BJSW Advance Access originally published online on April 25, 2007
British Journal of Social Work 2008 38(7):1370-1387; doi:10.1093/bjsw/bcm042
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Barriers to Retaining and Using Professional Knowledge in Local Authority Social Work Practice with Adults in the UK
Ann McDonald and Karen Postle are Senior Lecturer and Lecturer in Social Work at the University of East Anglia, Norwich.
Carol Dawson is a trainer and lecturer.
Correspondence to Ann McDonald, School of Social Work and Psychosocial Sciences, Elizabeth Fry Building, University of East Anglia, Norwich NR4 7TJ, UK. E-mail: ann.mcdonald{at}uea.ac.uk
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Summary |
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The development of community care policy and practice in the UK has taken place in the context of the growth of neo-liberal ideologies and managerialism. This has had an impact on service provision and professional practice which has been pronounced in statutory agencies. Research evidence indicates that the workforce in adult social care is demoralized and de-motivated and that there is dissonance between working practices and social work education. Empirical research undertaken in 2003 found difficulties at three levels: structural, managerial and practitioner. The difficulties encountered compromise effective inter-agency and partnership working, indicate problems in the supervisory relationship and lead to practitioners acting defensively and without reference to theory or a clear knowledge base. When these findings are compared with those from earlier studies, explanations may be found beyond blaming individuals or locating conflict within service users’ expectations regarding services. The paper concludes that there is an urgent need to consider and debate the form that contemporary practice in adult care should take and the education of practitioners for this task, in order to support the workforce and to meet the social policy aims of community care.
Keywords: community care, care management, managerialism
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Introduction/background: societal context for the study |
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Any discussion of social work practice with adults in the UK must consider its societal context. While there has clearly never been a ‘golden age’ of social work, it is apparent that influences over the last two decades have had a considerable and, we argue, negative impact on practice. This section briefly summarizes those influences.
The origins and history of social work/care management with adults have been well documented (Payne, 1995; Gorman and Postle, 2003; Means et al., 2003; McDonald, 2006a). The neo-liberal policies of successive New Right UK governments introduced market economics into welfare provision, predicated on the firm belief that this would lead to efficient and effective services and to economies (Hoyes and Means, 1993; Clarke and Newman, 1997). Thus, while community care policies were partly shaped by welcome changes away from paternalistic provision and rightly influenced by growing movements of people using services, it is important to note that strong ideological and economic influences played a very large part in shaping policy and have continued to do so. Significantly, the managerialist impacts of similar welfare policies have been noted in several countries worldwide (Flynn, 2000) with comparable effects on the work of social work care (or ‘case’) management staff. See, for example, Dinerman (1997), Roberts (2002), Vinton et al. (2003) and McDonald (2006b) for the impact of these changes in America and Australia.
While 1997 saw a change of UK government from Conservative to Labour, neo-liberalism has continued to influence policies (Giddens, 1998; Jordan and Jordan, 2000) with perhaps the clear distinction being New Labour’s emphasis on the modernizing agenda (Heffernan, 2006). This is evidenced in the prevalent consumerist approaches to service users’ participation and involvement in health and social care (Barnes et al., 1999). It becomes clear that market principles have replaced notions of universal service provision (Leonard, 2004). Managerialism (Clarke et al., 2000; Harris, 2003) is key to market operation in the provision of welfare. We briefly outline this and its impact.
Managerialism
In essence, managerialism is the application to public sector organizations of systems, techniques and structures used in business (Harris, 2003). It is epitomized by Hugman’s (1991) distinction between the former importance of a social services manager being an expert craftsperson and the likelihood that they would now be an expert manager, the skills, knowledge and expertise associated with management having superseded those of social work.
Drawing on Pollitt’s (1990) work, Harris (2003) outlines four key features of managerialism:
- progress is equated with increased productivity;
- application of technology is important to productivity;
- the labour force needs to be disciplined;
- management is a discrete organizational function providing solutions.
