WORKBOOK 1 - UNIT 1

VALUES & RIGHTS SECTION 3:

Values are what people believe is
SECTION 3
right. Impossible to sustain a value-
free approach in social care.
Human Rights legislation makes it
impossible for standards of
behaviour based on ideas of
freedom, citizenship, rights and
responsibilities to be protected by
law.
Awareness of rights and values may
help prevent social exclusion.
Values can cause dilemmas,
conflicts of interest and have
contested meanings in social care
practice.
Case study: Mr Trebus v Haringey
Council: Denied human rights,
values.
Argument: Environmental issues
for other in the area – their rights,
etc.
POWER & INEQUALITY: Power to
hire or fire, to decide what care type,
SECTION 2
MEANINGS, THEMES how to spend direct payments,
chose home care / residential, hours
VALUES AND VALUES THE
required, intensity of care / support /
AND COURSE
RIGHTS THEMES help. Power of carers, family,
professionals, etc. Opposite is the
SECTION 1 – WHAT’S IN A TITLE? reverse of all these.
DIFFERENCE & IDENTITY:
Cultural / religious differences, age,
gender, geographical,
COMMUNITY – SECTION 1.1: Can be based on who you are, demographics, labels, stigma,
own sense of identity, sense of belonging and not belonging choice, dignity, resources,
inclusion/exclusion). Mutual interests, sharing, strength, equality. information.
RIGHTS & RISKS: Choice, needs,
Defined by geographical boundaries. Personal relationships and eligibility, resources, costs, basic
support. Identity – spiritual, cultural, class, generations. human rights, protection, abuse,
Negative: control, pressure, exclusion, fear, rejection neglect, respect.
TERRITORIES & BOUNDARIES:
Aspects of life divided into
compartments by own/ other’s
definitions. Sometimes help, hinder
care provided/experienced.

WELFARE SECTION 1.2: Concern for others, benefits,
provisions, support.
‘System to help people’s needs which they can’t organise on
their own’ – post WW1 institutions power and control - then
Human Rights and campaigns for change due to exposure of
abuse / costs of institutions changed the welfare state to
community care after WW2 to this day.
Negative: needy, labelling, scrounging, poverty, idle, charity,
demeaning, stigma.
CARE SECTION 1.3: Support, empathy, helping, protecting,
love, attachment. Informal/formal, home/residential, hospital,
day centres. Eligibility criteria, direct payments, free, access
(minorities)
Established in law and gov policy - 1990 NHS & Community
Care Act / 1995 Carers Act. Rights of cared for and carers.
Care is identified, organised, regulated and costed.
Negative: abuse, controlling, burden, dependency, lack of. Poor
reputation since institutions post WW1.
 UNIT 1 - COURSE THEMES AND CASE STUDIES
•The words care, welfare and community are part of
everyday speech and yet evoke different meanings
•Identifying these meanings involves acknowledging
individual and social difference in experience
•Exploring the meanings of care, welfare and
community helps to identify how people support each
other at interpersonal and societal levels
•Awareness of why and how these different meanings
are evoked makes a positive contribution to meeting
need and supporting people in ways which they find
acceptable
•The course themes are ideas which help to organise
and challenge the evidence and information you’re
presented with in the course material
•Each of the course themes highlights a significant
issue in discussions about care, welfare and
community
•Power and inequality are issues for interpersonal care
relationships as well as for the provision of care at
national levels
•Difference and identity help to show that users of care
services may have varied ways of describing
themselves and that these have significance for how
they access and choose to make use of care and
support
•Rights and risk run through all aspects of decision
making about care provision where autonomy and
protection are at issue
•Territories and boundaries draw attention to those visible and invisible distinctions which
can sometimes help, sometimes hinder, the way care and support are provided for and
experienced
•Values are what people believe is right and underlie the different ways people
communicate with one another
•It is impossible to sustain a value free approach to social care work and is unacceptable
also
•Human rights legislation makes it possible for standards of behaviour based on ideas of
freedom, citizenship, rights and responsibilities to be protected in law
CASE STUDIES
R&R: Pamela Coughlan: Human rights: right to a home for life Health authority argued
that her needs and those of her co-residents were a risk to their budget and attempted to
shift financial responsibility to social services
R&R: Mr Tebus: Human Rights: right to a particular lifestyle. Local council argued that
his actions were potential risk to his own and his neighbours health and safety .
D&I / T&B: Meera Syal “Anita & Me”: Reader article 15 Ideas of community, physical
environment, Punjabi community, female community, cultural community. Community as
basis for personal relationships and support Community defined by geographical
boundaries Community based on identity
P&I / T&B / D&I: Claire & Andrea Michael & Clarice: Ideas about professional and
informal care. Caring for and caring about. Andrea is professional carer, cares for Clare.
Clare may not like being cared for and may prefer to see it as a service. Andrea may
also care about Clare as a client. Michael is informal carer for mother Clarice, and cares
about her. He makes sure she is cared for also, but not by him.

CARING ABOUT COMMUNITIES:
Amitai Etzoni’s ideas:
• a need for a set of shared moral values
•A commitment to responsibilities as well as rights
•Communities which lay claim on their members
•Fears of the alternatives: state coercion – moral
anarchy
GENDERED COMMUNITIES:
• Various differences in communities;
urban, rural, inner city, middle class,
working class, mixed, black, white,
multiracial, affluent, poor,
fragmented, cohesive. Experiences
based on; age, gender, disability,
culture, inclusion/exclusion.
Neighbourhoods, locality, area,
network, interest, identity, support.
• Role of men & women can differ but
changes have occurred throughout
the decades/centuries
• Communities – responsibilities,
trust, accepting of outsiders, helping,
supporting
WORKBOOK 1 - UNIT 2
ACCEPTING COMMUNITIES: RECOGNISING TRUST:
• Social exclusion – mental health problems • Etzoni’s – trust and co-operation
• Exclusion based on drawing attention to • Shared resources, initiatives, support
difference
• Inclusion, involvement,
•Assumption that people need to make partnerships/relationships, shared
contribution to be part of community interests
SECTION 5
•Effects of lack of recourses,
INCLUSIVE support for care
COMMUNITIES
REASEARCH & FINDINGS: CARE
SECTION 5 – INCLUSIVE COMMUNITIES IN, BY, FOR & OF THE COMMUNITY
SECTION 4 SECTION 3
SOCIAL NETWORKS OF CARE & SUPPORT:
GENDERED COMMUNITIES AND NETWORKS &
COMMUNITIES
NETWORKS SOCIAL •At about the time that government
INTERVENTION policy was shifting towards the
SECTION 1 – LIVING IN THE COMMUNITY community as a base for care and
support, some researchers were
LIVING IN THE COMMUNITY: questioning the survival of social
networks in some communities
•In practice, people use the notion of community to refer to shared
understandings built around place, culture and ethnicity
•Distinguishing care in, by, for an of
communities helps to identify the
•The resources within a community tend to be those which people
interconnections of formal and informal
identify for themselves or those they work with sources of care and support
•Making a change in a community depends on recognising what
•Recent research testifies to the
links as well as what divides people from each other and the survival of networks of support, for
environment and structures within which they live and work
example among older people, but with
SECTION 2 – COMMUNITY & POLICY changed characteristics

Key Points : THE SHIFT TO CARE IN THE COMMUNITY & IDEALS AND REALITIES OF COMMUNITY:
•The shift for community as a basis for care gathered momentum among policy makers in the late 20th century as it became linked with ideas of
cheaper and more effective care and support

•Wider social and economic structural change has sometimes affected the conclusions that sociologists have drawn about the communities they
have researched

•The ways people talk and write help to identify what are perceived as obligations to and expectations (both positive and negative) of community
life
 UNIT 2 - COURSE THEMES AND CASE STUDIES
Darnall & Tinsley residents - Unit 2, communities
ALL COURSE THEMES:
Ideas about community in relation to course themes
P&I: regeneration budgets; lack power to strengthen
bargaining position; competition for resources between 2
communities; health inequalities (health action zone set up)
D&I: separate communities, but lumped together; shared
language; shared backgrounds; family membership;
attachment to place
R&R: Idrisullah Bashir at risk without care and support;
Catherine Galloway at risk of depression and social isolation;
Mohammed Ayub at risk of serious health problems unless
traffic pollution reduced
T&B: 2 communities linked as one for administrative
reasons; but divided by physical environment & motorway
through centre; joint territory also divided from main city;
lunch club for Asian men requires separate territory
Unit 2, care in, by, for and of the community:
ALL COURSE THEMES:
Care in the community: Bangladeshi Home Care Service; Darnall
Elderly Asian Men’s lunch club; Tinsley Forum; Yvonne’s walks
Care by the community: Catherine’s family; Catherine’s support for
local youths; volunteers supporting Tinsley Forum
Care for the community: regeneration funding; grants for local
agencies from the council
Care of the community: Bangladeshi Home Care service
Keith Shires, Garth Crooks, Maurice Hayes, Janet Foster,
Kevin Hetherington - Unit 2, communities Reader article 11
Ideas about expectations and obligations of different communities
GENDERED WORKBOOK 1 - UNIT 3
COMMUNITIES:
INFORMAL CARE?
There are similarities and • The idea that informal care is the right solution to the problem of providing help and support in the community has been
differences in the experience
of individuals who give and
challenged by feminists who have regarded it as being oppressive to women.
receive care. • Their position conflicts with that of the disabled rights movement which argues that ‘care’ should be replaced by rights
and resources for people with impairments.
• Some of the main • It may be possible to reconcile these differing positions through a common agenda – one which works towards
differences are as a result of reductions in the effects of a disabling environment; and which recognises that personal support will continue to be
the influence on personal provided through informal relationships involving care by women and men, and that residential care can be a positive
relationships caused by such choice.
factors as position in the life
course, type of care being A HIERARCHY OF OBLIGATION /
given, mental health, gender, SECTION 5
DIFFERENT RULES FOR
and the nature of the IS INFORMAL CARE THE ANSWER?
SECTION 3
SECTION 4 DIFFERENT PEOPLE:
relationship between the carer WHY DO SOME • There is a hierarchy of obligation
and the person being INFLUENCES – CARING PEOPLE which influences judgements about
supported. GIVING/RECEIVING RELATIONSHIPS BECOME who should care for older people: in
CARE descending order, spouse,
CARERS?
• We are all givers and SECTION 1 – WHO ARE THE CARERS? daughter, daughter in law, son,
receivers of care at different other relative, non-relatives.
stages of our lives and TALKING ABOUT CARE / THE DEMOGRAPHY OF CARE:
• Spouses and partners are the first
therefore, across time, we all ‘line of defence’ in caring. It is only
experience different levels of •Substantial impairment is not common until beyond the age of 80. Even in this age
group four out of five people do not have substantial impairments. The family remains where there is no spouse, or the
dependence, independence spouse is unable to provide care,
and interdependence. the main source of care for disabled and frail older people.
that other family members are likely
•Two main groups of informal carers can be identified: those who provide personal to become main carers.
• Feelings associated with • Caring for someone who is not
giving and receiving care are and/or physical care for people who live in the same household, and informal helpers
who provide practical support for friends, neighbours and less close relatives. one’s partner is negotiable, but
influenced by power in within a framework of rules.
personal relationships and its • Who feels commitment to do what
interaction with factors such •Two out of five carers are men
in families may depend on
as inequality, sexual individual histories and feelings of
relationship and carers’ •The way survey questions are worded significantly influences responses. Geographical
mobility has affected the nature and frequency of caring contacts. obligation.
coping tactics. There is often reciprocity between
the parties in the caring
SECTION 2 – CARE BY FAMILY/COMMUNITY
relationship.
WHERE PEOPLE LIVE / FAMILY OR COMMUNITY?
• The majority of older people and younger disabled people live in their own homes in the community.
• Among younger disabled people those with learning disabilities are more likely to live in some form of residential care.
• Not all disabled people living in private households will necessarily be living independently in the kind of home they want to be in.
• The availability of family support will depend on a number of factors, such as expectations, housing, finance and the availability of help and support.
• The UK’s minority communities differ among themselves in many important respects.
• By focusing on problems there is a danger of overlooking the fact that some people from minority ethnic groups may be advantaged or coping well when it
comes to caring.
• Members of minority communities do have greater needs stemming from experience of poor health, unemployment, poverty and racism.
 UNIT 3 - COURSE THEMES AND CASE STUDIES
Unit 3, carers Audio 1, programme 1
Jonathan Smith & Jane Weston, Julie & Les, Carol

Ideas about caring relationships

Carol distinguishes between being a relative and a carer – social care workers do not always recognise who the carer is

Julie complains about the disbelief about the extent of help she provides her disabled 11yr old son, but feels rewarded by her
son’s development

Les and his wife complain they are often ignored at meetings with psychiatrists about their son’ mental health problems, but says
they still have a good relationship with their son

Jonathan and Julie run carers projects and see their role as enabling people to recognise their caring role and get the help and
support they need. Jonathan says that almost 100% carers do it because they want to because they love the person they are
caring for

Difference and identity , Power and inequality , Territories and boundaries

Unit 3, carers Audio 1, programme 1 - Anna Manwah Watson & Lily Sau Han Braid , Al

Ideas about meeting minority needs

Anna and Lily discuss difficulties caused by the isolation of the Chinese community in N.I. and the isolation of individual families
– been no development of services to meet the needs of people whose culture and language is different to the majority.
Families provide much of the care because there is no one else, and this gives false impression of self-sufficiency

Delays in race relations legislation in N.I. meant no pressure on authorities to improve services

Al is a carer for his parents and is not happy with his label, as he sees carers as people who are not relatives. He says he does
it out of respect and duty.

