Direct Payments and Social Work Practice: The Significance of 'Street-Level Bureaucracy' in Determining Eligibility

Sponsored both by governments intent upon fiscal restraint anduser movements keen to extend choice and control, ‘cash-for-care’schemes are replacing direct services across mature welfarestates. Recent legislation on direct payments, which has enactedthe UK version of cash-for-care, has attracted considerableresearch interest in the UK. Previous studies point to a numberof tensions for social workers in the implementation processwhich give rise, in turn, to considerable uncertainty, evenhostility, on the part of front line staff. This article, whichdiscusses the findings of a study of assessment and care managementpractice in one English council, seeks to make sense of socialworkers’ approach to the allocation of direct paymentsby reference to Lipsky’s (1980) theory of ‘street-levelbureaucracy’. The author concludes that despite ten yearsof managerialism, in the course of which professional practicehas been routinized and regulated, Lipsky’s work is stilluseful in analysing front line behaviour around direct payments.     

Social Care and the Modern Citizen: Client, Consumer, Service User, Manager and Entrepreneur

Since coming to power, New Labour has embarked on a programmeof modernization. Few areas of state activity have been morevisibly subjected to New Labour’s modernization agendathan the personal social services. Local authority social servicesdepartments have largely ceased to exist as separate organizationalentities. However, modernization has also required that therelationship between state and citizen be reconstructed. Thisis evident in New Labour’s vision for adult social carewhich envisages a move towards individual budgets. The individualizingnature of such schemes may be thought hard to reconcile withthe discourse of integration and partnership prominent elsewhere.However, a key linking concept is that of ‘person-centredness’.It is often assumed that this simply means that public servicesbecome more flexible to meet the needs of ‘the person’.This paper uses the example of direct payments to demonstratehow modernization also requires flexibility of ‘the person’.It would appear that inherent in New Labour’s projectof modernization is the assumption that the modern citizen shouldbe both managerial and entrepreneurial. What were once publicresponsibilities are being transferred to the individual. Theimplications for the users of adult social care are discussed.     

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.     

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.     

Direct Payments and Disabled People in the UK: Supply, Demand and Devolution

Direct payments have brought new opportunities for self-determinationand independent living to disabled people in the UK, featuringprominently in government strategy and the 2006 White Paper,‘Our Health, Our Care, Our Say’. However, ten yearsafter direct payments legislation, take-up remains low and implementationvaries greatly. Rates of take-up in England remain more thandouble those in other parts of the UK, raising questions aboutdevolution and equity. This paper presents data from a nationalstudy to examine some of the mechanisms underlying uneven outcomesfor disabled people in different parts of the United Kingdom,with particular reference to the politics of devolved governance.The analysis focuses on scope for interpretations of policy;resources for information and training; the impact of mandatoryduties and targets; extensions to new user groups; and the roleof support organizations and disability activism. The evidencesuggests that local variations have been produced not only by‘local’ factors, but also by different opportunitystructures for policy development in England, Scotland, Walesand Northern Ireland. This raises questions about the impactof devolution on equity and opportunity for disabled peoplein the UK.     

The State of Care Management in Learning Disability and Mental Health Services 12 Years into Community Care

This paper reports on the organization of care management froma longitudinal study of community care for people resettledfrom long-stay learning disability and psychiatric hospitals.The findings from a 12-year follow-up of care management arrangementsin 12 learning disability and eight mental health study siteservices are described. The diversity of care management arrangementsfound at earlier points in the evaluation remained evident.Also, many of the former ‘care in the community’service users were excluded from mainstream care managementarrangements in their localities. The difficulty of developingperson-centred arrangements in learning disability and the lackof integration of the Care Programme Approach and care managementwere evident. The findings and observations are placed in thewider policy and practice context, with suggestions for takingcare management forward nationally and locally.     

'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.     

Moral Positioning: Service User Experiences of Challenging Behaviour in Learning Disability Services

Several studies have indicated the importance of challengingbehaviour as a limiting factor on quality of life (Murphy et al., 1996;Brown and Thompson, 1997; Schwartz, 2003). This article presentsthe findings of research that aimed to investigate adults withlearning disabilities’ understanding and experiences ofwhat is perceived by staff and services to be challenging behaviour.This study was the final phase of research reported previouslyin this Journal (Hayden and Stevens, 2004). Interviews, groupdiscussions and observations were carried out with twenty-sixpeople with learning disabilities using social services’residential and day services. Participants were able to articulatecomplex responses about challenging behaviour, which is characterizedas a ‘moral web’: a complex network of antecedents,behaviours and consequences. Social care staff were seen byparticipants to play a key role: protecting people and ensuringthat appropriate (negative) consequences were suffered by instigatorsof challenging behaviour. These findings are interpreted withina positioning theory perspective, suggesting the importanceof understanding the ways that challenging behaviour is constructedthrough social interaction. Implications in the following areasare discussed: developing practice; the role of social carestaff; and the study of challenging behaviour as a social phenomenon.     