These features are clearly identifiable within current social work practice where concentration on core business and the importance of outcomes (compared with inputs and processes) have predominated in a climate governed by performance targets and budgetary procedures (Lymbery, 2004).
Several writers have documented the increasingly bureaucratic nature of social work (e.g. Postle, 2001) in which staff appear to have considerably reduced autonomy (Lymbery, 1998). Indeed, it seems that, across all fields of social work, bureaucratic solutions in the form of regulations, procedures and guidelines frequently dominate practice (Ferguson, 2005).
The impact of managerialism, together with the volume, pace and nature of change in their work, has had a detrimental effect on the social work workforce, with many staff feeling demoralized and devalued (Balloch et al., 1999; Jones, 2001; Lymbery, 2001; Postle, 2002; Huxley et al., 2005). For example, McLean’s (1999) work described a correlation between staff finding work stressful and sickness absence. This is unsurprising but worrying. This is the context in which the research was undertaken.
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Research method |
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The research was undertaken in 2003 and sought to address the question: ‘What do practitioners use to work with and make sense of complex cases?’ It was commissioned by managers in a large rural social services authority in order to inform staff training and policy agendas concerning decision making in risky and complex situations. The authority was being reconfigured in line with legislation and government policy (Department of Health, 1998). Services for people with learning disabilities and for people with mental health problems had each been joined with the relevant health care bodies, with pooled budgets and joint management systems. Services for children and families separated from adult service provision shortly after the research took place.
Because this work was commissioned by a local authority as part of its training and policy-making agenda, formal ethical approval was not required. However, ethical principles were upheld. The terms of the research sessions and confidentiality were agreed with individual practitioners. Both participants and commissioners agreed that material elicited could be used by the researchers in publications to further understanding of practice. With participants’ agreement, sessions were tape-recorded and transcribed verbatim with transcripts stored securely. All clients’ details were anonymized.
Twenty experienced fieldwork practitioners comprising eighteen social workers and two occupational therapists, who worked with adults with learning disabilities, older people, adults with mental health problems, disabled people and people with sensory impairments participated in the research. Of the twenty participants, two were hospital social workers and three were (or had been) approved to operate under the specific provisions of the 1983 Mental Health Act. Some carried additional responsibilities. Three were senior practitioners, one was a team manager, another an acting team manager and four were practice teachers for qualifying social work students. All had been in post for at least two years. Most did not know each other before the research began, although all knew the researchers. The sample was opportunistic but was chosen to represent the spread of local authority adult teams in terms of geographical areas, service user group specialisms and settings. All participants were asked to choose and describe a complex case from their recent practice which had caused them difficulty.
The participants were divided randomly into groups of four; within each group, each participant described their case in turn and was questioned by other members of the group. The researchers gave prompts to elicit:
- sources of knowledge;
- the value base and its source;
- skills employed;
- means of support.
While previous researchers (Kazi, 2000; Sheppard et al., 2000) used vignettes to explore social workers’ decision making, this study’s researchers used material brought by respondents, believing that this would demonstrate more clearly those situations in which staff struggled to access appropriate knowledge, tools and support in their decision making. Further, such real-life situations allowed personal emotional responses to be observed and reflected upon. This approach is similar to Banks and Williams’ (2005) use of social workers’ own choice of cases in their analysis of ethical dilemmas.
Themes arising from the sessions were coded by the researchers from the transcripts using a grounded theory approach (Strauss and Corbin, 1990). The themes elicited were similar across groups of interviewees and included areas such as ‘inter-professional conflict’ and ‘individual stress’. Although there was no attempt to undertake a narrative analysis of the ‘conceptual vocabulary’ of practitioners (Banks and Williams, 2005 p. 1006), the process knowledge involved in hypothesis testing (Sheppard et al., 2000) emerged from the interviews. As this was a small sample, it is acknowledged that the findings are not necessarily generalizeable to the wider picture of work with adults but they are illustrative of staff’s experiences of the dilemmas and difficulties which this work poses. Reliability, in the sense of consistency (Le Compte and Goetz, 1982), was addressed through peer examination of data and an audit trail was created to trace the derivations of findings (Sandelowski, 1986). The validity of the study lies in the extent to which changes in adult social care described in policy documents have been ‘operationalised’ (Mason, 1996, p. 24) in practice.
