Community care and management.
BA (Hons) Social work with Diploma in Social work
Candidate Number: 978454
HHSWD / SWD3
COMMUNITY CARE AND CARE MANAGEMENT
Title
The practice guidance from the Department of Health states:
The rationale for this reorganisation is the empowerment of users and carers. Instead of users and carers being subordinate to the wishes of service providers, the roles will be progressively adjusted. In this way, users and carers will be enabled to exercise the same power as consumers of other services (DOH 1991 P9).
Critically discuss this statement in relation to community care policy and service provision. Illustrate with examples from practice where possible.
The statement above is an ongoing issue and debate within social work care practice about whether; service users are able to be empowered as well as exercise their rights in choice. By recognising the dilemma, and acknowledging the possible conflict and how best practice allows social work professionals to be aware of these dilemmas. This also helps to find a balance to see both sides between these possible conflicting issues / dilemmas in social work practice.
For the purpose of this paper I will be looking at older people with dementia, the paper should then go on to examine the aims of social work practice with regards to empowerment and how service users rights in choice is not fully facilitated in regards to service provision.
This paper will then go onto look at community care policy, which facilitate these social work aims, and provide guidance for practitioners to promote changes for this service user group. This guidance will state whether the policy promotes service users and carers' rights as consumers.
I will be using examples from my very own practice as evidence, to highlight possible dilemmas, which may lead to issues of conflict with regards to social work practice. The paper shall then conclude by reflecting upon the importance of the awareness of these issues, so that hopefully demonstrates the need for developing skills and the need for more resources, in order to achieve a balance between these often competing aims.
Social work aims and role are diverse in order for social workers and practitioners to role facilitate and enable older people and other client groups, to enable to make change as well as maintaining areas such as health and well being.
How to achieve this is from using empowerment in service provision, an example of this maybe an older person having more of a say in the way their care is provided.
The issue, which may arouse around older people in care settings, is the conflict of what is considered to be best for the client. Their needs are weighed between empowerment and protection. Nolan et al (2001, p85) describes how both areas can be achieved, "yet involvement in decision making has positive benefits for the residents of nursing homes, with several studies demonstrating a relationship between the maintenance of personal control and resident outcomes such as psychological well being and satisfaction with care."
In terms of rights, laws, policies and legislations are available to provide support to an individual to live their life the way they wish to live. Laws, policies and legislations reflect, underpin and support the work social workers aim to achieve terms of empowerment and protection. In relation to law with older people, The Department Of Health's main function is to protect. Laws, policies and legislations underpin practice and place a duty and requirement on local authority to provide services, resources and funding for services and resources.
There are a few policy objectives, which have been the subject of such detailed analysis as such, Community Care. From my own observations it is evident that little has been done for older people apart from maintaining their lives within their own home. Walker (1995) book 'half a century of promises', explains how current policies continues to fail older people with the outlook of service providers and professionals still dominating, as agencies actively compete to discard responsibility for service provision to the most frail and vulnerable older people. The belief that the Community Care Act can provide an alternative to institutional care has not been assessed and not been proven properly, but the Audit Commission, Forget me not: Mental Health Services for Older People (2000) identifies the need for better service provision, services to be flexible and the need for better access to services. In regards to these recommendations, this may help a service user with dementia, to be empowered and rights are exercised by professionals in a method of working together.
Service users are now being considered as consumers of services as part of the 1991
Department of Health: Practice guidance. The guidance aims to promote service users rights as consumers. As a consumer the main principles we would expect is accessibility, information, complaints service, value for money, choice and support during the service delivery.
Community care uses a market principle of supply and demand for provisions of services. The belief that consumers are free to choose will help regulate price and quality in the market by eliminating poor and expensive services. In order for this ...
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Service users are now being considered as consumers of services as part of the 1991
Department of Health: Practice guidance. The guidance aims to promote service users rights as consumers. As a consumer the main principles we would expect is accessibility, information, complaints service, value for money, choice and support during the service delivery.
Community care uses a market principle of supply and demand for provisions of services. The belief that consumers are free to choose will help regulate price and quality in the market by eliminating poor and expensive services. In order for this to happen there should be a wide choice to allow competition. The balance of reduced costs and quality would only occur if there were competitions between service providers (DOH 1990a).