Difference and identity


DIVISIONS WITHIN
SOCIAL CARE / WORKING
ACROSS BOUNDARIES /
CONSTELLATION OF
NEEDS:
•Service users’ needs are
often complex and diverse.
•Health and social care
needs can be difficult to
disentangle.
•Joint working has been
given high priority in recent
health and social care
policy.
•Dismantling boundaries
between professions and
agencies brings with it
advantages and
disadvantages. The
advantages for users appear
to be considerable. For
workers there is a more
mixed picture.
WORKBOOK 1 - UNIT 4
WHAT USERS WANT / CARE OR
SERVICE / WHAT’S IN A NAME? /
SOCIAL CARE & CONTROL:
SECTION 4 SECTION 3
SHIFTING THE TERRITORY OF CARE, Users appear to value a one stop
BOUNDARIES SOCIAL CARE SERVICE, shop, and attention to small as well
HEALTH & CONTROL? as big issues.
SOCIAL CARE
SECTION 1 – WHAT IS SOCIAL CARE? •The concepts of care, service and
control are central to social care and
many other human service
NHS & COMMUNITY CARE ACT 1990: occupations.
• The NHS and Community Care Act 1990, and its equivalents in Scotland •User’s ability to determine the
and Northern Ireland, stimulated an increase in social care services and a services they receive can be
growing recognition of social care as a coherent set of job roles. compromised by the fact that they
are not directly paying the bill.
• Social care involves provision of support to people who require support to
lead autonomous lives. •There is vigorous debate over what
language to use to describe client
• Ideally, social care is flexible and offers different kinds of support and groups – with some believing it
services according to need. makes little difference what people
are called, and others arguing that it
• Social care may be as much about supporting carers as it is about is essential to get the language
supporting people who are regarded as service users or clients. right.
•Not all service users volunteer to
SECTION 2 – WHO WORKS IN SOCIAL CARE? be cared for.

ROLES OF SOCIAL CARE / RELATIONSHIP BETWEEN SOCIAL WORK/CARE / WORKING IN SOCIAL CARE:

•Social care involves a wide range of roles and tasks carried out in different settings.

•Social workers are a recognised professional group, with higher status and pay than social care workers.

•Care work varies widely in terms of salary, status and working conditions but is generally under-rewarded when compared with other types of work.

• Social care work draws on a combination of knowledge, skills and values, some of which are shared with other occupational groups.
 UNIT 4 - COURSE THEMES AND CASE STUDIES
MERIT - Unit 4, social care Audio 1, programme 2
Considers what characterises social care and gives history of community based services for older people with mental illness
Social care before 90’s was meals on wheels and home helps and ancillary social workers. Mavis Murphy suggests social care has become
recognised as important since NHSCC Act 1990.
MERIT also provides social care to people with dementia and people like Marjorie with learning difficulties.
Good illustration of how social care services have changed since NHSCC Act.
Territories and boundaries , Difference and identity
Unit 4, service user satisfaction - Service users want: flexibility, speed of service, one seamless system, care management approach

Rosemary Bland - “Independence, privacy and risk” Unit 4, social care or service? reader article 25

Territories and boundaries , Difference and identity ,Rights and risk

Ideas about the difference between social care and service. Comparisons with hotel model.

Mark: Unit 4, social

Carole McHugh “House calls” - Unit 4, working in social care Reader article care roles - Territories
32.1 – Territories and boundaries and boundaries
Julia Twigg “carework
Outreach worker who supports people with mental health problems in their own
homes
Introduces idea of
multidisciplinary teams.
and bodywork” -Unit
Discusses skills needed for the role and the dilemmas Carole faces in making 4, divisions within
choices and drawing boundaries social care Reader
Mark has needs relating
Highlights that social care work involves complex decision making, well developed article 33
to mental health, alcohol
interpersonal skills, wide-ranging knowledge and professional integrity use, housing, physical
Territories and
health and learning
boundaries
Raj & Gladys - Unit 4, negotiating social care - Power and inequality , disability.
Power and inequality
Territories and boundaries, Rights and risk
Multidisciplinary team
Discusses Raj and her caring relationship with Gladys. Raj is Asian, Gladys is white highlights that many
Ideas about care work
working class. Raj instructed not to do housework, but Gladys embarrassed about people in receipt of
and body work:
personal care and only wanted help with housework – this was denied. Raj did social care have needs
Personal care crossing
some housework on request after feeling sorry for Gladys despite it not being relating to other services
normal boundaries of
authorised because she has some spare time. They both ended up feeling good such as health, criminal
privacy and bodily
after this. justice or housing.
functions, normally with
older people and
BUT this could potentially leave them both vulnerable and at risk: Raj could lose her Highlights professional
disabled people, and
job and Gladys’ health could suffer because more time spent doing unauthorised territories, practice
normally by women
housework territories, and
boundaries of agencies
 WORKBOOK 2 - UNIT 5

AGEISM & THEORY OF
STRUCTURED
DEPENDENCY /
DEPENDENCE &
PRACTICE:
•Social care practice and the
theories that underpin it are
not value free
•Being clear about the value
base of theories helps social
care workers to understand
what they are doing and why
•It also helps to clarify and
explain some of the complex
dilemmas workers often face
SECTION 3
SECTION 4 THEORY IN IDEOLOGY
DIAGNOSING
SCHIZOPHRENIA /
VALUES AND CHANGING PRACTICE &
CHALLENGING DIAGNOSIS
THEORISING CONFLICT / PSYCHIATRY’S SCEPTICS
OVER
/ ANTI- PSYCHIATRY /
SECTION 1 – THEORY & THEORISING? THEORY DECLINE OF ANTI-
PSYCHIATRY:
ORDINARY THEORISING / GENERALISING &
• Theories underpinning
PREDICTING / GENERATING THEORY THROUGH
practice may be challenged
RESEARCH:
• Such challenges may be
• Theories are ways of explaining action and reality
part of a broader ideological
movement
• We all draw on theory to make sense of our everyday
lives and to justify our actions
• In the disputes that follow,
theoretical issues are raised
• Through the use of theory we are able to generalise and
that have major implications
make predictions
for practice and the values
underpinning it
• Theory is generated through a mixture of inductive and
deductive reasoning

SECTION 2 –DIFFERENT THEORETICAL PERSPECTIVES

BIOMEDICAL (medicine & biology) PERSPECTIVE / COGNITIVE/BEHAVIOURAL / DEVELOPMENTAL / SOCIOLOGICAL:

• Different disciplines draw on different theoretical perspectives in studying the same condition

• Within a discipline, debates centre on alternative theories and on research which tests and develops them

• Different theories are not necessarily incompatible, rather the are different ways of seeing and knowing

• People and organisations may have powerful vested interests in particular theoretical formulations
 UNIT 5 - COURSE THEMES AND CASE STUDIES

Yolande, Maeve & Mrs O’Brien - Unit 5, theory Mrs HortonUnit 5, dependence and practice

Yolande’s actions are based on theory that people develop tolerance to

painkillers – but just a personal belief Mrs Horton had decreasing mobility, visual
impairment and lived in residential home.

Frequently left her handbag unattended and

Susan & LeonieUnit 5, theory
manager had offered to look after money for
her. Felt it undermined her autonomy not to
Highlights importance of using theory to inform practice – in this case theory
be able to handle her own finances. Bag
about importance of activity in later life
stolen and she was branded unreliable
witness. She then kept her money stored in
the Office.

Unit 6, barriers
Mr Patel - Unit 5, generalising & stereotyping
Structural barriers: why was Mrs Horton in
residential care?
Mr Patel diagnosed schizophrenic, was Hindu man from
Uganda. Stereotyped that he would benefit from mixing
Environmental barriers: no locks on doors,
with ‘his own’ community and was encouraged to mix
no where to keep her bag safe, could have
with Asian group – he didn’t like it and requested to join
used internet banking
African-Caribbean mental health group which he greatly
benefited from
Attitudinal barriers: deemed unreliable as a
witness, attitude of care home manager was
questioned by daughter
DENIAL OF RIGHTS /
DISABILITY
DISCRIMINATION
LEGISLATION / RIGHT TO
INCLUSIVE EDUCATION /
LIFE WORH LIVING /
RIGHT TO PARENTHOOD:
•Citizenship comprises
political, civil, economic and
social rights
•Many people within society,
including disabled people,
lack full citizenship rights
and are excluded from living
in the mainstream
•Disability discrimination
legislation has a role to play
in overcoming such
exclusion
•Debates around education,
the right to life and to
parenthood highlight issues
relating to the inclusion and
exclusion of disabled people
from mainstream society
SECTION 3 – THE SOCIAL MODEL OF DISABILITY
WORKBOOK 2 - UNIT 6SECTION 4 RISE OF DISABLED PEOPLE’S
SECTION 6 MOVEMENT / COALITIONS /
THE
CITIZENSHIP LIVING IN THE DISABLED
DISABILITY ARTS MOVEMENT:
AND RIGHTS
MAINSTREAM PEOPLE’S
• There is evidence of resistance by
MOVEMENT
disabled people to their situation
SECTION 1 – DEFINING & EXPLAINING DISABILITY throughout the twentieth century and
earlier
DEFINING DISABILITY / EXPLAINING DISABILITY:
• The disabled people’s movement has
• Definitions of disability are not fixed, but vary widely over time and achieved changes in practice (CILs)
• Disabled people and the disabled
across cultures
people’s movement have been influential
• These definitions draw on different models or explanations which in the passing of the
• Disability Discrimination Act 1995 and
may conflict with and modify each other
subsequent disability discrimination
legislation
SECTION 2 – THE MEDICAL MODEL OF DISABILITY • The disability arts movement is part of
the disabled people’s movement. It offers
FOCUSING ON THE INDIVIDUAL /
alternative meanings of disability which
PSYCHOLOGICAL ADJUSTMENT / INTERNAL
can be liberating to some disabled and
OPPRESION:
non-disabled people
• The individual model of disability views disability as
being a problem residing with the individual NEGLECT OF IMPAIRMENT / /REPRESENTATIVE
MOVEMENT/ MULPIPLE OPPRESION:
• Disabled people do not always view disability in the
same way as non-disabled people • The meaning of disability is continually being debated
within the disabled people’s movement
• The ways in which disabled people are treated by • Some people believe that the social model of disability
health and social care workers and others can have neglects the impact of illness and impairment
an impact on their self-identity • The disabled people’s movement has been accused by
some people of being non-representative of disabled
people generally
SECTION 5
 It has also been criticised for neglecting issues of race,
CRITIQUES OF THE
gender, class, sexuality and age and the experience of
SOCIAL MODEL
multiple and simultaneous oppression

FOCUSING ON SOCIETY / DISABLELING BARRIERS / EMPOWERMENT AND LIBERATION / MAKING CHANGES:

•The social model of disability views disability in terms of barriers within society which obstruct people with impairments
•The social model of disability distinguishes impairment from disability and does not regard impairment as causing disability
•The social model of disability has arisen from the thinking of disabled people themselves and is still evolving
•The analysis provided by the social model of disability shares some common ground with that provided by other oppressed groups
•The social model of disability has had a positive impact on the self-identity of many disabled people
 UNIT 6 - COURSE THEMES AND CASE STUDIES
The best of both worlds video - Unit 6, linking disability to the course themes

T&B: explores different types of educational settings for visually impaired children, sometimes removed from home communities. Justin & Stephanie
suggest being in a community does not imply inclusion and can be isolating.
D&I: Martin & Paul recognise their difference but value being with peers and pleased they can cope with being in mainstream, BUT Justin values being
the same as his peers in special school. Peter never felt special because peers were also blind.
P&I: maybe attending special school places disabled children in unequal situation, but some argue that access to resources and environment that
caters for their needs is better. Stephanie feels she has less choice about going out in the evening at her new school but Justin finds he can do things
that he couldn’t at home.
R&R: potential risks to activities that visually impaired children were engaged in, Paul, martin and Stephanie dealing with flames and chemicals, Justin
using a stove. Peter said he was given no mobility training at all and Stephanie complained about mobility test because she could already get out and
about independently. Many would argue that disabled children had the right to engage in these activities.

Carol Thomas“Living in the borderlands of disability” - Unit

6, disability and self-identity – D&I
Born without a left hand and was left feeling ashamed of her
impairment by attitudes of professionals
Ayesha Vernon “Multiple oppression and the disabled, Unit
Andrew Hubbard - “On becoming a disabled person” - Unit 6, identifying
barriers
D&I, T&B, P&I - Structural, environmental and attitudinal barriers that Andrew
has experienced since becoming disabled.

6, multiple oppression – D&I – P&I Reminder of what these barriers can be….

People’s movement” Suggests that disabled people’s movement Structural barriers – refer to underlying norms, mores and ideologies of
fails to take into consideration of multiple or simultaneous organisations and institutions which are based on judgements of ‘normality’,
oppression. Disabled people have multiple identities and should e.g. norm to work 9-5 or for office junior to make director cup of tea. Some
not be pigeonholed by the most prominent identity disabled may be denied employment if they cannot fit into these ‘norms’.

Environmental barriers - refer to obstacles within the environment such as

Mary & Kate - Unit 6, disabled parents – P&I, R&R, D&I steps, narrow doorways, lack of resource, e.g no Braille books or sign
Experiences of parenthood for Mary and Kate. Mary, physically language interpreters. Also the way things are done to exclude disabled
disabled, single parent to twins. Has support from friends and people, e.g. meetings are conducted or the time allowed for tasks, etc
statutory services. Suggests that being treated like everyone
else meant her specific needs not always met. Has experienced Attitudinal barriers – refer to adverse attitude and behaviour of people
no negative attitudes from professionals, family or friends. Kate towards disabled people – patronised, stereotyped or harassed.
has been treated less favourably. Mental health problems.
Threatened with having child taken away if she became ill again.
Family also sceptical about ability as a parent. Kate feels having
a child has made her feel more included in the community.