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Findings for contemporary practice |
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The findings, though commissioned by an employing agency, gave an unexpected insight into the causes of and responses to stress in contemporary practice with adults. Many practitioners displayed a high level of distress when discussing their cases. Some used the language of battle and conflict and some also commented on the cathartic nature of the research process—a response also evoked by previous research (Postle, 1999a).
The issues presented here illustrate the findings overall that there were barriers to retaining and using professional knowledge arising from the context of service provision at three levels: structural, management and practitioner:
- at a structural level, where a rigid hierarchical system did not encourage use of practitioner knowledge, and where social services staff experienced conflict, rather than partnership with other agencies or professionals;
- at management level, where practitioners experienced supervision concentrating on workload management rather than professional issues and dilemmas (Banks and Williams, 2005), resulting in their experiencing difficulty in articulating the rationale for their work or locating an appropriate framework of knowledge;
- at practitioner level, where staff struggled with gaps in their knowledge, such as about legislation, and risked using defensive practice or relying heavily on procedures, rather than working proactively and creatively.
Structural
At an organizational level, a lack of clarity about function and boundaries created difficulties for all participants, without exception. Structural difficulties identified by participants were:
- a lack of geographically co-terminous boundaries between health and social care, leading to disputes about processes for referring people on—a situation made more complex by frequent restructuring of services;
- an absence of clear agency protocols for dealing with anticipated issues, such as rehousing disabled people, placing reliance on the goodwill developed at practitioner level;
- little sense of shared legal responsibility, even when agencies were formally working in partnership, e.g. there were a number of instances in which community nursing input was withdrawn without notice and without explanation;
- absence of clear processes for working together within and between adult and children’s services in the same local authority.
In some cases, all these four issues coalesced, leading to confusion for workers and service users:
Not only was she kind of pushed between, you know, learning disability and mental health, (but) also between districts and boundaries and locations and things as well and I just think that she was really let down by everyone (Social worker, people with learning disabilities team).
Even a previously good working relationship with other professionals did not help when different agencies perceived issues of individual rights and public protection differently. Sometimes, support was withdrawn abruptly in situations of conflict. In one case, a different social worker was brought in to detain a patient when a planned discharge into the community was suddenly reassessed as too risky by the consultant psychiatrist in charge of the patient’s care. Hospital social workers perceived themselves to be in a particularly isolated position:
Once a person walks out of that hospital . . . you are on your own. The hospital says it is you—the social worker (who has to deal with this now) (Hospital social worker, community hospital).
Hospital social workers also face other pressures, which mean that risk assessments may not be as thorough as, for example, this social worker would wish:
At the time that the hospital are referring to us, they are waiting for discharge, so you are on a pretty tight schedule to get this person out. You have hardly got time to make a relationship, never mind anything else, so I didn’t know her that well and I was judging on quite a superficial level that she was not safe.
A lack of cohesion in multidisciplinary teams has potential for scapegoating by locating blame at the level of the individual practitioner rather than at a systemic level (Fook, 2000). Another hospital social worker managed his anxiety through passing on responsibility:
Ultimately, it is the ward’s duty to discharge, not mine. The only thing I can do . . . we pull out the red card index, and we put a note on, saying ‘if this patient is finally discharged, she is at severe risk of whatever it is’, and that is normally enough to stop this, because no nurse will end up sort of discharging, having that written large all over the cardex.
