Promoting Healthy Routes Back to Work? Boundary Spanning Health Professionals and Employability Programmes in Great Britain

Between 2003 and 2011, the Pathways to Work (PtW) initiative was established across Great Britain, as policymakers sought to address the ‘health‐related, personal and external barriers’ faced by people who were out of work and claiming incapacity benefits (IBs). In the first 18 districts that PtW was rolled‐out, the Public Employment Service (Jobcentre Plus) and National Health Service (NHS) organizations worked in partnership to deliver ‘condition management programmes’, which helped IB claimants to cope with health problems. Evaluation research has identified significant health benefits associated with these condition management programmes, but there has been less discussion of the role of frontline NHS professionals in ensuring that services worked effectively on the ground. This article deploys the concept of ‘boundary spanning’ to explore the role of NHS professionals within PtW. Drawing on more than 50 in‐depth interviews, the article concludes that these NHS staff played a key boundary spanning role in facilitating partnerships, based on an ability to engage with the values/practices of other partner organizations (especially Jobcentre Plus) and a willingness to challenge established professional boundaries and ways of working. The article notes that recent policy initiatives have abandoned the PtW partnership approach in favour of more familiar models of contracting out, and that NHS professionals have been excluded from the delivery of health/employability services. It is argued that these recent changes may negatively affect the quality and range of health‐related services available to people on IBs.     

Activation Reform and Inter‐Agency Co‐operation – Local Consequences of Mixed Modes of Governance in Sweden

Organizational reform has become a recurring solution to problems of social exclusion and unemployment. In Europe, and other parts of the world, there is a trend towards policies of ‘activation’ in employment and social policy. The idea of flexible, individualized and tailor‐made services is coupled with managerial and market‐based reforms as well as collaborative governance. In these complex structures of service provision, coordination and inter‐agency co‐operation have become key concerns. Based on a study of a recent reform of programmes for newly arrived refugees in Sweden (Etableringsreformen), this article seeks to contribute to the literature on governance of ‘activation’ by examining the consequences of mixed modes of governance (market and collaborative) on local inter‐agency co‐operation. Drawing on data from in‐depth case studies in two municipalities, it is demonstrated how the coupling of managerial practices and quasi‐markets with existing collaborative arrangements has created barriers for inter‐agency co‐operation. The results indicate that institutional tensions between governance forms represent an important factor for explaining governance failure in this policy area.     

Effective casework practice with adolescents: perspectives of statutory child protection practitioners

Many child protection practitioners struggle with the complexity of problems and the limited casework time for adolescent cases. However, there is little research on child protection practice or case management that can guide a practitioner working with adolescents in the child protection system. The aim of this study was to explore and describe the nature of effective child protection practice with adolescents from the perspective of statutory child protection practitioners in one state in Australia. Data were collected through focus group discussions and interviews with child protection practitioners and managers currently working with adolescents (n= 44). A grounded theory approach was used to identify the dominant themes or categories and form linkages and relationships through constant comparison techniques. Seven key categories emerged from this analysis: characteristics of the young person and their family; ‘walking it together’– the centrality of relationships; ‘looking back/looking forward’– practice strategies; practitioner attributes and skills; ‘walking a fine line’– working with the families of adolescents; ‘walking with services’– effective inter‐agency work; and organizational context in effective child protection practice with adolescents. Key implications for practice and areas for further research were discussed.     

Ambiguity and Cooperation in the Implementation of Adult Protection Policy

Using a classification of public policy developed by Matland, we examine implementation of policy on adult protection as outlined in ‘No Secrets’, the government's guidance to local agencies. This policy appears to exemplify a ‘high‐ambiguity/low‐conflict’ model. Detailed interviews with staff charged with developing multi‐agency procedures, in local authority departments, health authorities, the police and the voluntary sector, confirmed the ambiguity of the policy and the uncertainty experienced by staff as a consequence. However, the interviews also revealed a number of areas of conflict, particularly as people gave precedence to their own professional norms and organizational priorities over partnership working.     