United We Stand? Partnership Working in Health and Social Care and the Role of Social Work in Services for Older People

The concepts of ‘partnership’ and ‘collaboration’have become amongst the most critical themes of ‘new’Labour’s social policy, particularly in respect of thedelivery of health and social care. Although the terms are rarelyprecisely defined and hence have become problematic to analyse,in most understandings successful partnerships rely upon goodsystems of inter-professional collaboration. Through revisitingthe extensive literature on the sociology of the professions,and the nature of inter-professional working, this paper willargue that effective collaborative working within health andsocial care is hard to achieve, particularly in the light ofthe vast differences in power and culture between various occupationalgroupings, and the inherently competitive nature of professionsjostling for territory in the same areas of activity. It suggeststhat these issues cannot be resolved unless they are properlyunderstood; a rhetorical appeal to the unmitigated benefitsof ‘partnership’ alone will not produce more effectivejoint working. In addition, it notes that an appropriate rolefor social work in the context of partnership working has yetto be defined and proposes specific tasks and values that distinguishthe social worker from other related professionals.     

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

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

User-Practitioner Transactions in the New Culture of Community Care

Correspondence to Nicky Stanley, Lecturer in Social Work, University of Hull, Hull HU6 7RX, UK. Summary This article describes the findings of a research project whichexamined the views and practice of social workers undertakingassessments in one local authority following the implementationof the NHS and Community Care Act 1990. While the assessorsexpressed dissatisfaction with some aspects of the new systemof care management, overall they appeared to be taking the newculture on board. Managers were consistently more enthusiasticthan practitioners. Both groups saw needs-led assessment, userchoice and keeping users in their own homes as central objectivesof care management. The shadowing of ten community care assessmentsallowed the degree to which these objectives were realized inpractice to be explored. Users' experience of the new culturewas also studied. The user-practitioner transactions observedsuggest that those users who were able to articulate their ownneeds forcefully were most likely to be able to exercise choice.It is argued that the new culture of community care embodies‘consumer choice’ rather than ‘user choice’.     

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

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

Understanding Adolescent Female Prostitution: A Literature Review

Correspondence to Dr Jill Jesson. Aston Business School, Aston Triangle, Birmingham B47 7ET. Summary Sexual behaviour and sexuality are currently topical issuesof concern for child care social workers. Social workers arespending more and of more of their time with children who comeinto care because of sexual abuse, or who have an involvementin the ‘rent’ scene or Prostitution. In additionmany teenage young women come into care because of social orparental concern over their lsquo;promiscuous’ behaviour.The review of research on adolescent prostitution offers severalexplanations for involvement in prostitution. which vary accordingto the discipline of the author. Explanations vary from pathologicaland personal psychology factors to the wider social aspectsof the family and local environment. This literature reviewwas used as a basis for research which examined the incidenceof female prostitution for a social services department. Thisis a relatively new field of interest and consequently thereis very little British research published on the issue of adolescentprostitution, or on under age (16) prostitution. There is nopublished research on girls in care and prostitution. We needto know much more about the reality of young people's livesbefore social workers can offer a meaningful response.     

The Treatment of Enuresis amongst Child Clients of a Social Services Department

Summary The adoption of an ‘outpatient’ model of supervisingthe treatment of bedwetting amongst child clients of a socialservices department is described. The treatment technique usedwas the generally effective ‘enuresis alarm’, or‘bell-and-pad’. Fifteen out of a total of 25 concludedcourses of treatment were successful, with an average treatmentduration of 14.9 weeks. Both this outcome, and the rate of drop-outbefore completion of treatment (ten cases) are comparable withthose obtained with non social services clients, and the useof the enuresis alarm with children in care (including thosein residential establishments) was found to be quite practicable.A high relapse rate (43%) was, however, found for social servicesclients, relapse usually following a placement change or othermajor stress.     