A lack of clarity around responsibilities for risk management created dilemmas for practitioners and had the effect of pushing issues downwards to individuals to resolve (Clarke, 1998). Other agencies were quick to shift responsibility onto the individual social worker, who sought either to make a ‘risky’ decision or to close a case where there was no clear mandate for intervention. Notions of risk to the public in these cases dominated decision making and overrode agency procedures or even boundaries of legal obligation. In such a context, not even the social worker’s demonstration of factual inaccuracies in medical records, never mind evidence of change, could persuade mental health services that long-stay patients should return to the community. In one case, it was shown that no offence against a child had actually been committed and, in another case, evidence of progress was overriden by fear of public retribution. In both cases, the wider societal context of aversion to risk (Beck, 1992) so powerfully influenced agency responses that workers experienced a challenge to their professional integrity which could not be overcome by reason.
The structural context which enabled blame to be placed on individuals simultaneously deprived them of freedom of action. In the UK, in all public services, performance indicators, leading to star ratings, have been set by government as targets against which to measure service provision. These remain central to community care policy (Department of Health, 2006). Further pressures were placed on workers by the need to meet these indicators, even in circumstances in which they were not considered appropriate:
I am not in the business of trying to sell a care package which is more than somebody needs just to get some star rating (Hospital social worker).
Commonly, ‘Allocation Panels’ comprising senior managers make decisions on provision of services in a process separate from the assessment of need. Government guidance on Fair Access to Care Services (Department of Health, 2002) requires social services authorities to set eligibility criteria for receiving services which are based on balancing resources against need. This removes discretion from front line workers who then have to explain to service users why a complex assessment agreed in partnership with them cannot be financed. This is a situation which will inevitably worsen as budgets tighten:
It’s knocking the professional. You have done the assessment, you have been trusted to do the assessment and they are really questioning you over a piece of money (Social worker, Sensory Impairments).
Much time and energy was spent on the micro-economics of commissioning packages of care to enable people to remain in their own homes because:
In the community, even now getting carers is a complete nightmare (Social worker, physical disability team).
The care available was allocated according to strict eligibility criteria, creating a tension between distributive and individual justice in rationing resources:
A lot, you know, we don’t push for things for some people because we know there is only a limited amount of money and limited amount of day services but surely we should actually be saying that it is this person I am working with, this is what we have all agreed is the best plan for that person, so that is where I am going with this (Occupational therapist).
The commodification of care—constructing ‘care’ as an entity to be bought and sold—has absorbed these practitioners’ energies, filling time available for working with individuals and families. Community care practice has become an exercise in resource finding within a market economy. As the ‘core business’ of statutory agencies has narrowed the range of services to those seen as essential to the fulfilment of statutory requirements (White and Harris, forthcoming, 2007), rationing has replaced universalism in providing support in the community, to the detriment of individual service users and the freedom of individual practitioners. This narrowing of tasks appears to contradict the government’s proposals for widening the health and social care remit to encompass preventative work and work within communities (Department of Health, 2005, 2006).
Management
At the level of management, key issues arose in terms of managers’ ability to be responsive to their staff’s needs, and their skills in delivering appropriate support. Recurrent themes from participants were:
- a sense of distance between workers and ‘the Department’ at a structural level, without compensating evidence in this study that line managers were able to act as an effective bridge between policy makers and practitioners or to be ‘morally active’ in testing the interpretation of agency tasks against ethical principles necessary for the practice of social work (Dawson and Butler, 2003);
- though individual managers were seen as personally supportive and affirming of practitioners’ expertise, in some instances, senior practitioners were isolated by expectations that they could resolve complex cases on their own;
- managers themselves were sometimes seen as lacking appropriate knowledge or expertise because of differing professional backgrounds.
A lack of confidence that professional knowledge would be respected extended to some individuals’ experiences in their own agency. There was frustration that practitioners’ good ideas for amending systems were not adopted by senior managers but also that, even when practitioners had followed procedures, their judgement could be overturned if clients complained. Not knowing how much creativity would be tolerated, and worrying that decisions made in good faith would still be challenged, led practitioners to describe defensive ways of recording information in case files.