The notion of market principle can be unfair and unreasonable. Services will function according to a set level of resource, despite consumer preference (Bamford 1990). This kind of system benefits those who are financially better off and those who are less fortunate have to settle for services provided through needs assessment by the local authority. Through placement experience, I had acknowledged that the local authority would bid for big tenders, as the competition would be vast. These big tenders would lower their costs in order to receive a contract for long-term service providing. So the service user would have to make do with whatever the local authority were providing if they could not afford elsewhere. The principle of choice can never be achieved for poorer consumers, because the market aims for richer people. The market providers aim to provide a service, which is profitable to them.
Choice is inhibited because of limited availability of resources, the notion that supply of services will meet responses to demand is inconsistent because cash stricken services.
Empowerment sits very nicely with social work value base, but it can also be argued that social workers and practitioners fail to promote service users rights because they are more concerned with control. This fundamental issue relates to professionals working within limited resources and budget control. Morris (1997) discovered barriers, which prohibited service users 's right to choice. One in particular was, social services having block contracts or service agreements with agencies/ residential establishments. This allowed social services departments to have control in delivering services that were cost effective to them but service users were subordinate to the provider's wishes and service users choice are not exercised.
Common and Flynn (1992, p35), also agree that choice is not practiced, "research results have prompted concerns that contracts limit innovation, increase bureaucracy and fail to increase user choice and involvement. The professionals assessing need and allocating resources still retain control over choices."
The assessment of people's needs is a local authority's responsibility part of the section 47, NHSCCA 1990. After assessment the needs are seen whether service provision by community care is required. Needs led assessments are being highlighted in order to move away from resource led assessments. This act allows professionals to fit a person into an existing service rather than getting the service to fit the person's needs. But because of limited resource and cheap services choice is prohibited. An example during placement experience, a home carer being g sent to an elderly person home to provide caring duties. Due to lack of resource and money the carer has to provide home care at an early time of 7pm. This is considered too early for the client who wishes to go to bed after 8pm. But as there were no other services the client had to settle for what was provided, this was a violation of the client's choice.
From my experience these issues can be magnified from discrimination and oppression into multiple forms of discrimination and oppression. This also may impact upon an older person. The principles of consumerism underpin many of the objectives from community care provision. Services are meant to be accessible in terms of location and user friendly. People have the right to information about the services and the eligibility.
The Carers (Recognition and Services) Act 1995 and the Community Care (Direct Payments) Act 1996 established statutory intervention in the caring field. With this act carers are able to have the right to an assessment but not to services, whereas the users is. Direct Payment scheme does allow users to obtain cash instead of services from local authority. It is then the responsibility of the user to obtain services with the cash given. Direct Payment scheme promotes a caring service, which revolves around contracts and employment law. For those who do not understand the legal jargon it can become confusing rather than empowering. The local authority still has an overall say, " local authority has discretion over whether to offer someone direct payments and can decide whether they are appropriate and whether the disabled person can manage them (DOH 1998a in Sharkey, 2000).
The case for people from minority cultures, for various reasons they are not being able to access these services, and if they do they may be misunderstood due to difficulties in communication, misinterpreted and subsequently misrepresented due to the lack of awareness because of the culture differences.
There are many reasons as to why some cultures do not or cannot access themselves to services. Family support may be non-existence within certain cultures. Families may wish to keep issues surrounding there family member within the family, another possibility of not accessing the services maybe that the family do not see it as a norm or find it embarrassing to access help. The common factor I found during social work practice was individuals not knowing where to go to find help, due to lack of information, communication problems and lack of support from family members and peers from the community. Here the adults are not being protected, are not empowered, and cannot exercise their rights to choice as they cannot access these services.
There maybe fear surrounding the support system, and the possibility of one service does not fit all but anti discriminatory practice ensures that it is correctly and effectively provides for individuals and groups from different cultures. This there fore counters the possible disadvantages of multiple forms of oppression faced by people. This ensures the best in empowering practice and the best in promoting choice within the scope of the remit and resources within the agency.