The proof of the pudding: What difference does multi‐agency working make to families with disabled children with complex health care needs?

More than 20 years of research with disabled children, young people and their families has highlighted the need for the different professionals and services that support them to work more closely together. The British policy and legal framework for ‘joined up working’ has never been stronger. However, there has been an assumption that multi‐ or inter‐agency working will inevitably be a ‘good thing’ for families. This paper discusses findings from a 3‐year research project which looked at both the process and impact of multi‐agency working on families with a disabled child with complex health care needs. Interviews with 25 parents and 18 children and young people who used six developed, multi‐agency services were carried out. Findings suggested that the services had made a big difference to the health care needs of disabled children but were less able to meet the wider needs of the child and the family – particularly in relation to social and emotional needs. Multi‐agency working appeared to make some positive, but not significant, differences to the lives of families.     

‘Creating NHS Local’: The Relationship between English Local Government and the National Health Service

Following recent reforms of both local government and the National Health Service, there is significant emphasis in both services on improving inter‐agency collaboration, user involvement and strategic commissioning. In response, this article reviews historical debates about the relationship between local government and health care, before arguing that these two ‘partners’ need each other now more than ever. If local government is to be a ‘place‐shaper’, then it needs significant influence over local health services, while the NHS needs to learn from the best of local government if it is to gain sufficient local legitimacy to take the difficult decisions it needs to take. Against this background, the article reviews different options for future joint working, exploring various options for enacting a new relationship between local government and the NHS.     

Putting the child at the centre of inter‐professional cooperation in out‐of‐home care

A large part of most children's childhood is about taking part in educational and leisure‐time activities together with other children across various contexts. However, children in out‐of‐home care do not always have easy access to these possibilities for participation. In general, parents coordinate their children's everyday lives, but in the case of children in out‐of‐home care, the responsibility of care is distributed between several professionals and institutions. Research often recommends that inter‐professional cooperation should put the child at the centre and be more child focused. But what does that mean? The paper investigates theoretical understandings of ‘child centredness’ in inter‐professional cooperation. It also includes an empirical example taken from a research project that followed four children in their everyday lives in two residential homes in Denmark. The research explored how professionals work together across contexts in order to support children to take part in school and leisure‐time activities. The overall reasoning leads to the point that for children in out‐of‐home care, the possibility of exercising personal agency in their everyday life constitutes a difficult but vital issue. How children in out‐of‐home care learn how to conduct their everyday lives, is closely related to the ways professionals cooperate across contexts. It points to the need for close inter‐professional cooperation in order to encourage and support children's initiatives and engagements in activities in communities with other children.     

Making meaningful connections: using insights from social pedagogy in statutory child and family social work practice

Reports into incidents of child death and serious injury have highlighted consistently concern about the capacity of social workers to communicate skilfully with children. Drawing on data collected as part of an Economic and Social Research Council funded UK‐wide research project exploring social workers' communicative practices with children, this paper explores how approaches informed by social pedagogy can assist social workers in connecting and communicating with with children. The qualitative research included data generated from 82 observations of social workers' everyday encounters with children. Social pedagogical concepts of ‘haltung’ (attitude), ‘head, heart and hands’ and ‘the common third’ are outlined as potentially helpful approaches for facilitating the intimacies of inter‐personal connections and enhancing social workers' capacity to establish and sustain meaningful communication and relationships with children in the face of austere social, political and organisational contexts.     

The Search for Coordination: The Case of the Central Policy Review Staff and Social Policy Planning, 1971–77

The Central Policy Review Staff (CPRS) attempted to create an ambitious strategy for the horizontal coordination of social policy in the UK during the early 1970s. The attempt – inspired largely by planning, programming and budgeting systems – was a failure, and gave way to a much modified ‘joint framework for social policies’ in 1975. Recent research has compared the CPRS's joint framework approach to the Labour government's promotion of ‘joined‐up government’ (JUG) in the 2000s. This article provides a case study of the CPRS's work on social policy planning, using archival sources. The case study addresses themes that remain significant, particularly approaches to and the politics of horizontal coordination. Finally, the article makes a modest attempt to signal the differences between the 1970s' approach and ‘JUG’.     