Disabled Children's Experience of Permanency in the Looked After System

Research with seven local authorities in England provided dataon the ‘care careers’ of 596 foster-children overthree years (Sinclair et al., 2005). One part of this studylooked at the experiences of disabled foster-children comparedto non-disabled foster-children. The research aimed to identifyif there were any particular difficulties in pursuing permanencyfor disabled looked after children. This article introducesa concept developed by the author from this work: the idea thatdisabled children may be at risk of experiencing a ‘reverseladder of permanency’; being less likely than their peersto receive permanent placements such as adoption and returnhome. The results of the study partially supported this hypothesis,reinforcing existing findings and highlighting some new ones.Foster-children with learning but not other impairments wereless likely to be adopted. All disabled children were less likelyto return home and therefore remained in foster-care for longer.Disabled children who were adopted, or who returned home, didso after a greater delay compared to non-disabled children.By contrast, children who were ‘clearly disabled’achieved a greater degree of permanence within the care system.The article concludes by considering the implications of suchfindings for policy and practice.     

Rethinking Family Support in the Current Policy Context

This article uses the concept of ‘the social investmentstate’ to understand key aspects of New Labour’spolicies in relation to welfare reform. It argues that ‘investingin children’ and creating ‘responsible parents’are vital features of many of the policies and service initiativeswhich have emerged since 1997. Such features have considerableimplications for policies and practices in the arena of familysupport. The article goes on to outline aspects of an importantcritique of the social investment state which has emerged fromthose engaged in research and policy analysis who argue fora ‘political ethics of care’. It argues that thisperspective offers important possibilities to family supportadvocates not only for critique, but also for articulating muchneeded policy alternatives to those currently being promotedby New Labour. It also signposts the importance of conductingongoing research into the meanings which are being attachedby individuals to complex and contested terms such as ‘family’and ‘support’.     

Gaining Satisfaction? An Exploration of Foster-Carers' Attitudes to Payment

The payment of foster-carers has long been controversial, reflectingboth philosophical debates as to whether fostering should bea voluntaristic or professional activity and concerns aboutplacement provision and service delivery for children. Althoughmany research studies have touched upon the question of foster-carers’satisfaction with payments, this has not been explored in anydepth. Drawing on findings from a study involving 1,181 foster-carersin twenty-one agencies, this article attempts to provide suchan analysis with four main objectives. These comprised: examiningassociations between attitudes towards payment and demographic,socio-economic and fostering career variables; comparing responsesbetween carers based in local authorities (grouped accordingto levels of payment and performance criteria) and independentagencies (IFAs); gauging the influence of carers’ ‘orientations’towards foster-care as a ‘professional’ task; andanalysing payments in terms of their different components, suchas fees, maintenance and certain designated expenses. Amongmany detailed findings to emerge were the generally low levelof satisfaction among local authority carers, especially incomparison with their IFA counterparts and the growing supportamong carers for salaried status. There was mixed evidence onlinks between attitudes towards remuneration and the performanceof agencies.     

Reflexivity, its Meanings and Relevance for Social Work: A Critical Review of the Literature

The concept of ‘reflexivity’ has become increasinglysignificant in social work literature in relation to socialwork education, theory and practice. However, our reading ofthe literature indicates that there is a lack of clarity aboutthe concept in terms of who is being exhorted to be ‘reflexive’,when and how. This article addresses these questions througha critical review of social work literature since the 1990sthat discusses the concept of ‘reflexivity’. Giventhat many authors seem to use the concepts of ‘reflexivity’and ‘(critical) reflection’ interchangeably, wealso apply this analysis to ‘reflection’ and ‘criticalreflection’. This article raises important questions abouthow the concepts of ‘reflexivity’, ‘criticalreflection’ and ‘reflectivity’ are definedand the different consequences such definitions might have forsocial work education, theory and practice.     

Understanding 'Going Missing': issues for social work and social services

Correspondence to Malcolm Payne, Professor of Applied Community Studies, The Manchester Metropolitan University, 799 Wilmslow Road, Didsbury, Manchester M20 8RR. Summary Recent research about young people and adults who ‘gomissing’ raises important issues for social work and thesocial services. Large numbers of young people go missing eachyear, becoming vulnerable to exploitation and at risk of committingcrime and suffering from other social difficulties. Adults leavebehind families with practical and emotional difficulties. Adefinition of ‘going missing’ should focus on absencefrom social expectations and responsibilities. Five groups ofmissing person are identified: runaways, pushaways, throwaways,fallaways and takeaways, reflecting different social situationsin which going missing occurs. It is argued that going missingis one of a range of choices which people in difficulties maymake, depending on their approach to problems in their livesand the availability of opportunities. Effective local co-ordinationto focus on reasons for going missing, on reunions and returnsto residential care or home, and to provide emotional and practicalhelp to people ‘left behind’, are required, providedthat care is taken to protect people who go missing becausethey are subject to abuse and violence.     

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.