NORMALISATION
PHILOSOPHY / RELEVANCE IN
21ST CENTURY /
NORMALISATION IN PRACTICE:
• Normalisation is the name given
to a set of ideas developed in
Scandinavia and the US during the
1950s and 1960s which asserted
that people in receipt of human
care services should be able to
access normal patterns for living
• Normalisation was a response to
conditions in institutions at the
time. However, it has
subsequently been influential in the
design of services of all kinds, in
particular for people with learning
difficulties
• Wolfensberger and Tullman’s
model of normalisation (social role
valorisation) emphasised the role
that services should play in
counteracting negative imagery;
that people should where possible
use integrated community service;
and that people should be helped
to adopt valued social roles
• Normalisation lays little emphasis
on challenging concepts of what’s
normal
• The five accomplishments
represent a set of outcomes that
services should aspire to deliver of
they operate on a normalisation
model
• The five accomplishments do not
emphasise considerations of safety
and risk management. Yet some
stakeholders see these as being a
priority.
SECTION 6
QUESTIONS ABOUT NORMALISATION
WORKBOOK 2 - UNIT 7 & SOCIAL ROLE
SECTION 5 STAFF ROLES: 4 CRITICISMS OF NORMALISATION /
• In the normalisation framework staff have an important role to COMPARING NORMALISATION WITH
play in fostering positive social roles. SOCIAL MODEL OF DISABILITY:
• There is a distinction to be drawn between supporting people • Normalisation has been criticised
and caring for them. Both have a place, but getting the balance because defining normal is difficult.
• It can be misused to justify failure to
right is not easy.
• Checklists of what staff should do try to bring technical provide the resources and support people
genuinely need.
rationality to bear on significant areas of activity. However, it is
hard to capture qualities of compassion and human kindness in • It implicitly devalues disabled people
and can therefore inhibit the development
such lists.
of a positive social identity.
SECTION 3 • It is a top-down philosophy which
SECTION 4 LABELLING,
NORMAL OR justifies the continuing role of traditional
WHAT IS LANGUAGE & service patterns.
NORMALISATION? DIFFERENT LIVES? RESISTANCE • The social model of disability offers a
competing perspective but one that
SECTION 1 – NORMALITY AND DIFFERENCE remains to be explored further in relation
to people with severe intellectual or
NORMALITY & DIFFERENCE: A BIOGRAPHICAL PERSPECTIVE
cognitive impairments.
Biographies – life story - important resource of information about a
person – can gain better insight into someone’s life, needs, etc. DENIAL OR PASSING AS
NORMAL / REJECTION OF LABEL
•How normality and difference are conceptualised can have far- / CHANGING LABEL /
reaching and sometimes extremely damaging consequences. SIGNIFICANCE OF LANGUAGE:
•Biographical approaches to constructing individual life stories can
counteract the tendency to view people in stereotypical ways.
• Labelling, negative stereotyping
SECTION 2 – THE SIGNIFICANCE IN LABELLING and stigma can be damaging.
• Individuals and groups who
LABELLING & DIFFERENCE / STIGMA
experience negative labelling do not
always passively accept the
• Putting people into certain categories and giving them labels is central
devaluation. Instead there is a
to a system of care and welfare which seeks to meet people’s special
variety of strategies to resist.
needs.
• Changing the terminology used to
• Debates about labelling revolve around questions of whether the label
describe people has been a favoured
described the individual’s essential characteristics or whether it is the
strategy. However, there is debate
product of social processes which name certain behaviours as abnormal
about whether language alone has
or deviant and treat them accordingly.
the power to fundamentally
• Stigma refers to a process by which negative attitudes to difference
challenge the negative value placed
lead to some individuals being negatively valued, and to a cycle of
on disabled people.
devaluation.
 UNIT 7 - COURSE THEMES AND CASE STUDIES
Jean “Out in the world” - Unit 7, D&I - Reader article 23

Discussion of Jean’s experiences of boarding school, group homes and hospital while struggling with abuse, aggression and learning difficulties

Unit 7, five accomplishments

Jean and the 5 accomplishments:

• Physical presence: clearly loves own home
• Choice: doesn’t need much support in making choices anymore
• Competence: work in the memories group gives chance to develop
• Respect: described her relationship with husband as important and agreed to use life story to help others
• Participation: as for respect

Goffman “Stigma” Unit 7, Stigma - Reader article Jane Hubert - Jan & Philip - Unit 7, life on a locked ward - Audio 2,
16 – D&I programme 2 – D&I / T&B

Discusses concept of stigma with relation to people
with physical disabilities; character defects and
people from certain races and religious groups.
Argues that stigmatized individuals feel sense of
shame, are stereotyped and that stigma helps set up
a self-fulfilling prophecy.
Ideas about impact of stigma and negative imagery, and feeling alone even though
surrounded by other people. Move from locked ward to more homely
surroundings.
Jan has more positive opinion of the move and believes that her son is able to live
more normal life now. however she doesn’t trust the move and feels insecure
about his future.

Wolfensberger & Tullman “The principle of
normalisation” Unit 7, normalisation - Reader
article 16.1 – D&I
Discussion of normalisation theory and social role
valorisation. Believe normalisation necessary to
counteract negative valuation of people in certain
social roles ad do so through behaviour changes
Walker & Walker “Ageing, learning difficulties and maintaining independence
”Unit 7, normalisation and normal ageing - Reader article 17 – T&B / D&I
Discussion of difficulties in creating services for older people with learning difficulties
that still allow independent ‘normal’ living conditions, as normalisation of services for
people with learning difficulties has made the services better than those for older
people.
HOUSING NEEDS/ FAILURE OF
HOUSING POLICY/
SUPPORTED
SECTION 4
ACCOMMODATION/ HOUSING
NEEDS IN COMMUNITY CARE
HOUSING &
COMMUNITY
ASSESSMENTS:
• There is a mismatch between
the demand for and the supply of
housing, particularly for people
with care and support needs.
• The decline in availability of
subsidised rented
accommodation, together with the
increasing costs of house
maintenance, put suitable and
affordable accommodation
beyond the reach of many
people.
• The lack of affordable and
suitable housing puts people at
risk of homelessness and may
lead those in need of community
care into institutions or other
forms of supported housing
unnecessarily.
• The role of supported housing
in community care is
problematical. There has been
debate about whether support
services should be attached to
housing or to people, and which
system might offer more choice to
recipients.
• Needs assessments require
close collaboration between
social care agencies and housing
agencies so that the fundamental
importance of housing and home
is addressed.
NEEDS & CICUMSTANCES/
WORKBOOK 3 - UNIT 8 CAUSE OR EFFECT/ SUPPORT
DEBATE:
SECTION 3
HOUSING & HOMLESSNESS • The lives of single homeless people
CARE
HOMELESSNESS & NEED are affected by a multiplicity of
factors. Routes in and out of
SECTION 1 – NEEDS, RIGHT, RESPONSIBILITIES homelessness are complex and
varied.
• A biographical approach helps is to
UNIVERSAL & PARTICULAR NEEDS/ SEEING
understand the links between
PRIORITIES/ ELIGIBILITY:
individual experience and common
• The idea that people share basic needs that are universal to circumstances.
• Many homeless people have care
humankind dominated 20th century social policy in the UK.
• The concept of need is closely bound up with the concepts and support needs in addition to a
need for housing.
of rights and responsibilities.
• Voluntary organisations may be in a
• Resources are finite and priorities have to be set in order to
better position to respond more
control access to services.
• Different needs are met by different agencies, each with its flexibly to these needs and to assist
the development of self-help and
own eligibility criteria, which restrict access and control
mutual support networks.
demand.
•Official responses to need are as
• The stigma attached to welfare can deter people from
much about the control of deviant
seeking help.
behaviour as they are about meeting
the care and support needs of
SECTION 2 – HOMELESSNESS & ELIGIBILITY individuals.
MEANING OF HOME/ LIGISLATING FOR HOMLESSNESS/ STATUTORY
HOMLESSNESS/ HIDDEN HOMLESSNESS:
• The designation of official or statutory homelessness is the responsibility of local authority
housing departments.
• Eligibility for housing is controlled not only by national legislation but also by the way in
which the legislation is interpreted, and this in turn is influenced by the attitudes of staff and
the availability of accommodation locally.
• There is evidence that many rejected homeless applicants are in as much need as those
who are accepted as homeless.
• There is also evidence that the legislation itself and the way it is implemented, including the
poor standard of accommodation on offer, may also deter people from presenting themselves
to the authorities as homeless.
• Women’s homelessness is often described as hidden.
 UNIT 8 - COURSE THEMES AND CASE STUDIES
Elizabeth Unit 8, Meeting particular needs

Elizabeth, 82yr old widow now living alone.

Previously received married couple’s state pension and his occupational pension. She is visually impaired and gets talking books. Husband used to
read newspaper to her. Also has mobility problems and had paid for stair lift themselves. Discussion about the kind of emotional and practical support
she needs.

Alan Perry “William and Teresa ”Unit 8, meaning
of home - Reader article 2 – P&I, D&I, R&R
Provided temporary accommodation by housing
department because they were homeless. Teresa
pregnant, William unemployed.
Accommodation was bad in deprived area, abusive
neighbours, frightened and insecure. Were treated
badly by hospital, suffered from stigma, unborn baby
died.
Ernest - Unit 8, seeking and gaining help - Audio 3, programme 1 – R&R, P&I
Ernest was overseas student who was faced with homelessness several times. Questions
about eligibility for housing, whether he would be a priority, and whether homelessness
would be considered intentional.
Seems to be in priority need due to vulnerability because of isolation and suicide attempt.
However, could be seen as intentional as he gave up his course, didn’t seek help from
college and lost his job – possible deportation.
Discussion of the different interpretation that can be seen within the eligibility criteria for
housing which Ernest’s case highlights. .

John, Danny & Paul - Unit 8, experiencing

homelessness - Audio 3, programme 1 –P&I, D&I
Ait - Unit 8, a voice in exile - Reader article 1.1 – D&I, R&R
John & Danny are not having many of their basic
needs met at all: both unemployed, neither has Ait is an Algerian asylum seeker with mental health needs who is in need of emotional and
protective housing, both reliant on public toilets for practical support. Discussion of the process of asylum seeking and impact on mental
washing and clean water, and both reliant on charity health.
for food.

Neither has access to health care and rely on A&E.

Christine Oldman “The importance of housing and home” - Unit 8, failure of housing
Neither has significant relationships and both policy - Reader article 37 – P&I, T&B
vulnerable to abuse and violence on streets. Both
dependent on alcohol. Discussion of the failures of the housing policy in meeting the community care needs of
people who use social care services.
Paul is more like Ernest as they both have protective
housing, both entitled to social security, both have
access to health care

SOCIAL NECESSITIES/
WHO IS POOR/ SOCIAL
EXCLUSION:
• The PSE survey, a major
survey of poverty and social
exclusion, used a combination
of income and deprivation
measures to measure the
extent of poverty and social
exclusion in Britain at the end
of the 20th Century.
• By the end of 1999, 26% of
the British population was
living in poverty, measured in
terms of low income and
multiple deprivation of
necessities.
• Roughly 17% consider
themselves and their families
to be in absolute poverty as
defined by the UN.
• Social exclusion is a
broader concept than poverty,
and focuses on social
processes and social
relations, rather than just lack
of resources.
• The idea of social exclusion
also directs attention to
potential policy changes
which could remove the
barriers to social inclusion
and participation.
WORKBOOK 3 - UNIT 9
SECTION 5 - RESPONSES TO POVERTY
DEFINING POVERTY/
THE EFFECTS OF POVERTY: ABSOLUTE POVERTY/
RELATIVE POSITIVE/
• How poverty is defined influences how it is responded to at both an MEASURING POVERTY:
individual and a policy level.
• During the last decade of the 20th Century, social services increasingly • Definitions of poverty are
contentious and ideologically
became a poor service for poor people.
• Although the actions social services workers can take to alleviate poverty loaded: how you define poverty
is affected by, and affects, what
are limited, they can take steps to improve the financial circumstances of
you intend to do about it.
those they serve.
• There is evidence that redistributive income policies would be the most
• Two of the main approaches
effective way of reducing inequalities in health.
to defining poverty are the
SECTION 4 absolute and the relative
EXTENT OF POVERTY & SOCIAL SECTION 3 approach. Both have their
POVERTY & WHAT IS strengths and weaknesses but
SOCIAL
EXCLUSION the relative approach was
POVERTY?
EXCLUSION influential in shaping policies
towards the poor in the last four
SECTION 1 – LIVING IN POVERTY decades of the 20th Century.
THE EFFECTS OF POVERTY: • Using income thresholds
alone to measure poverty is
• The main cause of fuel poverty is low income, which is itself caused convenient but limited.
by low wages or inadequate state benefits.
• An approach which combines
• The main effects of poverty on people’s lives are multiple and far- income levels with other
reaching – psychological, physical, relational and practical. An measures might be more
additional key consequence is stigma. revealing.
SECTION 2 – FINANCIAL EXCLUSION & COMMUNITY ACTION
PROBLEM OF FINANCIAL EXCLUSION/ ALLEVIATING POVERTY:
COMMUNITY ACTION:
•Initiatives such as credit unions and debt redemption schemes are rooted in
social justice, community solidarity and voluntary effort.
•Such schemes have the potential to make a real difference to the financial
circumstances of poorer people.
 UNIT 9 - COURSE THEMES AND CASE STUDIES

Angela Yih & Elizabeth Belk- Unit 9, fuel poverty - Audio 3, programme 2 – P&I, R&R, D&I

Discussion about fuel poverty and causes of it: low income, lack of knowledge of welfare benefits, stigma of benefits, means-testing. People who
spend more than 10% of income on fuel are in fuel poverty.

Mr & Mrs Martin - Unit 9, credit

unions – P&I
Peter Beresford “The effects of poverty - ”Unit 9,
poverty - Reader article 3 – P&I / D&I
Discussion of their debt problem and
how they used a credit union debt
Discussion of the psychological, physical, relational redemption scheme to clear their rent
and practical effects of living in poverty. arrears with the council to avoid being
evicted.

Mark Drakeford - “Poverty and the social

services” - Unit 9, poverty & social services -
Reader article 4 – P&I

Discussion of the traditional link between poverty and

use of social services, and the increasing closeness
of social services and social security.