Inter‐agency joint protocols for safeguarding children in social care and adult mental‐health agencies: a cross‐sectional survey of practitioner experiences

Parental mental illness, substance misuse and domestic violence are common risk factors for the maltreatment and neglect of children. Safeguarding children is everyone's responsibility, including professionals working primarily with adults. In the UK, Local Safeguarding Children Boards (LSCBs) were established to ensure that all agencies work together to safeguard children. Many LSCBs developed multi‐agency joint protocols to enhance collaboration, but there is limited evidence of their effectiveness. This paper reports findings from a cross‐sectional survey of practitioner self‐reported experiences of joint protocols, which was conducted in one inner London borough, to evaluate their impact on professional practice. A self‐complete questionnaire administered to all professionals in adult mental‐health and children's social care services in the borough yielded a response from 119 practitioners. The survey found that the protocols had been widely disseminated and provided clear guidance to practitioners. Practitioners perceived that they had increased awareness of the risk factors for safeguarding children and some had used the protocols to help them gain access to services for their clients. Practitioners also perceived that they had improved inter‐agency working between children's social care and adult mental‐health services. However, respondents indicated that positive interpersonal contact with practitioners from other agencies was equally important in promoting joint working and inter‐agency collaboration.     

The 'Dole or Drudgery' Dilemma: Education, the Work Ethic and Unemployment

Before the recession, Labour ministers claimed that much unemployment in the UK was voluntary. While social policy authors have repeatedly countered such claims by stressing that unemployed people generally possess a strong work ethic and employment commitment, their accounts typically neglect the role that choosiness in job search behaviour plays in deciding individuals' employment status. Fifty in‐depth interviews with both unemployed and employed respondents exposed considerable diversity in attitudes towards ‘dole’ (being unemployed and claiming unemployment benefits) and ‘drudgery’ (doing less attractive jobs). The more educated were more likely to prefer ‘dole’ to ‘drudgery’ (this was also found using National Child Development Study survey data), yet they usually found jobs despite their greater choosiness. Those with very low educational attainment often desperately wanted jobs but could not find them due to their low employability – which might offer an explanation for the often replicated (yet paradoxical) finding that unemployed people generally exhibit a strong work ethic and pro‐employment attitudes and behaviours. Furthermore, the findings indicate that the scope for many Jobseeker's Allowance claimants to increase their net income by undertaking an unattractive job is greater than social policy authors often imply. The question of ‘who must do the least attractive jobs?’ has been neglected by both social policy academics and policy‐makers.     

Externalizing an ‘Asset Model’ of Activation: Creative Institutional Work by Frontline Workers in the Norwegian Labour and Welfare Service

The past two decades have brought significant shifts in Norwegian activation policy towards a joined‐up and employability‐enhancing approach to labour market inclusion in order to promote return‐to‐work despite health problems or disabilities. Utilizing a concept from health promotion, we term this approach an ‘asset model’ of activation. The Norwegian Labour and Welfare Service (NAV) and its local offices are the main agents implementing the new policy. This article aims to investigate the strategies that the frontline workers of NAV engage in, in order to externalize an ‘asset model’ in the adjacent medical field and to the general practitioners (GPs) in particular. We analyze these strategies as forms of creative institutional work – the purposive actions undertaken to change existing presumptions and opinions among relevant actors. We argue that although the new activation policy is not theirs to develop, in order to bring about changes in practice, ‘creating’ institutional work by the frontline workers is required. Our findings show that the frontline workers develop strategies in order to externalize an asset model to the GPs, as part of operationalizing an ‘activation’ reform into practice. We identify four forms of ‘creating’ institutional work undertaken by the frontline workers: ‘defining’ – enacting legislation and regulation in relation to GPs; ‘constructing normative networks’ – creating a more collaborative relationship with the GPs; ‘educating’ – teaching the GPs about the rules and regulations, and the opportunities and assistive measures they can offer to the injured; and thereby also ‘changing normative associations’ of GPs towards the activation policy.     