A striking feature of the research sessions was the extent to which the participants were driven by their value base but at the same time found it difficult to articulate the theory which explained or could predict the outcome of their case. A managerialist approach which focused on concrete outcomes rather than meaning and process (Lymbery, 2004) was of little assistance to practitioners struggling with complex cases which called for more than superficial understanding of psycho-social needs (Howe, 1996). Objectives for involvement were often stated in very general terms and it was clear that they were defined in terms of values, most notably ‘the rights of the individual to be free of discrimination’. Though there was congruence between personal and (officially stated) professional values, the gap between aspirations and reality led to both discontent and cynicism. Hence, one social worker described how a service user’s ‘overbearing’ sister constantly made official complaints which were then dealt with by the department in a time-consuming way. This social worker said of the detriment thereby caused to her client:
A lot of what was happening with them was outside of what professionally I believed in, and what I though the department believed in (Social worker, learning disability team).
Many participants described cases which had ended by them going sick or changing jobs. One mental health social worker was very aware of her personal vulnerability to receiving blame from other agencies: ‘. . . you are a target within the job that you do.’ At the same time, there was an acknowledgement of an unfulfilled need for support from senior management within her own organization which had too readily relied on her own senior status as an indicator of resilience.
Though support could be found within multidisciplinary teams, the professional identity of the line manager was an important issue for confidence and containment:
I have got a manager who is from the Social Services social work background, and a deputy manager who is from a health background and their approaches are so different, and if I had to have supervision with the health manager I would find that very difficult because I don’t think he would understand the issues and where I am coming from (Social worker, physical disability team).
This sense of diversity of styles and the contested nature of what is valued as good practice was echoed by a social worker in mental health who observed the contrast between the monitoring, ‘checking out’ and objective position of general psychiatric service and her own use of person-centred work (Rogers, 1967). The case presented was long-term and not typical of this social worker’s caseload and she had observed her practice being changed in recent years:
This is the current ethos . . . that you go in, you assess, you provide a service if it is appropriate and then you pull out (Social worker, mental health team).
This routinization of work had also changed the nature of supervision to concentrate on workload and case management issues and to neglect the professional and personal development agendas of education and support (Kadushkin, 1976). If supervision is seen in restrictive managerial terms as checking adherence to procedures, experienced staff are left to struggle alone with complex cases. This results in the drift within cases and the workers’ uncontained anxieties observed in these interviews.
For service users, organizational rigidity (Smale et al., 2000) militated against a ‘seamless web’ (Department of Health, 1989) of service provision, and there was wider concern that some individuals, particularly homeless men with complex multiple needs, were missing out on any service because they did not meet the high eligibility criteria for any particular team. In contrast, other agencies’ generalized anxieties about risk (Beck, 1992) meant that cases were kept open when no productive work was being undertaken for fear of harm to the public, especially children. Although these structural pressures were likely in any event to have proved overwhelming, social workers who did not have a good knowledge of the legal mandate for or against intervention and who were not supported by managers able to negotiate with other teams were at risk either of being weaker advocates or of acting oppressively.
Practitioner
At practitioner level, the impact of structural problems and ineffective management was combined with anxiety in meeting the changing knowledge demands of social work post modernization (Lawler and Harlow, 2005). We found that:
- a wide range of knowledge was required of practitioners, covering the spectrum from organizational knowledge (of their own and other agencies’ responsibilities and powers), through ‘moral knowledge’ (or clarity in dealing with issues when personal or professional values were highlighted), to ‘practice knowledge’ or the taken-for-granted knowledge from experience (Osmond, 2005);
- there was a lack of appropriate sources of professional advice to deal with cases that were, by their nature, complex and fast-moving;
- anxiety generated by the work, and by the context in which the work was done, was high, leading to stress, sickness or, in some cases, resignations.