Birmingham Ladywood - Unit 9, reducing inequalities – P&I

Discussion of health inequalities in Birmingham Ladywood constituency, where it was suggested that 3 policies
might save the most number of lives: modest redistribution of wealth (save 17 excess deaths) , achieving full
employment (save 14 excess deaths), eradicating child poverty (save 8 excess deaths).

MAKING THE CONNECTION/
BIOGRAPHICAL
ASSESSMENT/ RAISING
EXPECTATIONS/
ASSESSMENT AS
DEVELOPMENT/ SELF-
ASSESSMENT:
SECTION 4
• There is a need to strengthen
MAKING IT
WORK
the connection between people’s
lives and their assessment
experience.
• A biographical approach to
assessment can lead to more
individual and appropriate social
care.
• For assessors, raising service
users’ expectations can be seen
as both a necessary challenge
and a potential minefield.
• Assessments which take place
over longer periods of time can
provide a fuller picture of the
reality of people’s lives than one-
off events.
• Self-assessment has a positive
role to play in assessment
arrangements.
WORKBOOK 3 - UNIT 10
USERS & CARERS/
COMMUNICATION/
MANAGING ASSESSMENT/
RISK:
• There is considerable
variation in the level of users’
SECTION 3 participation in their
ASSESSING NEED POLICY assessments. Poverty may be
INTO one factor associated with
PRACTICE this.
• Assessments muct focus on
the individual, but take into
account family relationships
and interdependencies.
SECTION 1 – SEEKING HELP • Implementation of the single
assessment process has
critical implications for all
SEEKING PERSONAL ADVICE OR SUPPORT/
those involved.
EXPERIENCE OF ASSESSMENT/ SUCCESS STORY:
• the concept “risk” has
• Seeking help can be quite stressful for many people.
become increasingly
• Much can be learned about how assessment works from important in assessment.
asking people about their experience of it.
SECTION 2 –THE ROLE OF ASSESSMENT

REASONS FOR ASSESSMENT/ ASSESSMENT AS PART OF A PROCESS:

• Assessment has been given a key role in the allocation of social care resources.

• Increased emphasis on formal and detailed assessment arrangements had curtailed the discretion of Local Authorities and individual assessors.

• In the attempt to meet a range of objectives, community care assessment has become a complex process.

• Financial assessment leading to charging for community care remains a disputed area.
 UNIT 10 - COURSE THEMES AND CASE STUDIES
Brian & Sylvia Anne - Unit 10, experiences of assessment - Audio 4, programme 1 - Involving service users and carers – P& I

Sylvia and Brian, and Anne discuss their experiences of assessment with Gaynor & Liz.
Neither Sylvia and Brian, or Anne were given appropriate information by their doctor, and had to initiate their own assessments. Sylvia’s first attempt at
seeking help was not successful but Anne (who had a background in social services) knew what she could apply for and so had more success, even
though the assessment wasn’t carried out in appropriate circumstances (in corridor).
Brian found the assessor spoke only with Sylvia and not to him, and that they had numerous assessments and were not happy with some of the
questions they were asked.
Anne was disappointed she did not get a home assessment.
Brian was present at initial assessment, but was not really involved. Sylvia was proud of her assertiveness and initiative and played a large part in their
assessments.
Anne participated in her assessment also, by requesting Occupational therapy assessment and responding to their questions.

Mr & Mrs Hanley Unit 10, experiences of Mrs Haynes - Unit 10, communication – P&I
assessment - involving service users and Mrs Haynes had communication difficulties because of profound disabilities and denied problems
carers – P&I during her assessment because she was ashamed of them, even though she desperately needed
help.
Mr & Mrs Hanley’s experience of assessment
was far more positive than that of Brian and William & Beryl Hargreaves - Unit 10, communication – P&I
Sylvia and of Anne.
They were included in the meetings, their R v. North Yorkshire County Council ex parte William Hargreaves (1994)William wanted to
interests dealt with sensitively, good coordination arrange respite care for his sister Beryl, but there was a dispute with the council over where this
between hospital and area staff, rehabilitation respite care should be spent. William argued in a judicial review that the council failed to find out
was arranged and other requests met. what Beryl’s feelings were, but the council argued that he had not permitted her to give an opinion.
Mr & Mrs Hanley had many opportunities to raise The judge found in favour of the Hargreaves’ and said that where a user is unable to actively
and talk through their concerns and were given participate it is even more important that they should be helped to understand what is involved and
choices during their assessment. Power and the intended outcome. Power and inequality
inequality.
Course themes - Unit 10, assessment and the course themes - T&B: who wants care and who gets care;
the role of users and the role of carers; can the single assessment process overcome the barriers between
Alison Worth - “health and health and social care? D&I: how far can assessment and care management take sufficient and sensitive
social care assessment in
account of race, culture, religion, sexual orientation and other aspects of difference? Can standardised
action” - Unit 10, managing
assessment forms provide a realistic picture of the whole person and the context within which support and car
assessment - Reader article 36 – might be needed and provided? What role can assessment play in building identity and awareness of choice?
T&B
P&I: in general, power in assessment rests with the agency and the assessor through the formal and informal
rationing devices used. Can the power relationships be shifted at least partially by clear guidance from
Discussion of the practical process government, better provision of information, greater involvement of users, cares and their organisations,
of assessment and the difference
greater use of advocates? Who is accorded power by the assessor, the user or carer? R&R: what rights of
between NHS and social work access do people have to assessment as a result of assessments? How is risk defined by user, carer and
assessments. assessor? In what circumstances and how far do people have a right to take risks? What is the value of
positive risk taking?
HEALTH TO SOCIAL
WORKBOOK 4 - UNIT 11 RESIDENTIAL & NURSING HOME CARE/
SECTION 6 SECTION 5 DOMILICIARY CARE:
CARE/ FUNDING LONG-
TERM CARE/ EUROPEAN PAYING FOR FUNDING MATTERS THE
LONG-TERM PRIVATE • Like the voluntary sector, the private for-profit
COMPARISONS:
CARE SECTOR sector is diverse. But unlike the voluntary sector,
SECTION 1 – MIXED ECONOMY OF CARE its activities are focused on the most
• Awarding amounts of
commercially viable forms of service provision.
money to eligible people is REINING-IN PUBLIC EXPENDITURE/ RISE & FALL OF SOCIAL • The sector is financed both by investments and
named ‘direct payments’. SECURITY SPENDING/ DEVELOPING MIXED ECONOMY: loans and by charges to consumers. So its
fortunes are strongly influenced by Government
• Most of the changes • Social security benefits are one source of funds for care. policy.
involve redefining the • Social security has a centrally funded and open-ended budget. • Since implementation of the NHS and
territory of services, and • One way of controlling and containing care costs has been to shift Community Care Act 1990 the private sector has
redrawing boundaries come to dominate the mixed economy of care
funding away from this open-ended budget to fixed, locally
provision.
between them. administered budgets. • Private care home providers, particularly the
• A further strategy for improving efficiency was to introduce smaller ones, are under pressure because of cuts
competition between service providers through the development of a in public subsidies and rising costs, and
SECTION 2 –
mixed economy of care. ownership has become more concentrated.
FINANCING LOCAL
• The Labour government of the late 1990s introduced 'Best Value' • Home care contracted out to the private sector
AUTHORITIES has become focused on those requiring intensive
as an alternative to market competition to control quality and costs.
packages of care.
• One of the outcomes of the shifting boundary
ALLOCATING BUDGETS/ MONITORING between pubic and private provision is that the
PERFORMANCE/ MANAGING BUDGETS: SECTION 4 cost to users has increased.
THE VOLUNTARY SECTOR
• The main sources of funding for local authority
services are government grants, council taxes and
service charges. DIVERSE ACTIVITIES; RESOURCES/ NATIONAL & LOCAL DIFFFERENCES:
• Central government closely controls local authority
income and expenditure. • The voluntary sector comprises an extremely diverse range of organisations in terms of
• Local authorities have to juggle the conflicting their functions, activities and sources of funding.
interests of central government and local taxpayers • Most voluntary organisations are multi-funded, drawing in the main on charitable donations
in trying to match needs and resources. and government grants and contracts.
• Front-line workers are engaged in a constant • There is a tension between the role of the voluntary sector as critic, advocate and innovator
struggle of trying to balance quality and cost. on the one hand, and implementer of state policies and programmes on the other.
• Where money comes from significantly affects what voluntary organisations can do.
SECTION 3 – CHARGING FOR CARE
CHARGING FOR RESIDENTIAL & NURSING HOME CARE; DOMICILIARY & DAY CARE / ANOMOLIES IN CHARGING POLOCIES:
• Charges have become an increasingly significant source of revenue for social services departments, indicating that the costs of social care are being
shifted from the state on to care service users.
• The majority of income accruing from charges comes from older people in receipt of long-term care. of long-term care.
• The increased use of charging has highlighted serious concerns about equity and impoverishment and about access to care provision.
• It has also highlighted concerns about the quality and nature of care provision, and where the boundary between free health care and means-tested
social care should lie.
 UNIT 11 - COURSE THEMES AND CASE STUDIES
Mr & Mrs Tosh and Irene- Unit 11, managing budgets – P&I / T&B / R&R

Mr & Mrs Tosh in their 80’s, live in isolated part of Aberdeenshire.

Mr Tosh had some health problems and a fall and is relying on wife and daughter for support and transport. Hospital social worker has arranged for
home carer to help Mrs Tosh, but she can only come weekdays. Mrs Tosh then falls ill and Mr Tosh is not recovering well. Irene is care manager and
is asked to assess them, and it has been decided that they are a category A case for domiciliary care, but Irene’s budget is limited to the cost of a
residential care place. Irene and the Tosh’s are trying to come to a decision about how best to utilise their resources to get the most additional help.

Health Service Commissioner & service user - Unit 11, funding long-term care – T&B /
P&I / R&R

Health Service Commissioner investigated a complaint from wife of a man with severe brain
damage. Argued that he needed continuing long-term care and believed this should be
provided by local health authority.

NHS said that they had a duty to determine priorities within the financial resources
available. Commissioner said that this implied a service user may never receive treatment,
said they had failed the man, and upheld the complaint.

Caroline Glendinning “European policies

compared” - Unit 11, comparing funding with
Europe - Reader article 34 – T&B

Discussion of the similarities and differences

between social care policy here and in Europe.

SERVICE USERS AS
CUSTOMERS/ EQUAL
PARTNERSHIP A MYTH/
CITIZENS TO THE FORE:
•User and carer involvement is
now widespread in health and
social care and there are
examples of good practice in
partnership working.
•Developments, however, remain
uneven and different traditions in
health and social care are still
visible.
•There have been moves away
from a consumer perspective
towards a wider notion of citizens
in partnership for health and
social care.
•Important issues remain of
responding effectively to user
challenges and developing the
capacity to rethink services in an
imaginative way.
•In Labour's reformed structures
there are controversies about
directions of change.
WORKBOOK 4 - UNIT 12
SECTION 3 INTEGRATED CARE IN
SECTION 2 SCOTLAND/ ANOTHER LOOK AT
PARTNERSHIPS
PARTNERSHIPS = TURF WARS/ GETTING BEHIND
WITH SERVICE WORKING RESULTS?
USERS THE RHETORIC:
TOWARDS
PARTNERSHIP • There was a sharp increase in joint
working initiatives after 1997 and the
range of agencies and sectors
SECTION 1 – LEGACIES THAT LINGER involved in partnership projects is
now immense.
•There are now many examples of
efforts to join up services across all
BORN DIVIDED – NHS, HEALTH & WELFARE/ AFTER sectors and for all client groups.
1979 – NEW DIVISION/IDENTITIES/ AFTER 1979 –
PARTNERSHIPS IN SHARPER FOCUS: •Questions of history, culture,
organisation and funding need to be
•The creation of the Welfare State both unified and divided
considered as 'drivers and barriers' to
services. change.
•Divisions have been, and remain, administrative, financial •Successful partnerships involve
and professional, and they intertwine. working at building relationships and
recognising the different worlds of
•Successive attempts of governments to encourage co-
participants and the different power
ordination and integration have been only partially successful. they have.
•The overtly 'partnership-based' approach of the Labour
Government shows continuities with the past, although it has
also offered important new incentives to joint working.
•Variations in service structure across the UK are becoming
greater and may affect possibilities for partnership.
 UNIT 12 - COURSE THEMES AND CASE STUDIES
Jane Lewis - “The boundary between health and social care for older people - ”Unit 12, health and social care divide - Reader article 35 –
B&T

Discussion of the boundaries between health care and social care for older people: financial, organisational and professional boundaries.

East Ayrshire personal record of care - Unit 12,
partnership working – T&B
Discussion of the scheme set up in east Ayrshire to
allow people who receive care from more than one
organisation or from more than one home help to
have the option of a personal record of care in their
homes.
Creating a joint occupational therapy service - Unit 12, partnership working – T&B
Discussion of the setting up of a steering group to explore joint working between Stobhill
hospital and East Dunbartonshire Council.
Aim was to create a user-focused service for occupational therapy for adults in the area with
the exception of mental health and learning disabilities.

This includes basic information about them and their

circumstances and about the services that are
provided to them.
Howard Doris Centre, Wester Ross - Unit 12, partnership working T&B
There is a communication sheet for the staff to fill in
and inform other team members. A whole host of Discussion of local minister of religion becoming aware of needs of older people who were
professionals are involved. Worries about having to move away for increased support with living.
confidentiality were ironed out through training and
discussion. Developed a sheltered housing scheme that filled the gap in services and fitted well with
strategic plans of health board and local council.