Domestic violence and child protection: exploring the role of perpetrator risk assessments

This article explores the issue of severity in relation to domestic violence and provides a number of reasons for the necessary engagement by workers with such a contentious issue. The specific role that the assessment of the risks posed by the perpetrator which has now developed in some police forces in the United Kingdom is examined, and its relevance to child welfare intervention discussed. A range of factors are identified that heighten the risks of increased violence. These include prior sexual assault; stalking and controlling behaviour; substance misuse and mental‐health problems; separation and child contact disputes; pregnancy; escalation including the use of weapons and psychological abuse; attempts and threats to kill; child abuse; isolation and barriers to help‐seeking. The ways in which perpetrator risk assessment can be used to inform the filtering of referrals to the statutory child care agency, enhance multi‐agency working, provide a structure for the assessment of the perpetrator, enhance partnership‐working with survivors (usually women) and inform the protection strategies for workers are explored.     

The Policymaker's Dilemma: The Risks and Benefits of a ‘Black Box’ Approach to Commissioning Active Labour Market Programmes

In September 2009, the British Government launched a new employment assistance model called Flexible New Deal. It was soon replaced by Work Programme in 2011. Both prioritized what is often called a ‘black box’ approach to public employment assistance, whereby the government purchaser focuses predominantly on outcomes and does not seek to direct agency operations. Using a study of the orientations and strategies of frontline employment services staff in 2008 and 2012, we seek to enhance understanding of the impact of so‐called ‘black box’ commissioning on key aspects of service delivery. Black box advocates propose that it is a hands‐off approach that allows agencies to be innovative and to improve efficiency. These effects are thought to be due to improved local service quality and greater flexibility to tailor services to individual clients. Critics argue that this increased discretion facilitates under‐servicing of some jobseekers and agency profiteering. These practices are commonly referred to as ‘parking’ and ‘creaming’. In this UK study, we provide evidence of both positive and negative activities associated with black box commissioning. We find some small improvements in flexibility at the frontline, but little to no evidence of increased efficiency as measured by the reported rates of jobseekers moving into work. We also observe an increase in practices associated with creaming and parking. We conclude that improving efficiency and maximizing innovation are not guaranteed by black box commissioning, and that the aim of facilitating increased frontline flexibility, while also minimizing risk, persists as a major policy design tension.     

From Street‐level Bureaucrats to Street‐level Policy Entrepreneurs? Central Policy and Local Action in Lottery‐funded Community Cancer Care

Recent contributions to the policy implementation literature have applied Kingdon's model of ‘policy windows’ to the implementation of policy on health inequalities in the UK, and have identified the key role played by ‘policy entrepreneurs’ at local as well as national level. Despite this, the picture that emerges is of frustration of central policy intentions at the local level, alongside frustration of local aspirations by the centre. This article explores the relationship between central policy and local implementation in the context of a Lottery‐funded initiative to develop community cancer care in the UK. We examine the relationships: between the BIG Lottery Fund and central government; between BIG and the cancer care projects it funded; and between the projects and their local economy of cancer care. We found evidence of success both in vertical cascading of policy and in local policy innovation; 83 per cent of projects succeeded in obtaining continuation funding at the end of their Lottery funding. We suggest that this was due, in part, to two features of Lottery funding and accountability that combined to differentiate it from the other policy initiatives studied. They meant that projects were ‘buffered’ not just from national policy churn, but also from competing local priorities. In the ‘protected space’ that was thus formed, ‘street‐level policy entrepreneurs’ played a key role in developing cancer care innovations for adoption by mainstream funding agencies.     