Kazi (2000) usefully distinguishes between product (outcomes) knowledge and process knowledge when considering the cognitive processes at work in practitioners’ decision making. The present research was concerned with both process and product knowledge. The researchers identified important gaps in knowledge, particularly concerning legal issues, such as use of guardianship and enduring powers of attorney, local authority responsibilities to care leavers and the rights and obligations of public sector tenants. Such lack of knowledge placed social workers at a disadvantage in their negotiations with other professionals within their own agencies and externally. They were not confident in challenging decisions made by others and, in some cases, this lack of knowledge exacerbated the difficulty of decision making by raising the possibility of alternative courses of action, which were not legally available. So, for example, not knowing which of the possible alternatives, such as a family member or someone holding enduring power of attorney, had authority to arrange an older person’s admission to residential care created delay and confusion in resolving the case. Similarly, pressure from a service provider to move on a young woman with complex needs led to a series of unsatisfactory short-term placements because the issue of her rights as a tenant was not investigated.
Team managers, as noted, were not always able to act as professional advice-givers, particularly where their professional background differed. In some cases, they had no greater knowledge than the worker but, more generally, managers had become monitors of workloads, rather than sources of professional supervision (Lawler and Harlow, 2005). Access to external sources of knowledge, such as local authority solicitors, was, in turn, controlled by the team manager, as it was a commissioned service which was chargeable. Sometimes, professionals from other agencies were seen as helpful sources of information and advice but, in other cases, they were experienced negatively as prescriptive or not open to negotiation with respect to the knowledge they contributed. For example, a psychologist who gave the opinion that a woman with multiple sclerosis was not able to exercise parental responsibility did not involve the woman’s social worker at all when reaching this conclusion and a consultant psychiatrist in a statutory role did not share his diagnosis of personality disorder with the social worker in the multidisciplinary team.
There have been a number of studies which have considered the use of knowledge and reflection on knowledge in social work. These:
. . . have painted at best a picture of limited formal knowledge use in practice, and at worst, of such knowledge being of marginal importance . . . in the absence of conscious use of knowledge, others have resorted to a subconscious assimilation thesis whereby the absorption and use of knowledge is so ingrained and automatic that practitioners are unaware of its uses (Sheppard et al., 2000, p. 171).
If theory is used unconsciously and without articulation, ambiguity may arise in the service delivery process and practice behaviour is potentially unclear (Osmond, 2005). It was apparent in these sessions that theory did not provide a frame of reference within which the case study was presented. In the hurly-burly of activity and change, the opportunity to use theory to understand the world, to predict and to guide, had largely been lost. Nor could other members of the discussion group help with this. In a sense, their empathy with the other’s distress in the ‘telling’ of the story consumed their energy. This perhaps is why, although colleagues in the workplace were seen overwhelmingly as supportive, they too could not help to theorize situations:
After a while, when you are in this situation, you get to the point when you can’t even think clearly about theory (Social worker, physical disability team).
Ruch (2002) sees that reflective practice comprises diverse sources of knowledge which acknowledge both the intellectual and the emotional dimensions of social work learning and practice. Splitting off emotional experiences is a survival tactic in terms of the preservation of the self, but reinforces managerialism by leading to ‘prescriptive encounters’ (Ruch, 2002, p. 205) and ‘risk averse decisions’ (Ruch, 2002, p. 207). Relationships between social workers and clients then change their character from interpersonal to economic, from therapeutic to transactional, and from nurturing and supportive to contractual and service-orientated (Howe, 1996). So, in these cases described, although issues of loss and bereavement, poverty and abuse were obvious themes, analysis largely focused on the minutiae of day-to-day encounters and the first solution was seen as service provision, rather than a search for meaning based on the client’s history and relationships. Consequently, although involvement was long-term, it was largely reactive to crises in the client’s life or to service providers’ lack of confidence in their task. This meant individual practitioners were bombarded with telephone messages asking them to verify details of the client’s daily care routines which ultimately proved unproductive and exhausting.
