? A Description of Social Work with the Elderly in Two Area Offices

Summary This article analyses information from Case Review Forms completedby social workers on 199 allocated elderly clients. These peoplewere very frail, most were considered to be ‘at risk’and to require regular, reliable and frequent care. The questionof the client moving to a tafer setting arose in two-thirdsof the cases, concerning which there was often some dispute.It is argued that social workers require a high level of professionalskill in dealing with clients, and others involved, faced withsuch questions and that this requirement will remain with thedevelopment of ‘community social work’.     

Where is the Community Which Cares?

Summary This paper attempts to answer three questions. O what does acommunity consist in industrialised societies and why does ithave such evaluative appeal? What are the evaluative assumptionsbehind current emphasis on community care, and are attemptsat it inevitably authoritarian? Can communities be redevelopedwhere they have apparently disintegrated? The answer to thefirst question stresses the management of personal networksof supportive and socially integrative friendship relationshipsas the basis of a community in modern urban societies, and theindependence of these from limited neighbourhood locations,because of modern communications systems. In answer to the secondquestion, community care is argued to be impossible if the reconstructionof solidary neighbourhood communities is what is envisaged.On the other hand, the level of competence necessary to developand manage an evolving supportive friendship network may bebeyond the capacities of many of the dependent and inadequatewho are presented as candidates for community care. Nonetheless,in answer to the third question, the mobilisation of a diverserange of organised social resources, voluntary and state financed,offers both the best hope of achieving social competence andautonomy and of avoiding authoritarian dependence upon limitedsources of assistance.     

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.     

On the Relevance of Informal Social Networks to Social Work Intervention

Summary Taking as its starting point the Barclay Committee's definitionof community in terms of local informal networks, this papersets out to cull some relevant material from the literatureof social networks and to use it to demonstrate the appropriatenessof orienting social work practice to the community. In suggestingan emphasis on supporting rather than supplanting existing informalcaring systems, it is made dear that, if motivated by parsimonysuch an approach risks irresponsibly increasing distress andsocial costs.     

Self-determination and Paternalism in Community Care: Practice and Prospects

Correspondence to Dr Chris Clark, Senior Lecturer in Social Work, Adam Ferguson Building, George Square, Edinburgh EH8 9LL, Email: Chris.Clark{at}ed.ac.uk Summary Self-determination is long established as a key principle ofsocial work ethics, but has seldom been the subject of empiricalresearch. This article reports on a qualitative study of theprinciples and beliefs of community care social workers in alocal authority. It is shown that, while workers retain strongattachment to traditional ideas about self-determination, theyalso appreciate that paternalistic intervention is sometimesjustified. The more recently fashionable concept of empowermentappears to have had little useful impact. The paper argues that,while the persistence of self-determination is a strength ofsocial work and should be defended, traditional practice ethicsare weak on the political issues embedded in community care.Five key issues are identified: the threat to individualizedservice under care management; the problematic determinationof mental competence; social ambivalence about the extent offamily responsibility for dependent adults; the threat to equityarising from variable interpretations of self-determination;and the excessively elastic interpretation of empowerment.     

Factors Predicting Admission of Elderly People to Local Authority Residential Care

Correspondence to Dr Ian Sinclair, Director of Research, National Institute for Social Work. Mary Ward House, 5–7 Tavistock Place, London WCIH 955 Summary Successful community care may partly depend on identifying thoseat risk of entering residential homes and targeting servicesto them. This article is concerned with how this identificationcan be achieved. It considers a sample of old people livingalone. in touch with home helps or social workers and followedup for between two and four years. The research examined thefactors likely to produce admission, and used discriminant analysisto predict it.     

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.     

Moving beyond Litigation and Positivism: Another Approach to Accusations of Sexual Abuse

Correspondence to Professor Lena Dominelli, Department of Social Work Studies, University of Southampton, Highfield, Southampton SO17 IBJ. Summary The Current polarized debated about false memory and reclaimedmemory with regard to child sexual abuse have trivialized thesignificance of experimental knowledge and contributed to thesilencing of the voice of the victim-survivor. They have alsoenabled the alleged abuser to avoid confronting those elementsof his behaviour which are problematic for others and discouragedpreventative approaches by locking the protagonists into adversarialpositions. We argue that this need not be the case if therapeuticrelationships can operate outside of court driven proceedingsand be aimed at responding to the needs of the victim-survivorto have their experience of abuse validated and of the allegedabuser to work on non-abusive ways of relating to others.     

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 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.