Circumstances Change Cases: Local Government and the NHS

The role of local government in health care matters in Britain has never been trouble-free. From the dissolution of the Boards of Guardians in 1929, through to the creation of the NHS in the 1940s and the introduction of the internal market in the 1990s, there have been political and professional arguments surrounding the issue and, for the most part, the case for democratic local governance of health care has failed to carry the day. This paper looks back to earlier debates, examines the current policy context, and looks ahead to possible future scenarios. It argues that the changing circumstances of both the NHS and local government makes this an apposite time to rethink established structures.     

The journey effect: how travel affects the experiences of mental health in-patient service-users and their families

The qualitative study presented in this paper explored the perspectives of service-users, family members and staff about the impact of travel issues on the lives of mental health in-patients and carers. This topic was chosen because it was prioritised by members of Xplore, a service-user and carer research group, and has received little research attention. Travel problems were a significant issue for many service-users and carers, bound-up with mental health issues and the recovery experience. Travel facilitation through the funding of taxis and the provision of guides was appreciated. A few service-users and carers positively valued distancing from their previous home environment. The meaning of travel issues could only be understood in the context of individuals’ wider lives and relationships. The significance of the findings is discussed in relation to the social model of disability.     

Immigrant Transnational Organizations and Development: A Comparative Study1

This article explores how ninety Colombian, Dominican, and Mexican transnational immigrant organizations pursue philanthropic projects that aid in the development of their country or community of origin. We find that each nationality's context of exit and reception affects the origin, strength, and character of their organizations. We produce “maps” of the interaction of transnational organizations with each country of origin and conduct multivariate regressions to establish determinants of key organizational characteristics, including their degree of formalization and form of creation. Generally, Colombian organizations assume more middle‐class forms, Dominican organizations stem largely from politics in the country of origin, and Mexican organizations are primarily hometown associations with greater involvement of the national state. We observe that regardless of nationality, transnational immigrant organizations’ members are older, better‐established, and possess above‐average levels of education, suggesting that participation in transnational activities and assimilation are not incompatible. The character of proactive activities by each national state are examined. Theoretical implications for immigrant adaptation and community/national development are discussed.     

'Normal' Life in a Hazardous World: How Adults with Moderate Learning Difficulties and Their Carers Cope with Risks and Dangers

Semi-structured interviews were conducted with 20 adults with moderate learning difficulties attending Adult Training Centres and with their informal carers. Interviews covered friendships, relationships with the opposite sex, leisure and independent living and were analysed using a grounded theory approach. Ways of dealing with hazards emerged as an important theme. Hazards could be seen as dangers to be avoided or as risks to be calculated and minimised. Adults and informal carers usually viewed hazards in a similar way but there were conflicts of view in some families. Treating hazards as dangers to be avoided appeared to be associated with professional or skilled manual social background and the presence of both parents in the household.     

Dressing for success. Promoting independence among cognitively impaired elderly

In demented persons, activities of daily living skills may deteriorate more quickly than their cognitive decline warrants because caregivers do not allow them to perform ADLs to the full extent of their abilities. Caregiver actions that promote independent behaviors were used with subjects in home and nursing home settings. Four of five home subjects showed decreased caregiver assistance and increased ability to dress more independently. Although nursing home subjects did not show a decrease in caregiver assistance, observation showed that some nursing home caregivers did incorporate behavioral strategies, suggesting potential clinical efficacy of the strategies.     

Rethinking Empowerment: A Postmodern Reappraisal for Emancipatory Practice

Summary This article is concerned with the implications of the postmodernchallenge to critical theory for the practice of empowerment.How do we conceptualize empowerment from a postmodern perspective?It is argued that the modernist concept of power upon whichempowerment rests, can have unintended disempowering effects.By conceptualizing power as a commodity, identities are forcedinto a powerful–powerless dualism which does not alwaysdo justice to diverse experiences. Thus we can sometimes contributeto dominance in spite of our liberatory intentions. It is arguedthat social workers need to become more aware of the self-discipliningand self-regulatory processes involved in professional workto address the social relations of power embedded in professionalpractices. Foucault's analysis of how marginalized knowledgesare affected by dominant cultural practices suggests a redefiningof empowerment as the insurrection of subjugated knowledge.The implications of this redefinition for practice is illustratedby reference to work with indigenous people in Australia.