Concerning the impact upon themselves, participants described cases which ended with them going sick or changing jobs. The hospital social workers and mental health team workers were faced with particularly difficult issues involving people’s mental incapacity, mental ill-health and offending behaviour. Fundamental issues of control and care are brought into conscious conflict in such cases. When seen in psycho-analytic terms, Shohet’s (1999, p. 51) comment that ‘we often mirror our client group’s inability to think clearly because of our distress’ well describes the anxiety of the worker. Systems and groups which are unable to contain such anxieties (Bion, 1961) lead to defensive practice, with one individual being isolated as others ‘disown’ parts of the problem. From a managerialist perspective, Balloch et al. (1999), in their survey of staff attitudes to contemporary social work, found that dissatisfactions with the way in which the organization was managed were most significant. Huxley et al.’s (2005) research into stress and pressures in mental health social work also found that long hours, paperwork, vacant posts, lack of access to services and resources, constant change and reorganization, statutory responsibilities and ‘being out of sympathy with the way services are run’ (Huxley et al., 2005, p. 1075) were significant stress factors. Positive factors were support from co-workers and managers, good supervision and harmonious relationships within the multidisciplinary team. Our participants’ responses mirrored these agendas and similarly located stress factors within the managerialist discourse, providing an analysis of the reasons for social workers’ dissatisfaction with their role and task.
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Discussion and conclusions |
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As the findings have clearly indicated, barriers to retaining and using professional knowledge were identified at structural, management and practitioner levels. The puzzle is why these barriers existed and persisted in staff educated, in some cases recently, to use professional knowledge and skills. A simplistic explanation would be that these practitioners had forgotten or were somehow wilfully ignoring everything they had learned during their education and choosing, instead, to act in ways bordering on unhelpful for the people with whom they worked. This solution appears to endorse Mencken’s (1917) well known dictum that ‘There is always an easy solution to every human problem—neat, plausible and wrong’, forcing us to consider other explanations.
When findings from this research are compared to and contrasted with those from earlier research (e.g. Jones, 2001; Lymbery, 1998; Postle, 1999b), some explanation, moving beyond blaming individual staff, seems feasible. In this research, as in other studies, staff were found to be relying on bureaucratic systems, fearful of blame for their actions, driven by the need to quantify performance outcomes, and accessing supervision which did not meet their need for guidance or support. When we compare these concerns with Harris’s (2003) key constructs of managerialism, above, clear patterns emerge. For example, staff described supervision as concentrating on procedural issues, sometimes with someone unfamiliar with their own professional ethos and way of working. If, as Harris suggests, management’s role is perceived as providing organizational solutions, this leaves little scope for a supervisory task encompassing, among other things, exploration and containment of anxiety or development of creativity. This also accords with findings from the outcomes of child death inquiries (Ferguson, 2005). Similarly, staff’s gaps in knowledge and its application seem at best puzzling and at worst very worrying. While there is a possibility that these may have been examples of the stage of unconscious competence at which practitioners operate instinctively and hence do not articulate formal theory (Sheppard et al., 2000), this seems a generous explanation. It seems more likely that they no longer relied on their knowledge, being dependent instead on a raft of procedures and routines.