Central England People First - Unit 12, equal

partnership myth – P&I

Discussion of the inequality despite the equal Frances Hasler “Partnerships between disabled people and service providers - ”Unit
partnership approach. 12, partners in service delivery - Reader article 38 – T&B / P&I

White Paper for Valuing People was not fair to Discussion of strategies for addressing inequalities of power when trying to include service
people with learning difficulties, it wasn’t published in users.
an accessible format and they were not involved from
the beginning stages.
 SECTION 5
DIRECT
PAYMENS
SECTION 4 PERSONAL
ASSISTANCE
CASE FOR PERSONAL
ASSISTANCE/ MAKING
PERSONAL ASSISTANCE
WORK/ RIGH & RISKS FOR
BOTH PARTIES:
• Using personal assistance
has a long history but has only
recently been recognised as an
established alternative to
receiving care services.
•Some disabled people regard
personal assistance as a
human right.
•Being able to employ personal
assistants can turn round a
disabled person's situation.
•Personal assistance, like any
other employment
arrangements, is open to
exploitation.
•There are rights and risks on
both sides; having clear and
agreed statements about what
is expected can help to prevent
misunderstandings and bad
practice.
WORKBOOK 4 - UNIT 13
DIRECT PAYMENTS/ BARRIERS TO REALISING POTENTIAL/ LOCAL VARIATIONS/ SEAMLESS SERVICE:
• Since 1997 local authorities have been able to make payments legally so that people assessed for community
care can pay for their own help and support.
• Some user groups face extra barriers when it comes to being assessed for direct payments.
• Someone's capacity to manage or understand direct payments should not be judged on the basis of their ability to
manage other aspects of their lives.
• Local and national variations mean that direct payments are not equally available within or between authorities and
regions.
• Direct payments offer the possibility of breaching the boundaries between health and social care for service users.
SECTION 3
BUYING CARE AND ASSISTANCE BUYING & SELLING
SECTION 1 – TRENDS FOR CARE AT HOME
•Care, like other aspects of life, is
• Budgetary restrictions have led to a change in what is defined as increasingly being costed as a
necessary support. commodity, something to be bought
• A focus on rehabilitation may mean that the valued help which and sold.
'keeps people going' is no longer provided.
• Low-intensity services are important to most people, but •Governments - welfare states - have
particularly to some older women for whom evidence of managing increasingly looked for ways of
their home may be central to their sense of identity. identifying and paying for the costs of
• Often it is quite ordinary and everyday things that make a informal care.
difference to how autonomous people feel in their living
arrangements. •Typologies help to identify
• Help that people get in their homes is now provided by a variety of differences and similarities between
paid and unpaid carers. social phenomena.
SECTION 2 – ORGANISING CARE
•Payments for care have come about
as a result of a number of factors,
ARRANGEMENTS FOR CARE & SUPPORT/ VALUING CARE:
including pressure from carers,
disabled people and feminists as well
• People who give and receive help and support depend on a mix of as government policies seeking ways
paid and unpaid sources. to reduce costs and regulate care.
• For most carers and people being cared for finding out about
'benefits and entitlements is a constant struggle. •Wages for care recognise the value
• Informal care has a cash value which carers are aware of. of work but may affect the nature of
• For many carers and people being cared for there is a tension the care relationship and the range of
between identifying the costs of care and the feelings of love and choices open to carers
friendship which caring involves.
 UNIT 13 - COURSE THEMES AND CASE STUDIES
Diane Mallett & Paul - John Avery & Mr Ashgar - Enid Francis & son - Sarah Fletcher - Alex Zinga - Unit 13, care Clare Ungerson - “Care as a
transactions - Audio 4, programme 2 – T&B / P&I / D&I commodity” - Unit 13, care giving
and receiving - Reader article 39 –
Diane says she doesn’t get any payments although used to get invalid care allowance (ICA) when mother-in-law was T&B
alive. Paul gets lower level DLA, but Diane thinks he would have got more if he had been assessed before she
intervened. Diane says that she gets help with dog minding, gardening, shopping an other jobs around the house. Diane Discussion of the trend towards the
says she cannot imagine being paid for what she dies and feels obliged to do it. John says Mr Ashgar gets Attendance commodification of care.
Allowance, but thinks he is unable to get ICA as it may affect his other benefits. He gets long term friendship from Mr
Ashgar, advice and support. Daphne du Maurier - Alice Kadel -
John describes the basis of caring as a mutually beneficial relationship. Enid’s son gets higher DLA and she gets ICA, but Ruth Bailey “Good Companions” -
she’s worried she won’t be entitled once she turns 60. she saves her son’s money and buys them clothes and other Unit 13, personal assistance - Reader
things with it. She spends her ICA on herself. Enid also gets help from friends and relatives. She looks on caring as a article 40 – T&B
parental responsibility. Sarah gets direct payment topped up by Independent Living Fund. Her money goes towards her
volunteer helpers at Uni, who help her get around and do some personal care. Sarah also gets help from her disabled Discussion by the three writers of a
mother at home and help from other students. She thinks that by calling it care can make it sound like dependence, and situation in which social and personal
wonders if they do care. distance is being maintained between
Alex also gets direct payment. She uses it to pay for personal assistances and uses her pension and savings to pay for employer and employed person in
taxis and train fares. She is self-reliant and doesn’t really need any extra help. She tries to keep the care she gets to a circumstances where quite personal
minimum and she likes to be in charge. tasks of assistance are being carried
out.
Sarah & Alex - Unit 13 - right to support and the course themes
Alex & Kathryn - Unit 13, a working
P&I: Alex has power to hire and fire assistants – they rely on her for employment, BUT if they did their job badly Alex relationship - Audio 4, programme 2
could be left feeling vulnerable. Possibility of inequality and exploitation. – T&B
D&I: Sarah has strong sense of identity as a disabled person and as a student. Depends on her helpers to sustain her
student identity. Discussion of Alex and Kathryn’s care
R&R: both Alex and her carer are aware of risks to them in enabling Alex to live life she chooses. Potential clash relationship as care user and personal
between R&R for each of them. assistant. Neither of them mention
T&B: Alex mentions she is keen to maintain her privacy and goes to bed early to avoid having more people coming round anything in their discussion about
in the evenings BUT she also has to accept help with personal and intimate care. Sarah and her helpers live in same professional skills or training. Disabled
accommodation. people tend to prefer to train their
assistants themselves.

Daphne du Maurier - Alice Kadel - Ruth
Bailey “Good Companions” - Unit 13,
personal assistance - Reader article 40 –
T&B
Discussion by the three writers of a situation in
which social and personal distance is being
maintained between employer and employed
person in circumstances where quite personal
tasks of assistance are being carried out.
David - Unit 13, direct payments – T&B / P&I / R&R
David’s parents felt he was getting older and that he and his family needed a break from each other. The
difficulties with respite care is that it is often about carers needs and not the needs of the person with
learning difficulties or other disability. His parents didn’t want to use a traditional respite facility and decided
that direct payments would be better. They had a discussion with the local Independent Living Advocate
and realised they would be able to use direct payments to enable David to do the things he wanted with the
people he wanted to. They set up an Independent Living Trust with a close family member acting as the
3rd trustee and David’s care manager made all the arrangements. He had choice in what to spend the
money on and chose to use it for holidays and weekends away with supporters. He got to choose his
supporters. The Local Authority recognised David’s trust as a good way for people who may not have the
capacity to consent to take advantage of direct payments as there are safeguards for him to be able to
make choice and control.

SECTION 4 HOME HELP TO
HOME CARE
ORIGINS OF HOME HELP/
DEVELOPING CARE IN THE
COMMUNITY/ LIMITATIONS OF
GROWTH/ CLEANING OR
CARING?:
•The home help service began as
a voluntary sector initiative and
was only slowly taken into the
statutory sector as part of the turn
to community care.
•In the past the work of home
helps was confined to housework
and training was basic, often non-
existent.
•Today’s home carers take on a
wider range of duties, including
personal care, and housework is
a minor element of the job
description. However, there is
evidence that both home helps
and home carers do and did more
than the job description formally
allows.
•Home carers, like home helps,
are low paid. Though training
opportunities have improved, it is
still seen as women’s work with
skills transferable from the
domestic sphere
WORKBOOK 5 - UNIT 14
SECTION 3
HUMAN RIGHTS &
PRESSURES FOR CHANGE WRONGS
SECTION 1 – THINKING ABOUT CHANGE, POLICY & POWER NEW VOLUNTARY
ORGANISATIONS/ MENCAP/
POWER/ FORCES FOR CHANGE/ ENDURING ISSUES IN PRESSURES TO CHANGE
SOCIAL CARE: INSTITUTIONAL CARE/ MENCAP
& HUMAN RIGHTS AGENDA/
• Pressures for change come from stakeholders, from changing RIGHTS INTO POLICY/ COST
ideas, and from underlying social structural changes. PRESSURES
• Getting questions on the agenda that challenge the dominant •Reaction against the institutional
ideology is a way of exerting power. forms of care created a context to
reform both the law and practice
• There are a number of enduring issues in social care: who should surrounding community care.
provide care, who deserves care, and the balance between care and
control. •However, it was public disclosure
about abuse in institutions and
scandals that credited enormous
SECTION 2 – THE 1913 MENTAL DEFICIENCY ACT pressure for change.
IDEAS AS A PRESURRE FOR CHANGE/ CAMPAIGNING FOR
•Questions of cost also added to
CHANGE/ POLICY INTO PRACTICE: IMPACT OF THE ACT:
the pressure to shift care into the
community.
• Eugenics, the idea that human perfection can be attained through
managing breeding, was a popular and powerful force throughout •From the second half of 20th
much of the 20th Century. century the voluntary sector has
played a significant role
• The campaigns which sought to control ‘feeble-minded’ people in campaigning for the rights of
the first two decades of the twentieth century generated public fears service users and their families.
and drew on the development of a new body of expert knowledge.
•Users’ rights are now at the
• Opposition to the 1913 Mental Deficiency Act came from those who forefront of community care
were concerned to protect individual liberty. debates following the development
of service users’ movements
• The 1913 Act introduced state control into the lives of people with
learning difficulties and their families for the first time
 UNIT 14 - COURSE THEMES AND CASE STUDIES
The Kallikak family - Unit 14, campaigning for change – D&I / P&I / R&R

Discussion of eugenics and the Kallikak family. Marrying and having children with a ‘feeble-minded’ girl
produced a son with social problems and a mental defect in each subsequent generation. The second woman
he had children with was ‘normal’ and they went on to have ‘normal’ children. The study of the family
generations found on the one side drunks, prostitutes and criminals, and on the other land owners, judges and Shirley Maddrell & Ann
lawyers. Collingwood, Lee Davidson &
Eileen Dixon - Unit 14, from
They concluded that this evidenced the belief that feeble-mindedness was hereditary and such people should home help to home care -
not be allowed to procreate. Audio 5, programme 2 – T&B /
D&I, P&I
David Barron - “From community to Brenda Nickson, Ann & Michael Tombs, Discussion of the differences and
institution – and back again” - Unit 14, Beryl McLennan, Kim Bell - Unit 14, Mencap similarities between home help
institutional life under the mental - Audio 5, programme 1 – D&I / P&I and home care in the past and
deficiency act - Reader article 1.3 – P&I more recently.Shirley and Ann
talk about their work as home
Discussion of David’s experiences within a Discussion of Bedfordshire Mencap and why helps in the 70s and it seems
long-stay hospital where punishment, ban on change was needed. Brenda talks about the their identity as housewives and
mixing with the opposite sex and absence of lack of support when her son was young; the mothers was enough of a
rehabilitation meant there was a power ignorance of the medical profession; the need qualification for home help, with
imbalance. for respite care and leisure provision and the no formal training.Lee & Eileen
need for contact with other parents going see things differently today as
through the same thing.Ann & Michael talk home carers, and place emphasis
about the need for more services; the on the personal care tasks they
Jan Walmsley & Sheena Rolph - “The importance of a pressure group; the need for
history of community care for people with carry out. They have training
campaigning; and the need for alternatives to courses and work with other
learning difficulties” - Unit 14, community hospital for long-term care provision.Beryl talks
care under the mental deficiency act - trained staff like district nurses.
about the needs of parent for information, for They also know their boundaries
Reader article 6 – P&I / T&B / R&R befriending, for practical support in benefits and and roles when it comes to
the needs of Asian families.Kim talks about handling medication. They keep
Discussion of the period from 1913 to 1946 Mencap needing more radical change to reflect
where families were expected to care with little a professional distance even
the needs and interests of younger people who though they speak with sensitivity
financial help, expected to exercise control expect more than special schools and
over their family member, subjected to critical about their clients for which they
residential provision. She believes Mencap is provide intimate care.
surveillance and threatened with having their too dominated by older people who are not
relative removed, and they had no rights in representative of the younger people like her
law. son.
 SECTION 5 TOWARDS BETTER PRACTICE?
WORKBOOK 5 - UNIT 15
LEAVING HOSPITAL/ MANAGING RELATIONSHIPS/ PRACTICE LINKS:

•People in care settings inevitably experience numerous changes as they or the staff move on.
•Roles, such as the role of key workers, which require close relationships to be built up for their success, are particularly hard to end.
•Enhancing people’s ability to bring their personal resources to bear on managing change require robust, well-resources systems, and staff who are
TRANSITIONS
prepared to listen to what people want, not force upon them & CHANGE
what the service wishes to provide.
•Managing transitions successfully demands a high level of skill and sensitivity on the part of workers.

