News

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 Ltd (www.avenueconsulting.co.uk) and visiting professor at the University of Liverpool. He is editor of Loss and Grief: A Guide for Human Services Practitioners, published by Palgrave Macmillan, 2002

References

¹ Neil Thompson , Understanding Social Work: Preparing for Practice, Palgrave Macmillan, 2000.