Increasing bureaucracy has been widely documented (see, e.g. Postle, 2001) and is directly linked to the operation of the market for care. There is a real risk, however, that, for example, staff concentrate on the minutiae of putting care services together instead of seeing themselves and the skills developed through training as a resource. Hence, this becomes something which anyone can do, as long as they can complete the forms and professional knowledge and skills, being under-used and devalued, wither. This results in staff being unable to recognize and articulate their knowledge base and resultant lack of clarity in their practice (Osmond, 2005). This, in turn, is exacerbated by increasing workloads encompassing increasingly complex work generated by, for example, changes in demography including longevity, the ability to treat previously untreatable medical conditions and the ability to maintain people with mental illness within community settings thanks to innovations in medication and treatment. While these changes are undeniably positive, their impact on health and social care has not been reflected in policy initiatives. Furthermore, the increase in bureaucracy, particularly in forms such as standardized procedures and computer records, is evidence of the pervasive regulation and surveillance of social work. Such increased regulation, in addition to deterring autonomy and creativity, has been identified as emphasizing rules and apparent certainties, rather than acknowledging imprecision (Preston-Shoot, 1996). Thus, such procedures also serve to prevent working with uncertainty in ways which should be a hallmark of the profession, distinguishing it from those professions which seek concrete causes and solutions to people’s problems (Fook, 2000). The context of high-volume, low-intensity work itself militates against the need to have and apply detailed professional knowledge. It is hardly surprising that, as practitioners’ use of their professional knowledge is compromised and constrained by managerialist imperatives, they lack confidence, including the confidence to challenge other professionals appropriately or to act assertively unless other professionals support them. This demoralization and loss of confidence, in turn, resonates with staff’s feelings of stress and being devalued, both of which may well contribute to ill-health (Huxley et al., 2005; Ruch, 2002).
There are serious implications for the continuation of the ways of working described here. Fair Access to Care Services (Department of Health, 2002), with its emphasis on the banding of eligibility criteria according to risk rather than need and prevention, limits social work discretion and is likely to lead to practice which is predominantly investigative and forensic (Kemshall, 2002; Cestari et al., 2006). For people using services, this combination of barriers to retention and use of professional knowledge at structural, managerial and practitioner levels means that the key aspirations of the recent proposals for reform of services for adults in the UK (Department of Health, 2006), such as autonomy and choice for people using services, are less likely to be carried out satisfactorily. The modernization agenda depends upon robust partnership work across agencies and between professionals but this research evidence indicates that, as Lawler and Harlow (2005) describe, reduced autonomy and emphasis on micro-management militate against the likelihood of integrated service delivery and seamless services.
Further, the development of a risk-averse culture (Ginsburg, 1998; Parton, 1996) has led not only to mechanistic decision making and over-reliance on bureaucracy, but has undermined trust in other professionals as responsibility and, crucially, blame is seen to be located at individual practitioner level. Awareness of and sensitivity to the human rights of people using services is lost or frustrated as they become objects of concern and concurrently a lack of realism about the limits of social work involvement leads to an absence of consultation with service users about the appropriateness of continuing statutory involvement.
Social work staff working with adults increasingly find that the rhetoric of community care does not coincide with the reality of their everyday work (Gorman and Postle, 2003). Most worryingly, their practice in many cases is guided not by professional knowledge, but by procedural requirements and the need to meet government targets. Conflict between ideal and expected role performance, demands placed on them as employees as well as professionals, increased emphasis on instrumental rather than individual outcomes and societal pressure have all been identified as sources of stress in social work (Lloyd et al., 2002) and were all present here. The key dichotomy (Lloyd et al., 2002, p. 262) is ‘the discrepancy between the ideals of social work and what social workers actually do in practice’. This calls into question, as Jordan and Jordan (2000) have suggested, whether local authority social work has a viable future in the UK. If social work practice is to remain viable within this context, and we argue it should, there is an urgent need to consider and debate the form that it takes, particularly in relation to:
- how it works in real partnership with other agencies and professions, especially health (Lymbery and Millward, 2000);
- the impact of new ways of working with people who use services (Postle and Beresford, 2005) which necessitates a model emphasizing partnership and continuity, not surveillance and fragmentation;
- how social workers are educated for the test of retaining and enhancing knowledge, skills and values in adverse circumstances (Lymbery and Postle, forthcoming, 2007; Postle, 1999b);
- what models of management and supervision best support people in their task.
A commitment to empowering strategies enabling people to maximize choice concerning care, the combating of discrimination and social exclusion and a more equal partnership in ways professionals work with people using services raise challenges which it is critical to address. Both academic and practice agendas need to support and sustain the commitment and enthusiasm of all practitioners by debating and seeking to resolve structural, management and individual barriers to ethical and effective practice.
Accepted: March 1, 2007
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