Government, Social Services Departments and the Health of Children and Young People: Which Way Forward?

Summary Despite the dearth of research into the health of children andyoung people in contact with or ‘looked after’ bylocal authorities, a series of official and quasi-official reportshave begun to raise awareness of this issue. There are goodreasons to believe that this group of children will be disadvantagedin terms of health as they are in other aspects of their lives.The evidence suggests that local authorities do not live upto the standards of ‘good parents’. Current notionsof good practice are critically appraised and the article concludesthat social work is unable to do more than mitigate the effectsof Government policies which affect health and social servicesand which have lead to widening social inequalities.     

Joint Reviews: Retracing the Trajectory, Decoding the Terms

Correspondence to Dr Jill Humphrey, School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, NR4 7TJ, UK. E-mail: j.humphrey{at}uea.ac.uk Summary Joint Reviews of social services authorities in England andWales are heading for their fifth anniversary. In spite of theirprolific publications record and their high-profile status inthe worlds of practice and politics, there is little recordof their existence in the relevant academic journals. This isintended as an introductory article to begin to rectify thisomission. It is informed by a year-long study of the Joint Reviewteam. My aim is twofold: to retrace the historical developmentof Joint Reviews under three successive governments, and toexplore the nature of Joint Reviews by decoding the meaningsof their constituent terms. The underlying argument is thatJoint Reviews represent a new species of regulation that hasbeen essential to the realization of a new mode of accountabilitybut that the complexity of this new accountability has spawnedsome confusion and conflict among stakeholder audiences.     

Patterns of Provision in Respite Care and the Children Act

Summary This article presents the findings of a three-year study intorespite care services to disabled children and discusses thesein the light of the 1989 Children Act. The aims and methodsof the research are first outlined and the various servicesincluded in the study are described. Access to services was found to be uneven, with families fromlow socio-economic groups and from black and ethnic minoritycommunities apparently having less choice. The characteristicsof users are identified: some of these varied according to typeof facility used or amount to care received. Agency records and registers were often found to be inaccurate:the Children Act will require authorities to maintain updatedregisters. New powers to charge for services may create furtherbarriers to access although requirements to take account ofchildren's racial and cultural background should extend it.The Act will help authorities regulate the amount of respitecare children receive and introduces certain safeguards. Itsemphasis on consulting young people is to be welcomed. Overall,the new legislation has the potential to improve many aspectsof respite care; its ability to do so will depend on havingadequate resources.     

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.     

The Creation of an Inter-occupational Relationship: the introduction of a counsellor into an NHS General Practice

Correspondence to Neil Small, Lecturer in Social Work, School of Applied Social Studies, Univer of Bradford, Great Horton Road, Bradford, West Yorkshire BD71DP Summary The article presents an account of the introduction of a counsellingservice into a National Health Service general practice. Itexamines the experiences of the counsellor and locates thesewithin a theoretical context that draws upon the insights offeminism to examine the work done and the context within whichit was done and the literature of the therapeutic communityto offer a guide to practice. Further, it examines the impactupon the organization of the practice and the problems in oreatingan inter-occupational relationship. These problems emanate bothfrom the assumptions general practice operates within and fromthe external system of accountability to which it conforms.     

Poverty: Consensus and Alternatives

Summary The purpose of this article is to examine the published viewsof two leading politicians who can claim to speak for theirparties. From their discussion of poverty and social deprivation(and the terms will be used interchangeably) an attempt willbe made to emonstrate that their policies or proposals reston similar assumptions about society and a similar model ofpoverty. Their consensus of approach will mean that no alternativepolicies are being seriously mooted within the party politicalsystem. Their assumptions will be examined critically and thesuggestion made that an approach deriving from an alternativemodel is required to counter poverty.     

Supervision, Role Strain and Social Services Departments

Correspondence to Department of Social Work and Social Administration, University of Western Australia, Nedlands, Western Australia, 6009 Summary The paper analyses the potential for ambiguity and ambivalencetowards the supervision of practice in social services departments.While supervision may be integral to much social work practicein clinical settings, the culture and tradition of supervisionin social services departments looks to be permeated with confusionabout ‘supervision’ or ‘consultation’,the nature of accountability and the functions of supervisionof qualified and experienced practitioners. To move beyond anideology prescribing supervision, the paper considers evidenceof the effectiveness of supervision practice, analysing thetransition from practitioner to line-manager/supervisor andthe subsequent strain on the supervisor's authorities of positionand of expertise in some current arrangements for supervisionin field-work ‘teams’. Finally, there is an unequivocalassertion that effective supervision is an essential componentin the monitoring of client service and the maintenance of practitionersengaged in stressful forms of practice. Such supervision needsto recognize the managerial and administrative tasks necessaryto protect the agency and the client from poor quality practice,while also respecting the emotional and educational needs ofnewly qualified and experienced practitioners exposed to thedemands of high-risk judgement and practice.     