Care, control and change in child care proceedings: dilemmas for social workers, managers and lawyers

This paper draws on findings from an interview‐based study of the ways that local authority social workers, social services managers and lawyers work together in child care cases in England. The study shows how stressful social workers can find care proceedings, and how much they look to the lawyers for support. It also shows how the lawyers’ involvement can bring new stresses and dilemmas. The managers are especially likely to resent ‘over‐involvement’ (as they see it) from lawyers, but lawyers are quick to defend their role and responsibilities. The paper shows how the complex, multifaceted dimensions of care, control and change interweave with professional differences in care proceedings: care for children, parents and social workers; struggles for control against the court, the other parties and sometimes the other professionals on one's own side; and responsiveness to change set against wariness about ‘lawyers’ deals’ and undue risk to children. The paper concludes that the valuing of difference, rather than its avoidance or suppression, is at the heart of effective inter‐professional work. It calls for greater recognition of this in current initiatives to promote interdisciplinary working in children's services in England.     

Safeguarding children: challenges to the effective operation of core groups

Founded on an evaluative review of core group practice in a northern metropolitan borough of England, this paper highlights the tensions and difficulties that might inhibit the quality of post‐registration services to children and their families. Insights from the empirical data as well as theoretical literature have been explored in the light of current and developing policies. This exploration is focused on inter‐agency coordination; inter‐professional relationships; and partnership with parents and children. The recruitment and retention of social workers, the potential contribution of Children's Trusts, as well as unconscious processes relating to child abuse and child protection, are all given consideration.     

Morphogenetic theory and the constructivist institutionalist challenge

This article engages with two meta‐theoretical approaches to social analysis, ‘morphogenetic theory’ and ‘constructivist institutionalism’, and specifically explores how the former fares under the critical scrutiny of the latter. The key proponent of constructivist institutionalism, Colin Hay, has offered two detailed critiques of morphogenesis that criticise its position on the foundational sociological issues of structure‐agency and material‐ideational. Although Hay's critiques are largely rejected in an overall defence of the morphogenetic approach, the process of engagement is seen to be particularly useful for morphogenetic theory because it allows a number of important clarifications to be made and it also opens up space for theoretical development. In the course of this debate, accessible introductions are given to both theories, and the similarities and differences between them are outlined, providing clarity to both. Therefore, although this article ultimately operates as a defence of morphogenetic theory, especially in the form proposed by Margaret Archer and Douglas Porpora, it finds a great deal of fruitful discussion in the constructivist institutionalist challenge.     

Attributing Outcomes to Social Policy Interventions – ‘Gold Standard’ or ‘Fool's Gold’ in Public Policy and Management?

In recent years there has been increased interest in outcome‐based social policy‐making and management. The UK has been in the forefront of this movement but similar movements have been identified internationally. This interest in outcome‐based decision‐making has been given particular impetus through the ‘results’‐based movement in evaluation and performance management since the 1980s, which has increased in scope over time, slowly changing its emphasis from cost reduction and measuring outputs to measuring outcomes. This change has been widely welcomed by policymakers, practitioners and academics. However, there is evidence that the reality is often rather less than the rhetoric. Moreover, the ‘attribution problem’ of attributing changes in outcomes to specific social policies has remained a major issue. The conceptual solution of constructing ‘cause‐and‐effect’ models, imported from the policy evaluation field, has only recently become common for operationalising these models. This article outlines the evolution of interest in outcome‐based social policy‐making up to recent times and the growing realization of the importance of the attribution problem. It then outlines both how the ‘cause‐and‐effect’ policy modelling approach can partially tackle the attribution problem, but also its inherent limitations. Lastly, the article uses several case studies in current UK social policy‐making to demonstrate the potential importance of the reasoning embedded within cause‐and‐effect models but also the dangers in policy‐making which adopts this approach without understanding its conceptual basis or in fields where it is inappropriate, given the current state of our knowledge of social policy systems.