SECTION 1 – TRANSITIONS USING LIFE STORIES

SECTION 4 LINEAR MODELS OF
CHANGE & ADJUSTMENT
HOPSON & ADAM’SMODEL
OF CHANGES IN SELF-
ESTEEM/ BEREAVEMENT &
PEOPLE WITH LEARNING
DIFFICULTIES/
IMPLICATIONS FOR
PRACTICE:
• Linear models of adjustment
to change posit a fairly
predictable cycle of responses
to personal transitions.
• Indiscriminate application of
models of linear adjustment run
the risk of setting a rigid norm
against which individual’s
actions are judged.
• However, in some care
contexts, such as learning
disability services or dementia
care, ignorance of linear
models, or a failure to apply
them, can lead to highly
unsupportive and inhumane
practices.
TRANSITIONS &
INDIVIDUAL MEANINGS / IDENTITY & DIFFERENCE / GLENDA: CHANGE
VIDEO DIARY/ INDIVIDUAL ACCOUNTS: STRENGTHS AND
WEAKNESSES/ BIOGRAPHY, AUTOBIOGRAPHY &
DEVELOPMENTS IN PRACTICE: SECTION 3
MODELS OF TRANSITIONS
• Transitions are a process of personal change which requires inner SOCIAL ADJUSTMENT SCALE/
adjustment. INDIVIDUAL
• Transitions usually refer to changes in an individual’s life that involve CHARACTERISTICS:
discontinuities in place, relationships, role and status. HARDINESS/ COPING
•Life maps are a tool for sequencing the main events in a person’s life. RESOURCES & RESPONSES:
• Some normative theories of human development predict and describe
what should be happening at a given time in an individual’s life, while
• Theories which seek to explain
other theories recognise a multiplicity of factors combining to determine
how people adjust to transitions
the individual life course.
and change tend to emphasise
• Theories of modernity contrast with more traditional understandings of
individual characteristics such as
fixed life stages arguing for a more fluid approach as people construct
‘hardiness’.
their own identities and biographies.
• Both individual agency and social structural factors are important in
•At the same time the ability of
explaining life course perspectives.
people to cope with change also
• Techniques like a video diary allow the teller to project his or her own
depends on their access to
identity, rather than one imposed by others, and can facilitate sensitive
resources such as social networks
individualised practice.
and mutual help.
SECTION 2 – TRANSITIONS USING RESEARCH
SETTLING IN & MOVING ON/ SPATIAL ODERING OF CARE & HOME:
• Some transitions, such as a move into residential care, may not always be experiences negatively.
• Friendship and the fostering of social skills may be a key to a successful transition.
• It is important to be aware of the wider contexts and particular design when evaluating research.
• Receiving care at home can mean that people’s accustomed territories and boundaries of space, role, status
and relationship may be challenged.
 UNIT 15 - COURSE THEMES AND CASE STUDIES
Glenda - Unit 15, transitions Video – D&I
Discussion of Glenda, a middle aged woman who spent most of her life in mental
health system. Glenda’s account makes use of a life map to help her explain
significant changes and stages in her life which were important to her, which adds
meaning to her account. Glenda doesn’t present her identity as a mental health
survivor or as someone who has an illness. She attributes her life course to chance
and personal qualities, which explain her life in terms of personal misfortune and her
willpower to succeed. However, her story does leave bits out and this is a danger
with subjective accounts.
Glenda - unit 15 and social adjustment theory D&I
Holmes and Rahe scale of social adjustment.
Glenda’s head injury would feature on this scale. Scale seen as too general and of
limited use in helping people understand their own lives.
Mabel Cooper - Unit 15, transitions D&I
Discussion of Mabel’ life story from memory, and then using
evidence found in case records to help her to understand why she
was in care – fill in the gaps.
Reed et al “Settling in and moving on” - Unit 15, transitions
T&B
Discussion intended to develop understanding of how older
people accommodate the idea and experience of moving into a
care home. Found that the key to a successful adjustment was
social relationships (networks). Existing social skills were also a
factor in enabling residents to build up social resources.
Difference and identity

Glenda - unit 15 hardiness D&I
Glenda’s experience using Korbasa et al’s model.
Control: Glenda puts a lot of emphasis on control. She talks of determination to
regain some control over her life, and is important for her to be in control of her life
now also through having her own car and administering her own medication.
Commitment: commitment isn’t mentioned much and her family have not given her
consistent support.
Challenge: Glenda relishes in challenge, her life has been a challenge and she
takes pride in rising to it.
Julia Twigg “Care work and bodywork” - Unit 15, transitions
Reader article 33 – P&I / T&B / D&I
Discussion of whether receiving care at home is a different
experience to receiving care in residential setting regarding
transitions. Twigg argues that being at home with personal
possessions mitigates against loss of identity. Being at home
alters the power relationship between client and worker, and
control of space is easier at home.

Mary in Gubrium “The prospect of
residential; care” - Unit 15, transitions as
linear process Reader article 24 - P&I /
T&B / D&I
Discussion of the processes that care givers
and receivers should go through when
recognising the need for institutionalisation.
Mary tries to resist pressure to institutionalise
Nina, details why she resists the pressure and
explains the tension caused by the resistance.
Cas Alland - “Places in between” - Unit 15, leaving hospital Reader article 1.2 – D&I/P&I
Cas’s story of her own battle to successfully leave hospital. She describes the impact on her
identity as profound. Cas had resources available to her to be able to cope with the transition.
Cas and Korbasa’s model – T&B
Relevance of Korbasa et al’s model: Challenge: rose to challenges of navigating the benefits
system alone, fighting for the kind of support she wanted. Commitment: she marshalled important
personal relationships to support her. Control: she fought to gain sense of control. Cas believes
she was strong or ‘hardy’. She says that the system is designed to support weakness rather than
strength, and the system is flawed as was misinformed about eligibility criteria and entitlements to
benefits.

Julie & Stephen - Unit 15, managing relationships - Audio 2, programme 2 – T&B. Stephen had a dependence on Julie, and she had successfully built
up a good and trusting relationship with Stephen. However, when the time came for her to move on she did not handle it well. Julie promised to still have
involvement in a friendship sense rather than as staff. As she had to gradually withdraw from her involvement with Stephen due to her new job role and
demands, his behaviour became more and more disruptive. This was probably just his way of coping with the transition, which Julie should have managed
more professionally and imposed some boundaries far earlier on.
 SECTION 5 A
ROLE FOR
RESEARCH
SECTION 4 CHANGING
ORGANISATIONS
WORKING CONDITIONS/
ARRANGEMENTS FOR
SUPPORT/ OPPORTUNITIES
FOR LEARNING:
• However great the changes
in social care, there are many
continuing issues.
• Such issues are being
tackled at many levels, from
individual social care agencies
to the European Union.
• Workers need to be confident
of appropriate support in order
to meet the expectations of the
quality agenda.
• Training, education and other
opportunities for learning are
critical aspects of such support
WORKBOOK 5 - UNIT 16
• Good quality research is indispensable as an aid to understanding, and can make an important contribution to
improving practice.
• A questioning approach and critical capacity are necessary, if social care workers are to seek out research and
draw on it effectively.
SECTION 3
THE CHANGING SOCIAL CARE WORKFORCE
WHO ARE THE WORKERS
SECTION 1 – THE VOICE OF WORKERS NUMBERS & EMPLOYMENT
PATTERNS/ CHARACTERISTICS &
CHANGING RESPONSIBILITIES/ EASING BOUNDARIES EXPERIENCE/ EVALUATING
STATISTICS
• Some workers have had to develop new skills to meet new demands.
• Information about the social care
• Shifting health/social care boundaries have encouraged rethinking of workforce is needed to judge the
training structures and aims. effects of past policies and to plan
recruitment, retention and training
• More emphasis on the views of users and carers has led to changes in strategies.
work relationships and the planning of training.
• The available information about
SECTION 2 – ADAPTING TO CHANGE characteristics of the workforce
suggests questions about who gains
access to the social care workforce
ORGANISATIONAL CHANGE/ PRACTICE CHANGE:
and what their experience is once in
post.
• Organisational change can provide valuable new opportunities, but
is often accompanied by uncertainty and stress. • Statistics are an invaluable tool –
but caution is required in interpreting
• Organisational change may have implications for practice, but so and drawing on them
too do shifts in ideas and policy priorities, and in local populations.
•Effective achievement of new objectives requires understanding of
the dilemmas which social care workers experience in their practice.
 UNIT 16 - COURSE THEMES AND CASE STUDIES
Audio 5, Programme 3 (track 3) – changing responsibilities & relationships – T&B, R&R, D&I, P&I

Relates to relationships with service users, skills used, boundaries between health and social care.

Barbara - Relationships – closer contact with service users before NHS and Community Care Act, 1990.
Wider range of resources, better meet individual needs, continuity with service users.

Skills – more paperwork, availability of diverse services, more innovative, more specific skills, more tarining
and development.

Boundaries – most caring tasks by nurses not undertaken by family or social care workers, health and social
care under one umbrella, social carers not nursing carers – a difference in social and medical models of care.
.

Audio 5, Programme 3 (track 4) – interprofessional learning – T&B, R&R, D&I, P&I

Positive aspects – closure of long-stay hospitals, changes in the training of nurses, preparation for working in the community, wider skill base
and training, joint training for health and social care needs, holistic way to provide services to users using wide knowledge and experience base
from medical/social professionals.

Possible problems – health/social care have different values – create animosity/resentment/threat, conflicting individual cases biased on two
different approaches/models, medical needs & social needs vary, staff identities threatened or compromised, joint training seen as another
encroachment on their territory, dilution of established boundaries

The reader Chapter 32.3 Being reorganised – all course themes

Negative: Established relationships disrupted, had to be rebuilt, service users experienced upheaval,
increased staff turnover, more chiefs fewer Indians, instability and uncertainty, increased stress, confusion and
low morale, lack of sensitivity to employees and service users

Positive: staff functioned as a team, drew on each other’s experience/knowledge, meetings more holistic,
clearer job descriptions, training and other opportunities.
 SECTION 4 COMMUNITY SECTION 5 COMMUNITY INVOLVEMENT
INITIATIVES WORKBOOK 5 - UNIT 17 & DEVELOPING CARING COMMUNITIES

BUSINESSES/SOCIAL COMMUNITY INVOLVEMENT/CARING COMMUNITIES:

ENTERPRISE/EXAMPLES:
• Community regeneration
initiatives aim to address a local
unmet need – for example,
provision of jobs, skills, goods or
services – and to secure long-term
financial independence.
• The main forms of community
initiatives (e.g. LETS, credit
unions) are community businesses
and social enterprises (e.g. co-
ops).
• The greatest benefit of
community businesses may be in
capacity building and meeting
social needs unmet by the market
economy.
• Social care co-ops, such as
home care co-ops, can be
innovative and flexible in ways
which meet the needs of carers
(members) and users.
HISTORY/EXAMPLES/METHODS/EVALUATING DEVELOPMENT:
• Community involvement is a prerequisite for the success of
regeneration programmes.
• Creating caring communities means taking a broader view of
communities and their needs.
• Caring for communities means involving everyone from bottom to
top. SECTION 3
• Community development methods are essential to building caring REGENERATING COMMUNITIES
communities.
POLICY/CAPACITY
BUILDING/SUSTAINABILITY:
CHANGING COMMUNITIES
SECTION 1 – WHAT IS THE COMMUNITY? • Regeneration started with a
concentration on economic initiatives
• Memories of past communities illustrate the significance of but has now broadened to include a
community and its meanings for community members today. range of social activities.
• From different perspectives the idea of community can generate • Community regeneration is a goal
issues which may both divide and unite people. (or ‘task’) that depends on community
development, which is an activity (or
• Communities tend to be defined as much by identity and support ‘process’).
as by space.
• Two key concepts in regeneration
• ‘Strong’ communities are not necessarily immune from problems. are capacity building and
sustainability.
SECTION 2 – COMMUNITY DEVELOPMENT

• Community development seeks to release the potential within communities and to change the relationships between people in communities, as well as
the institutions that shape their lives.

• Involvement of the people in a community is usually considered essential to healthy and sustainable community development.

• Community development has adopted and developed a range of methods and techniques. These include community profiling and policy analysis,
capacity building, communication, organising, negotiation, networking and resourcing.

• Community development has had an impact during the last 50 years through its methods and goals – particularly on public authorities, professions and
social movements.
 UNIT 17 - COURSE THEMES AND CASE STUDIES
The Butetown Women - Unit 17, what is the community? - Audio 5, programme 4 – D&I/ T&B/ P&I

Discussion about the idea of community for the women of Butetown, home of one of the earliest established Black communities in Britain. They
compare the past to now and discuss the impact of racism, poverty and stigma on their community and on the relationships of the residents of the
community who seem to have thrived in sticking together through the years against oppression.

Yvonne Wells & Shaffaq Mohammed from Darnall & Tinsley - Unit 17, community LETS as community development - Unit 17,
development Video 1, programme 1 – D&I/ T&B/ P&I community development – P&I/ T&B

Discussion of Yvonne and Shaffaq’s community development roles in comparison to the Discussion of the advantages and disadvantages
women of Butetown. As with Butetown, sense of community from shared hardship and of LETS scheme. Advantages include: skills
neglect, stigma attached to postcard. Tinsley described as close knit community. Yvonne outlet; developing organising and networking skills;
and Shaffaq have local knowledge and are aware of changing needs. Darnall and Tinsley improvements to the members’ self-esteem and
qualify for government assistance under the Single Regeneration Budget and there are a better social contact; getting help with gardening,
number of projects of a community development nature ongoing. Yvonne’s health project household and computing problems.
for example. Keen to build on community strengths and stress the importance of bringing Disadvantages include: tendency towards closed
people together. They have an organising and campaigning role. and similar types of membership.

Steve Clarke - “The regeneration of communities” - Unit 17, regeneration of communities - Reader article 12 - D&I/ T&B

Discussion of the process of community regeneration as opposed to community development. Suggests success in regeneration depends on:
defining the community; involving people in the process of planning and decision making; awareness by a community of its capabilities.