Placing Children on Child Protection Registers: Risk Indicators and Local Authority Differences

Correspondence to Dr David Gordon, School for Policy Studies, University of Bristol, 8 Woodland Road, Bristol BS8 1TN, UK. Summary Wide variation in rates of children on protection registersin different authorities has led to doubts about the reliabilityof local decision making. A study of 1,752 referrals, for suspectedabuse or neglect in eight English local authorities, found thatindicators of child and family vulnerability were more importantthan local area in explaining selection for initial child protectionconference and placement on registers. There appeared to beagreement on ‘common-sense’ risk indicators butstronger measurements of risk would enable child protectionprocedures to be better targeted.     

Sponsored Places: The Use of Independent Day-Care Services to Support Children in Need

Correspondence to: Dr June Statham, Project Director, Thomas Coram Research Unit, 27-28 Woburn Square, London WC1H OAA Summary The implementation of the Children Act 1989, with its emphasison family support through the provision of non-stigmatizinglocal services and on local authorities working in partnershipwith voluntary and private service providers, has given a newfocus to the use of independent day-care services to supportchildren in need and their families. This article uses datafrom research in England and Wales on the implementation ofthe Children Act as it affects early years services, to considerthe extent of sponsored day-care, the circumstances in whichit is used, and the issues it raises for local authorities,independent day-care providers and the children themselves.     

Community Care for the Elderly -- Rhetoric and Reality

Correspondence to A.C. Bebbington, Assistant Director, Personal Social Services Research Unit, Cornwallis Building, The University, Canterbury, Kent CT2 7NF. Summary This paper investigates the management and delivery of carefor 176 elderly people receiving both community health and socialservices. These people represent a crucial group if the communitycare policy is to become a reality, and they receive high serviceslevels. The study provides both quantitative and qualitativeevidence of inadequate case management and lack of co-ordinationin providing care. Assessment, determining services, and reviewwere all inefficiently managed. Liaison was non-existent forthe majority, and opportunities for substitution were missed.There could be conflict over role, particularly in relationto personal care. Innovations designed to tackle these problemsremain limited in scale. These difficulties are recognized andaddressed by the 1989 White Paper ‘Caring for People’which makes a number of proposals to clarify responsibilitiesand accountability. The different professional assumptions andwork practices among the plurality of agencies providing carewill need to be resolved if community care is ever to offera realistic alternative to care in institutions for increasingnumbers of people with high levels of dependency.     

Un-charted Territory? Experiences of the Purchaser/Provider Split in Local Authority Children's Services

¹Ian Kirkpatrick Public Services Research Unit. Cardiff Business School, Aberconway Building, Colum Road, Cardiff CF1 3EU, UK. Summary A primary goal of Conservative government policy, expressedin the 1990 National Health Service and Community Care Act,was to encourage the development of market mechanisms throughthe separation of purchaser and provider roles. The main targetfor reform was to be adult services although, in the absenceof specific guidance, a number of local authorities also implementedpurchaser/provider structures in services for children and families.To date, little attention has been given in the literature eitherto describing what purchaser/provider structures involve inthis context or to assessing their impact. Drawing on case studydata from seven local authorities, this article seeks to addressthese deficiencies. It is argued that many changes have beencosmetic and that, while it is not possible to evaluate thelong-term effectiveness of the model, there is evidence thatit can have some negative consequences for the co-ordinationand delivery of services.     

Questions Raised for Local Authorities when Old People are Evicted from their Care Homes

Correspondence to Peter Scourfield, School of Community, Health and Social Studies, Anglia Polytechnic University, Cambridge CB1 1PT, UK. E-mail: p.scourfield{at}apu.ac.uk Summary Successive government policies have created a situation wheremost residential and nursing care is provided by the independentsector. It is in the nature of a marketized and privatized caresystem that homes will periodically close or change ownership.The physical and mental well-being of elderly residents experiencingeviction and relocation can be seriously damaged by the experience.No policy and practice guidelines have been issued from centralgovernment to cover how care home closures should be managed.Local authorities are therefore dealing with such events onan ad hoc basis. Understandably, the main emphasis is oftenput on actually finding appropriate alternative placements.Practices vary across different local authorities. This articleasks whether the necessary work required to minimize the harmfuleffects caused by the stress of relocation is actually beingcarried out properly. It also raises the questions of what exactlyshould be offered to older people when they are given noticeto quit, who is best qualified to do the work and whether caremanagement as it has developed within the ‘purchaser/providerframework’, is adequate to the task. In short, where cansocial work for older people be found when it is needed?     

