Neil Thompson looks at research relating to
ambiguities and tensions in care management work, which have a detrimental
effect on staff morale.
In this important paper, Karen Postle draws on
recent research into the workings of care management and combines this with
insights from her own study in which she undertook observations and interviews
with two teams of care managers working with older people. From the research
she was able to identify five tensions, as follows:
– Restricted resources to meet needs, as
against emphasis on assessment of needs.
– Focusing on the precise detail of financial
assessments, as against dealing with the person.
– Spending time on paperwork and IT, as against
taking time to develop a relationship.
– Increasingly complex work, as against more
reductionist processes such as checklists.
– Concern about all aspects of risk, as against
speed of work throughout increasing risk.
Postle points out that such tensions are not
new in social work, but argues that the changes brought about by the
implementation of the NHS and Community Care Act 1990 have certainly
exacerbated them. With these changes, she argues, comes a degree of confusion
and disillusionment that have a detrimental effect on staff morale.
I am well aware from my own work as a trainer
and consultant that this is the case. My experiences reflect and reinforce the
researcher’s views that considerable confusion exists over the role of care
management and its relationship with social work – for example, with many
practitioners regarding care management as a replacement for social work rather
than another form of it.
Postle’s basic message from the research is
captured in her comment that, “It seems likely that a deskilled and demoralised
workforce perceiving itself to be operating a reductionist process of assessment
in a climate where managerialist and financial concerns predominate will give
poor quality service to the older people with whom it works.” It makes sense to
argue that standards of practice will be adversely affected by anything that
undermines morale and job satisfaction, given the relationship between such
factors and motivation.
She welcomes the decision to move towards
degree-level professional training for social workers as an important step
towards addressing some of the issues identified in her study. However, the
recent comments of government minister Jacqui Smith, which present her view of
social work as a “practical” activity, with theoretical matters clearly
de-emphasised, lead me to wonder whether a degree based on such a mentality would
actually add to the problems Postle identifies, rather than go some way towards
tackling them. Social work is very much about practice, but it has to be a
well-informed practice if it is not to collapse under the pressures of the
inherent conflicts, tensions, dilemmas and difficulties that arise so
frequently. As I have argued previously, “To reject the value of academic
matters is therefore to fail to recognise the important interconnections
between theory and practice, thinking and doing.”1
Postle is right to argue that professional
education should aim for a “both/and” approach to maintaining academic
standards and meeting employers’ needs, rather than an “either/or” one. I think
she is also right to argue that: “If an either/or approach continues, it is
likely to be the front-line staff, rather than their senior managers or
academics, who are left to try to resolve this tension, thus exacerbating the
ambiguities already experienced.”
– K Postle, Working “Between the Idea and the
Reality”: Ambiguities and Tensions in Care Managers’ Work, British Journal
of Social Work, 32(3), 2002.
Neil Thompson is director of Avenue Consulting
and visiting professor at the University of Liverpool. He is editor of Loss
and Grief: A Guide for Human Services Practitioners, published by Palgrave
1 Neil Thompson , Understanding Social Work:
Preparing for Practice, Palgrave Macmillan, 2000.