The White paper Caring for people (DOH, 1989), aims hope to enable people to live a normal life as much as possible in their own homes or in a homely environment in the community. It also states that the right amount of care and support should be provided to help people achieve independence by maintaining basic living skills to achieve daily living activities. The main aim, which highlights empowerment, is the prevention of gate keeping allowing individuals to have a greater say towards how they live their lives and the service provision. During placement, gate-keeping services was evident. I had observed how senior professionals would delegate how the services would be rationalised due to budgetary and resource control. This would be passed through various professionals within the department. Social workers would be messengers to services users, they would explain how certain services would not be available due to the lack of funding. Social workers are in a clear disadvantaged position because they have to compromise the services user's choice by having to be within the budgets of the department.
This is in relation to my social work practice, within the team and neighbouring teams they were experiencing difficulty in funding and their resources were low. For older people it was a conflict of protecting the individual from risk and still providing opportunities to be independent. The lack of resources and funding meant whatever services were available could be offered, empowerment was not promoted but protection for the older person was being demonstrated, allowing the individual to be free from risk and isolation. Part of the community Care Act 1990, highlight choice, Kemshall (2002, p76) states how this can be conflicted with one's own personal view, "choice, a central principle of community care, can be significantly undermined by professional desires to prevent risk."
Both empowerment and choice was not demonstrated simultaneously, but laws such as the Community Care Act 1990 which place a duty care and protect, can overpower the argument of protection when preventing an individual and others from risk.
The laws, policies and legislation compliment the social work value base and requirements, which is laid down by the General Social Care Council and The Central Council for Education and Training in Social Work.
The General Social Care Council highlight codes of practice that call for attention towards empowerment and choice. The guidelines are aimed at employers and employees to maintain to a standard of practice within the social work field. The General Social Care Council, codes of practice expect social care workers to, "Supporting service users' rights to control their lives and make informed choices about the services they receive; " (G.S.C.C. 2002 p1).
The Central Council for Education and Training in Social Work has a list of requirements for social care workers and trainees to demonstrate within their practice and during their practice experience. However, choice is not clearly written within these requirements. It is thought that choice is interpreted and implied within these requirements. Without choice being clearly written in the practice requirement, choice will not be promoted and not seen as a priority as part of a duty of a social worker. Though the social work value base does emphasise choice, CCETSW (2001 p5) "promote people's right to choice, privacy, confidentiality and protection, while recognising and addressing the complexities of competing rights and demands."
Delivering services within a limited resource and budget and promoting choice will always have conflict as social workers aim to balance out the odds and evens to link the two aims together. It becomes evident during practice, that the two share values, which can go either side still making each side both right and both wrong. Personally it depends on what the service users wishes are. The needs of the service user maybe a priority compared to their wishes, but if a service user wishes to have their wish met over their needs then that is the service users right. However the complexities of older people with dementia of what I have seen through social work practice, is the law taking control of the situation and the service user if they are unable to look after them self or unable to make a fully informed decision. The law is placed to protect the service user and others from possible risks, but the law also states empowerment and choice to be promoted.
Lack of resources may not empower but the only course of action if there are no resources to support the service user in the community, and then we should use our human values and power to take action against oppression. Often the balance will not reflect one reality or the other. It will only meet people's needs if resources are available.
Awareness and anti discriminatory practice gives a balance. From my own experience I had learnt that some agencies might have limited resources and lack of awareness. If a social worker is not aware or informed of these factors, then they will not be able to achieve empowering practice and that they will find their practice may revolve more around issues of empowerment and choice and evidently service users and carers choice is forgotten.
In addition working in a culturally sensitive manner, it is an aim and wish for services to be improved and that the appeal and accessibility of services to minority groups who are under represented. Awareness of these issues is critical part of our practice as well as balancing the needs and rights of service users is an essential part of social work practice. Knowledge and skills need to be updated for managers and practitioners, via training. The balance of delivering a service and promoting choice is different for each case study and service user group.
Service user empowerment is used when trying to promote consumer choice. Those who have an assumption that consumer choice helps to enlarge the market place is clearly mistaken. When placing consumerism, people who believe support and independence and control together, it is highly unlikely to achieve its goal because it causes conflict when matters like limited resources prevent empowerment from taking place. Market place principle, limited resources, gate keeping, resource led assessments only prevent consumer choice. Assessments may have strict criteria but if the user does not meet the criteria they will have to wait until they do, unless the individual consumer can provide money for their own care themselves. This will allow the statement above of having the rights as other consumers of other services to be achieved.
Candidate Number: 978454