The Impact of New Labour Health Policy on Social Services: A New Deal for Service Users' Health?

Summary The health policies of the Labour Government of 1997–2001included an increased emphasis on social services departments'(SSDs) contribution to promoting health. Three dimensions ofthis policy shift are discussed: first, the drive towards organisationalfusion between elements of the NHS and SSDs; second, the newmechanisms for conjoint funding of health and social services;and, finally, the new policy focus on tackling health inequalitiesby combating social inequalities on a national and localitybasis. In each case, the touchstone of our analysis is the consequencesfor the health and well-being of SSD service users as membersof socially disadvantaged groups. We conclude that New Labourhas taken some steps, particularly reducing child poverty, whichwill have long lasting health and social benefits for actualand potential service users. However, inadequate funding ofSSDs undermines their effectiveness as a partner in integratedhealth and social care. As signalled by service user initiatives,SSDs potential for promoting more equal chances of health andwell-being in ill-health will also not be realised without substantialchanges to current SSD policy and practice.     

Social Work and General Medical Practice: Personal Accounts of Three-year Attachment

Summary In the area of social worker-general practitioner collaborationmuch has been written about conflict of roles, differing functions,avenues of accountability, and problems of distributing scarceresources. This paper suggests that if the two professions areto work more comfortably with one another, then it is imperativethat both also share the despair, hopelessness, anxiety andanger that are the occupational hazards of each. Ways are suggestedin which doctor and social worker can look at the pain theirpatients are suffering to the benefit of the patient and theiro working relationship.     

Research Note: Developing Outcome Measures in Child Care

Correpondence to Dr Harriet Ward. Research Associate, University of Bristol, Social Policy and Social Planning. The Alfred Marshall Building, 40 Berkeley Square, Bristol BS8 1HY. Summary The complexity of the concept of outcome has discouraged researchinto the impact of the care experience on the child. This Notesummarizes the conceptual thinking behind a comprehensive systemof assessment which is being piloted in four local authorities,and reports on the preliminary results.     

Problems in the Perinatal Prediction of Child Abuse

Summary The aim of this paper is to consider and comment criticallyupon the recommendation by some eminent authorities that effortsbe made to design and implement procedures to predict the abuseof children. My view is that this move toward prediction—‘sponsored’largely by American paediatricians—is less of a new departurethan an extension of the dominant conceptual tradition wherebychild abuse is seen as analogous to a disease. However, in spiteof its basis in a medical model, it is clear that the idea thatthe abuse of children can be accurately predicted has greatappeal for many social workers. I shall argue, however, thatserious obstacles stand in the way of prediction; that theseobstacles are insufficiently appreciated by the advocates ofprediction; and that—consequently—social workers(and others) should temper with scepticism their enthusiasmfor these developments.     

Area Teams in Social Work Practice: A Programme for Research

Summary This paper critically examines assumptions underlying the beliefthat the organization of service delivery through a system ofarea teams has major advantages in the field of social work.It is generally felt that area teams are accompanied: (1) byimproved client access to service provision, (2) by a closeridentification with the local area on the part of social workers,(3) by decentralized organizational decision-making, and (4)by an increased sense of colleague support amongst professionalstaff. A review of some relevant literature casts doubt on thevalidity of these assumptions and reveals that the operationalacceptance of the area team principle has not been complementedby thorough investigations of organizational and other influenceson service delivery. In outline a programme of further researchis proposed. The paper attempts to broaden discussion on thissubject and place the basic philosophy of area teams for comparisonagainst a body of empirical research material.     

Agency Decentralization: Planning and Assessment

Summary Criteria are examined for the location of area offices in SocialServices Departments, drawing on the monitored experience ofdealing with voluntary callers to an area office in the ProbationService. Changes were observed in numbers of voluntary callersand the kinds of problems presented, together with developmentsin inter-agency relationships. The caller's subjective feelingsregarding the accessibility of the agency were found to be importantdeterminants of agency use. Implications are drawn out for planningdecisions in local authorities     

Joint Reviews: Judgement Day and Beyond

Correspondence to Jill Humphrey, Adoption and Family Finding Unit, 3 Unthank Road, Norwich NR2 2PA, UK. E-mail: jill.humphrey.socs{at}norfolk.gov.uk Summary Joint Reviewers are the central regulators of social servicesauthorities in England and Wales. This article explores howreviewers arrive at their judgements about the performance ofsocial services authorities and how these authorities respondto Joint Review reports and recommendations. It also offersa framework for evaluating the costs and benefits of Joint Reviewswhich enables us to appreciate the ambivalence which local authoritystaff harbour towards their central regulators.