Shepshed carers Co-Op - Unit 17, community initiatives –

Sandwell Regeneration Partnership - Unit 17,
regeneration of communities – Offprints – D&I/ P&I
Discussion about capacity building and the Sandwell project.
Capacity is referred to as something to develop in the local
population so that it plays a fuller role in regeneration and
development.
T&B
Discussion of a carers co-op and how it works. Formed in 1994
through two women who had lost their jobs. They were
experienced members of St John’s Ambulance and were
encouraged by district nurse to fill a gap between social services
home care and family support. By 1995 the co-op had 41 carers
and 112 clients. Of these, 61 were social services referrals and
51 private arrangements. In 1997 the co-op found an office
space. Training was seen as vital. By 2004 there were 75
carers and 250 clients and the co-op provided over 1000 hours
of care a week.
SECTION 5 SYSTEMS TO RESPOND TO ABUSE WORKBOOK 6 - UNIT 18 SECTION 6 CRIME AND ABUSE

SPECIAL PROCEDURES/REDRESS THROUGH ORDINARY

DIFFERENT PERSPECTIVES/ LABELLING PEOPLE VULNERABLE:
CHANNELS:
• Any intervention designed to protect should lead to acceptable outcomes.
•A number of different systems are available for policing the wrongful
• Heavy-handed and insensitive responses can leave people worse off,
treatment or abuse of vulnerable adults who are users of services.
compounding the vulnerability.
•Inter-agency coordination is important if the systems are to be
• Respect for autonomy and self-determination has to be weighed against
effective.
the overall goals for ultimate benefit and empowerment.
•Access to ordinary systems of justice is problematic for vulnerable
• People are more vulnerable when they have limited access to resources
adults, who are often excluded from opportunities to seek redress and
to help them to recover from crime and abuse.
lack the support needed to enable them to take part successfully.
• A social model vulnerability suggests a radical agenda for protection, one
SECTION 4 CRIME AND ABUSE designed to prevent vulnerability and promote resilience.

WHO IS RESPONSIBLE/DENIAL- SECTION 3

VICTIM BLAMING:
• Vulnerability can be compounded by a
failure of individuals and organisations
to respond. appropriately to victims of
violence
• One response is to blame the victim
for what has happened.
• Insensitivity to victims and to the
trauma they may have suffered may
make it difficult for them to give an
account of what has happened.
• A sensitive response is important in
terms of gathering evidence so that
others can be protected in the future
and criminal charges brought when
necessary.
DEFINING / RECOGNISING ABUSE:
VULNERABILITY & PROTECTION
SECTION 1 – WHAT IS VULNERABILITY?
DIFFERENT PERSPECTIVES/ LABELLING PEOPLE
VULNERABLE:
• Vulnerability may be seen as resulting from a range of
different personal and social factors.
• Being labelled a vulnerable adult may entitle someone to
additional support or services.
• On the other hand, such a label may be interpreted as
stigmatising.
SECTION 2 – WHAT IS MEANT BY ABUSE?
SOCIAL MODEL OF VULNERABILITY
ORDINARY RISKS/COMPUNDING
FACTORS:
• Seeing vulnerability as located in
individuals may give a distorted
impression of what is happening to
them.
• We may forget that many risks are
ordinary risks and include crimes, which
should be seen as such.
• We may also fail to recognise that
people not specifically labelled as
vulnerable can experience abuse.
• Thinking in terms of a social model of
vulnerability draws attention to the way
vulnerability is created and compounded
by a lack of social, material and political
resources.

• Abuse may involve physical or psychological harm, sexual or financial exploitation, neglect, negligence or discrimination.
• Some actions described as abuse would in other circumstances be labelled as crimes or other illegal acts.
• Deciding whether or not something should be termed abuse is often a matter of judgement.
• Such judgements may be influenced by whether an action or a failure to act is seen as deliberate or malicious, by how serious the consequences are,
or by how powerful those responsible may be.
 UNIT 18 - COURSE THEMES AND CASE STUDIES

Clifford - Unit 18, vulnerability and abuse – P&I/ R&R

Discussion of Clifford, an African-Caribbean man with learning difficulties and hearing impairment, and difficulties in walking resulting in awkward gait.
Lives near brother but other family not around. Landlady lives on site. Unreliable for work, stopped attending day centre as he got bored. Falls
between 2 services and on borderline of being classed as vulnerable adult. Gets attacked.

The police did not pick up on his learning difficulties or his deafness and so was not offered the appropriate support for his interview; the social services
did not want to bother getting involved at the early stages for what they deemed was a trivial incident, and his own brother believed that Clifford must
have brought it upon himself. No one thought it necessary to get Clifford’s injuries checked out properly, which could have led to serious
repercussions, and the police should have had a duty of care to Clifford. I

t is possible that Clifford was assumed to be in some way responsible for his attack as he appeared to be in a drunken state. Wasn’t until later when
police returned his wallet that they realised his learning difficulties and offered a proper interview with the support Clifford required. He was though
considered an unreliable witness and his case never made court. In the meantime he had lost his job and brother was annoyed with him, got behind on
rent and landlady was threatening eviction. Became depressed and displayed signs of PTSD, began drinking and was too scared to leave house even
to sign on or cash his giro.

Clifford eventually consented to social services being contacted and they decided it would be best for him to go back to day centre, but he didn’t want
to.

Eric & Nancy - Unit 18, vulnerability and abuse - Audio 6, programme 2 – R&R/ P&I

Discussion of Eric and his wife Nancy who lives in a care home.Nancy’s bracelet had gone missing and she had some bruising and the staff were
unable to make sense of what had happened, but Eric knew what questions to ask to find out from her what had happened and he managed to get to
the bottom of it.

Mrs Willis, Mike and David - Unit 18, vulnerability and

Michael Preston-Shoot - “Evaluating self-determination” -
abuse - Audio 6, programme 2 – R&R/ T&B
Unit 18, vulnerability and abuse - Reader article 22 – R&R /
P&I
Discussion of Mrs Willis’s daughter in law’s concerns about
the care she was receiving. Mike had to ascertain the
Discussion about older people living at home in at risk situations
situation on behalf of social services, the police officer was
with their carers, but who do not want to take any action or
responsible for dealing with the proprietor’s wrongdoing and
receive any intervention. The author discusses positive and
the district nurse was responsible for Mrs Willis’s care.
negative freedom. Positive freedom allows for self-
determination, autonomy and choice.
 SECTION 4 INVOLVING
SERVICE USERS WORKBOOK 6 - UNIT 19 SECTION 3
MANAGING RISK & DANGEROUSNESS
USERS/CARES’S VIEWS/
RIGHTS/ETHICAL RIGHTS & DANGEROUSNESS POLICY/HIGHRISK
FRAMEWORKS: INDIVIDUALS/STRATEGY:

•Technical approaches to risk • Different risk policies have different

management and assessment can
position service users as objects
rather than subjects of the process.
•An overemphasis on
dangerousness and safety can
obscure the needs and strengths
of service users.
•More attention is being given to
the rights of users in relation to the
assessment of risk and
dangerousness and ways of
making those rights a reality.
•The assessment and
management of risk has to be
placed in an ethical framework and
informed by the perspectives of
those subject to decision making.
SECTION 1 – RISK/DANGEROUSNESS IN EVERYDAY LIFE implications for practice, ranging from
empowering practice at one extreme
EXPLORING MEANINGS/EVALUATING/MEIDA’S ROLE: to highly protectionist practice at the
other.
• Risk taking is a feature of everyday life, including health and
social care work. • Strategies for managing groups
• The concept of risk is often confused with the concept of identified as high risk or dangerous
dangerousness. have advantages and disadvantages.
• Risk taking can have positive as well as negative outcomes.
• Assessing risk in the context of everyday life involves • Anti-protectionists argue that
weighing possible negative outcomes against possible positive blanket strategies will inevitably
ones. threaten the civil liberties of some
• Evaluations of dangerousness are strongly influenced by individuals.
personal experience and values.
• Risks and dangers which are characterised by fright factors • A transparent and explicable model
tend to get more attention than others. of risk assessment goes some way
• Our perceptions of risk are influenced by the way in which towards combating the uncertainty
blame is allocated in society. inherent in predicting risk and
• The media and campaigning organisations play a key role in dangerousness and helps to generate
influencing individual values and perceptions of constructive interventions.
dangerousness.
SECTION 2 – RISK ASSESSMENT IN HEALTH/SOCIAL CARE

TWO APPROACHES/POTENTIAL OUTCOMES/EXAMINING EVIDENCE/IMPORTANCE OF VALUES:

• Two main approaches to assessing risk and dangerousness in health and social care are the actuarial and the clinical.

• A model of risk assessment which combines these approaches and encourages practitioners to be explicit about severity and likelihood can be useful.

• It is important to critically examine the quality of evidence used in assessment of risk and dangerousness.

• Written reports may contain ambiguous language. Numerical scoring can give the impression of accuracy, but can also be ambiguous.

• Professional values are significant in shaping decisions about risk and dangerousness.
 UNIT 19 - COURSE THEMES AND CASE STUDIES

James - Unit 19, risk and dangerousness – R&R/ P&I
Discussion of James, 34, moderate learning difficulties living in supported
accommodation. James is spending a lot of money on scratch cards and
lottery and not on personal hygiene items. Parents have been in contact to
say he shouldn’t be allowed to spend his money in this way as it will lead
him to gambling addiction. James argues he should be allowed to spend his
money how he pleases. They agree in the end to allow him so much for
scratch cards and the rest for his other needs.
Daniel Joseph - Unit 19, risk and dangerousness and the media –
Offprints – R&R
Andrew Alaszewski- “Risk and dangerousness” - Unit 19,
risk and dangerousness - Reader article 21 – R&R
Discussion of the difference between lay and professional
perceptions of risk.
John - Unit 19, risk assessment – R&R
Discussion of John, 33, unemployed and history of depression
and at possible risk of harming himself. John’s father killed
himself, so GP is anxious at John’s sudden comments about
self-harm and suicide.

Media report about the case of Daniel Joseph, who murdered a girl, Carla
Thompson. He has a history of mental health problems, was deaf and was
also Black. The article is presented to show that he was let down by the
services and was a vulnerable young man and did not allude to the usual
stereotypical reports of madmen on the loose.
Anthony Smith - Unit 19, risk assessment – evidence – Offprints – R&R
Report on Anthony Smith who killed his mother and step-brother. History of
mental health problems, was reported to be carrying weapons regularly.
Evidence from his father and other associates was ignored and not recorded
as it was subjective material, but this could have provided valuable clues.
Joy and Nadine, Ernie and George - Unit 19, risk
assessment – values in decision making - R&R
Joy and Nadine work in residential home, and Joy is Ernie’s key
worker. Ernie is 78 and physically frail, and suffers from
depression. Reluctant to move to a nursing home. Nadine is
key worker for George who recently moved in. He is 72 and has
had an unsettled life, including homelessness. He finds Ernie
irritating and winds him up. He has been treating Ernie
aggressively, and although Ernie has not complained, Nadine
and Joy feel it is a risky situation.

Brenda Unit 19, risk policies – R&R

Discussion of relevant risk policies for Brenda, 35, lives in group home for people with learning difficulties. Wanting to go on holiday with friend
Louise who also has learning difficulties.

Jenny - Unit 19, risk management strategy – R&R

Discussion of Jenny and trying to find a risk management strategy for her.Jenny, 45, with learning difficulties, living in supported housing with 2
other women. Been drinking heavily and the other women have been complaining about her. She recently set the chip pan on fire after trying to
cook drunk. A neighbour saw the smoke and called the fire brigade. Residents were frightened and the staff are now concerned that Jenny may
be a danger to herself and others.

SECTION 4 ASSESSING
QUALITY
MEASURING QUALITY/USERS’S
VIEWS/OBSERVATION:
• Quality must be defined and
assessed for it to be incorporated
into regulatory standards.
• A major issue in assessment is
the distinction between subjective
and objective dimensions of quality
of life.
WORKBOOK 6 - UNIT 20
MEETING STANDRADS/INSPECTION PROCESS:
•Standards are only the base against which quality of life in care settings is judged.
SECTION 5
•Managers and care staff need to feel accountable for the care practices in the care ESTABLISHING
settings where they work. STANDARDS
•Recent legislation about whistleblowing should help workers to voice concerns about
abuse and malpractice.
•Comparisons across service user groups can help to develop a more critical approach to
assessing regulation and inspection as a process.

• Ways of eliciting users’ views REGULATING FOR QUALITY SECTION 3

include questionnaires, focus
groups, interviews and
observation.
• A combination of approaches,
including objective and subjective
measures of experience and care
environments, is commonly used in
assessing quality of life in
residential settings.
REGULATING WITH LIGHTER TOUCH
SECTION 1 – WHAT IS QUALITY OF LIFE?
• Maintaining the boundary between
OBSERVING QUALITY OF LIFE/RESIDENT’S & a domestic and an institutional setting
EXTERNALVIEW/PERSPECTIVES: is an issue that concerns owners,
residents and the inspectorate.
• Residents and other parties’ views on what constitutes quality of
life differ because of their different interests and perspectives. • In small homes a lighter touch
• Observers may use many different ways of judging quality of life in approach to inspection has supported
residential settings. more informal styles of residential
• Inspectors have to weigh up competing and sometimes conflicting care for vulnerable adults
interests as part of the regulatory process.

SECTION 2 – REGULATION

INSPECTION/REGULATION/STANDARDS:

• The main purpose of regulation and especially inspection is to guarantee that standard of care being provided to service users.

• Nationally agreed minimum standards of care have taken time to achieve because of the sometimes conflicting interests of different stakeholders and
variations in how quality has been assessed.

• The regulation and inspection of care services against care standards is carried out by the CSCI in England and Wales; the Scottish Commission for
the Regulation of Care in Scotland; and the Northern Ireland Health and Personal Services Authority in Northern Ireland.
 UNIT 20 - COURSE THEMES AND CASE STUDIES
Stella Best, Elizabeth Russell and Theresa Lefort, and Hannah Hanley- Unit 20, quality of life - Audio 6, programme 3 – T&B/R&R

Discussion of what Stella, Elizabeth and Theresa think of their residential home, and of how Hannah gathers information from them to ascertain quality
of life in the home.Each of the ladies had a different opinion about the home, Elizabeth thought it lovely while Theresa found it clinical. Stella suggested
you couldn’t really say what you thought. There was a lack of magazines and flowers and tea making facilities which made her feel as though there
was an assumption that people couldn’t do it for themselves. They were all concerned about the difference in age groups between staff and residents
and the fact that they were all young and black.Hannah has to check records and make a mental checklist when looking round the home, as well as
talk to the residents. Her job is to make an objective assessment of whether it meets statutory standards.

Holland and Peace “Regulating informality: small homes and the inspectors” - Unit
20, regulating with a lighter touch Reader article 28 – T&B/R&R Brenda in John Burton “Exposing abuse in
care homes” - Unit 20, whistleblowing Reader
Discussion of the process of regulation in smaller residential homes as opposed to larger article 27
ones. R&R

Discussion of Brenda, a care assistant in a

Gladys Unit 20, whistleblowing – Offprints – R&R residential home for older people, who tried to
report abusive behaviour she had witnessed.
Discussion of Gladys, a resident in a care home who was being abused by the manager. However, she was not taken seriously and found
The inspector received an anonymous phone call from a member of staff and later the whole system to be corrupt and uninterested in
contacted the district nurse, police and social services. The owner was arrested. Plenty of the allegations. The resident died and Brenda
evidence led to the owner’s appeal being denied and the home was shut down. Gladys resigned.
died shortly after.

Jane and Mary - Unit 20, whistleblowing – R&R/P&I

Discussion of Jane, a day care assistant at a private rest home, and Mary who also worked there and was abusive to the residents and staff.Jane
witnessed a catalogue of abuse from Mary towards the residents. She decided to inform the inspectors when they visited. The inspector on
hearing the evidence from Jane and other workers referred the matter to the police and Mary was suspended. However, Jane was also
suspended in case she hindered the investigation. Jane was then told she faced disciplinary action for breaking confidentiality and damaging the
reputation of the home. Jane contacted Public Concern at Work who assured her of her legal rights and drafted her a letter. She was welcomed
back at work and all action was dropped.
SECTION 4 OBTAINING PRACTICE
REMEDIES/GAINING
ACCESS/EQUALITY & JUSTICE:
• The law provides victims of
injustice with various remedies,
such as the right to use a social
services department or NHS
complaints panel, access to the
Ombudsman procedures and to
the courts, including judicial review.
• Although the law can be
accessed via the internet and
libraries, if you know what to look
for, in general, the use of expert
intermediaries (including care
workers) is helpful, if not essential,
to clarify what are the key issues.
• Many disabled people and their
carers have immense problems in
using these remedies for non-legal
reasons such as exhaustion, a
sense of powerlessness and fear
of indirect repercussion.
• Social care workers can help
people to make changes by
knowing about law, how to access
it and understanding the difficulties
using the law may entail.
RIGHTS, DUTIES & POWERS/STATUTE,COMMON,CRIMINAL & CIVIL LAW/PUBLIC & PRIVATE LAW:
WORKBOOK 7 - UNIT 21 SECTION 5 MAKING CHANGES
CHANGING NATIONAL LAW/SETTING PRECEDENTS/CHANGING LOCAL GUIDANCE:
• There are many reasons why laws are introduced or amended, although increasingly the primary reasons
tend to be political and social factors.
• Many important social welfare laws have originated as private members’ bills.
• Test case strategies have been used by lawyers to clarify in a positive way the interpretation of many social
welfare statutory obligations.
• Local policies can be influenced by the use of social services and NHS complaints procedures and their
respective Ombudsmen.
SECTION 3 - RELEVANCE OF EUROPEAN LAW
USING THE LAW EUROPEAN UNION/EUROPEAN
SECTION 1 – THE FUNCTION OF THE LAW? CONVENTION ON HUMAN RIGHTS
(ECHR):
CULTURAL, NATIONAL & REGIONAL DIVERSITY:
The ECHR protects important
• Your perspective of the law depends on your socio-political status: negative rights such as the right not
for the poor and socially excluded the law can be an oppressive to be the victim of degrading
instrument. treatment, the right to a fair hearing
• The political philosophies underlying the UK’s social welfare laws and the right to family life.
have changed radically over the last 50 years and the territory of the • These rights are now part of UK law
law has changed accordingly. as a result of the Human Rights Act
• The law sometimes leads (as with race relations legislation) and 1998.
sometimes follows public opinion. • EC law has previously concentrated
• Laws are shaped by cultural, regional and political forces; even upon harmonising economic
within states such as the UK there are significant local variations in arrangements among its member
the law. states: increasingly it is now requiring
other common standards such as sex
equality and non-discrimination on the
SECTION 2 – TYPES OF LAW grounds of race and age.

• UK laws are either statutory in origin (i.e. approved by parliament) or are derived from the ancient common law (i.e. judge-made).
• Social welfare law is predominantly governed by statute law.
• Governmental guidance, although lacking the status of law, is of crucial importance in the development of local social welfare rights and services.
• Social welfare guidance falls into two broad categories: policy and practice guidance. Policy guidance has a higher legal status and must in general be
followed by local councils and NHS bodies.
• Most disputes concerning social welfare services are civil law matters. Criminal law is generally concerned with a deliberately evil intent and usually
enforced by the police.
• Disputes between private individuals are known as private law matters, whereas legal issues that involve a public authority are known as public law
matters. Judicial review is an example of public law proceedings.
 UNIT 21 - COURSE THEMES AND CASE STUDIES
Margaret Forster - “Paying for nursing home care” - Unit 21, identifying legislation - Reader article 10 – P&I

Discussion of Margaret Forster, who fought to have the charges for her father’s nursing care covered by the authorities. She took the authorities to a
tribunal and won.

Gaskin v. United Kingdom - Unit 21, European Law –

Luke Clements - “Community care law and the Human Rights Act
D&I / R&R
1998” - Unit 21, European Convention on Human Rights - Reader
article 29 – R&R / P&I
Discussion about Gaskin, who successfully managed to gain access to
his records of his time in care, arguing that it was the only way he could
Discussion about the ECHR and the UK Human Rights Act with relation
find out about his early life. He won and the Data Protection Act 1998
to health and social welfare, and the failings of the Acts for disabled
was enacted to make the changes identified by the European Court as
people.
being necessary into UK law.

London Borough of Southwark (99/A/988) Unit 21, ombudsmen – R&R / P&I

Discussion of Mr Grant, who has multiple disabilities and health problems, and his community care assessment which was reassessed and saw his
care hours cut by 20 hours per week. This meant he would no longer be entitled to a grant from the ILF. He also disagreed with the way the
assessment had been done and made a formal complaint. He then complained to the Ombudsman. The Ombudsman found in favour of Mr Grant
and recommended that he be compensated and his care plan be reviewed immediately.

Mrs Clarke & Kulvinder - Unit 21, advocacy – R&R / P&I

Airey v. Ireland - Unit 21, legal aid – R&R
Discussion of the case of Airey, who wanted to divorce her
husband but was told she could not receive legal aid to
assist this. She argued that this would mean she had an
unfair hearing as she was unable to afford a lawyer. The
European Court upheld that she could not have a fair hearing
without legal aid, as the divorce rules in Ireland were such
that a lawyer was needed for a fair hearing. As a result the
law was changed in Ireland.
Discussion of Mrs Clarke, severe dementia, in hospital. A member of the public
visiting another patient witnessed Mrs Clarke being force fed and Mrs Clarke was
left breathless and in tears. The visitor then saw the same member of staff taking
Mrs Clarke to the toilet and was still being rough. The visitor approached the
hospital advocacy service. Kulvinder, the advocate, arrived on the ward 2hrs later
and Mrs Clarke was still in the toilet, and had been purposely left in there to
prevent her being disruptive to the other patients. Kulvinder was told she was
wasting her time and interfering. She tried to communicate with Mrs Clarke, but
she was very upset and appeared to have forgotten what had happened, or was
simply unable to say. Kulvinder called the ward manager and reported the
problem, despite Mrs Clarke not having consented to this. Kulvinder said she
would be making a formal complaint. Staff were suspended and ward procedures
were reviewed.
 UNIT 21 - COURSE THEMES AND CASE STUDIES - CONTINUED

R v. London Borough of Hammersmith and Fulham ex parte M - Unit 21, setting precedents – P&I / D&I / R&R

Discussion of the case of asylum seekers who were barred from receiving social security payments or assistance with housing. A court case later
suggested that they were entitled to help under section 21 of the National Assistance Act 1948.

Complaint 99/B/00799 against Essex, 29/3/2001

- Unit 21, changing local guidance – P&I / T&B

Discussion of the case of a severely disabled

person and carer, both in 90s. An assessment
was made that he needed help to get in and out of
bed but because of recruitment problems the
Gateshead Metropolitan Council (99/C/02509) Unit 21, changing local guidance – agency proposed to withdraw its service to him.
R&R/ P&I The council couldn’t find another willing agency,
and all the ones that would do it wanted travel
Discussion of the council’s charging policy for disabled people. The council would only expenses covering. The council wouldn’t do it as it
waive the community care service charges for disabled people if they could prove was against their policy. The Ombudsman
hardship. The complainants provided evidence, but the council decided to impose full nevertheless found in favour of the couple and
charges anyway. The Ombudsman concluded that the council had acted improperly and decided that the council was guilty of
misunderstood the law. The council then amended its charging policy and the changes maladministration.
also sparked other councils to do the same as Ombudsmen reports are copied to other
councils.
 WORKBOOK 7 - UNIT 22
SECTION 3 & 4
SKILLS FOR ADVOCACY -
ADVOCACY AND CAMPAIGNING CAMPAIGNING

SECTION 1 – DEFINITIONS, DEBATES, DILEMMAS

POLICY/CAPACITY
DEFINITIONS/TYPES/SERVICES/PRINCIPLES/POLICY/ BUILDING/SUSTAINABILITY:
PRACTICE

• Advocacy means speaking up for yourself or others (advocates • Advocacy requires a wide range of skills.
speak/act on behalf of others)
• Support for self-advocacy draws on skills one
• There are many different types of advocacy; all share common would expect from any good care worker
values (Empowerment, autonomy, citizenship, inclusion) (Self- together with awareness of political context and
advocacy, Citizen, peer, professional, crisis, parent/carer values of justice and empowerment.
advocacy – P72/73 Unit 22)
• Self-advocacy supporters often work in
• There are arguments over who should be advocates, how isolation with few opportunities for training and
advocacy should be funded, whether advocacy should be short or reflection and are frequently accountable only to
long term, and how differences can best be represented . the self-advocates they support.
(See case studies for campaigning)
• Different types of advocacy are popular with different groups of
people.

• Uncertain funding means that advocacy is not available to all who

need it..

SECTION 2 – SPEAKING FOR OTHERS/YOURSELF

RANGE OF ADVOCACY TYPES/SERVIC-BASED/INDEPENDENT SELF-ADVOCACY/DIFFERENCES:

• Advocating for people with limited mental capacity or who have limited means of communication requires great sensitivity and high ethical standards.

• There are pros and cons to advocacy as a paid professional role.

• Whether or not service-based advocacy can do more than address immediate concerns is much debated.

• Self-advocacy is viewed as qualitatively different to advocacy, and more empowering for oppressed groups to engage in; some claim for it the status of
a new social movement.
 UNIT 22 - COURSE THEMES AND CASE STUDIES
WASSR & MK SUN - Unit 22, advocacy Video 2, programme 2 -– All course themes

Discussion of 2 advocacy services.

WASSR: started by older people who saw that some older people lacked confidence to manage their affairs and needed support to assert their rights to
health and social care. Most volunteers are women, although from all ages. It relies on paid workers to support and train volunteers. It is entirely
independent from health and social care services. It is mainly concerned with individual advocacy and has a desire to improve services. It is a short-
term crisis advocacy service.

MK SUN: service for mental health service users which believes that being a service user in the mental health sector is disempowering, as is lack of
information about the law and rights. It limits its recruitment to survivors of the mental health system and is a peer advocacy service, relying entirely on
volunteers. It is independent of health and social care services. It is a long-term service and want to improve services.

Unit 22, skills for advocates MK SUN focuses on individual advocacy and campaigning.

WASSR needs to be able to set boundaries to their role and focus on short term crises.

MK SUN needs networking skills to spread the word about advocacy and to be willing to engage in long-term relationships outside the boundaries of
the service. Their advocates have a broader educational role, informing users of changes in legislation etc.

Both need to people skills, listening skills, ability to locate and communicate information, assertiveness, persistence, and to be able to subscribe to the
principles of autonomy, empowerment and inclusion.

Cheryl - Unit 22, advocacy for people

Simone Aspis - “self-advocacy for people with learning difficulties - ”Unit 22, self-advocacy
who cannot speak up for themselves –
-Reader article 30 – P&I/D&I
P&I/D&I
Critical discussion of self-advocacy for people with learning difficulties. The author describes
Discussion of Cheryl, a young woman who
speaking-up courses and what they entail. They teach communication skills, decision and choice
has always lived in institutional settings,
making and assertiveness. She criticises that these individualise self-advocacy skills and confine
and was thought to be unable to
them within a particular context. No one is taught about challenging policy, law or power
communicate verbally. Befriended an
relationships. She suggests that self-advocates only challenge practice in a particular context and
advocate who after building up a
have a naïve view of power on an individual level. She suggests that teaching about rights is
relationship over a few months realised
idealised and impractical. She sees self-advocacy as a tool to find out what people want of a
that Cheryl could talk quite well. They
service rather than a chance to challenge the philosophy of services and the system that creates
adapted a system of communication using
them. She believes that people are the victims of internalised oppression and that self-advocacy
advocates elbow so that Cheryl could
should be about challenging society to change the way it values people within learning difficulties
signal when she wanted to say something.
and fighting for an ideal.
Cheryl began to find her voice .
 UNIT 22 - COURSE THEMES AND CASE STUDIES
Vignettes 1-8 - Unit 22, supporting self-advocacy – P&I/R&R

Scenarios to show how supporters and advisors can help self-advocates to make decisions for themselves. Cliff was overheard verbalising violence
towards a member of staff – one of the advisors suggested he go to anger management classes.

Ken was told to stop making tea in case he scalded himself – the advisor suggested the staff at the home show him how to make it safely.

Lillian wanted to order herself a taxi but one of the supporters was worried she would get the address muddled up. They wanted to double check on
her address, not believing she would be right. One of the group members shouted up and said it was right.

Imran retorted angrily to a joke a supporter made about not burning his house down with a lighter he had found.A young Asian man wanted to join a
social group but one of the members suggested he wouldn’t understand and wanted him to go away. The advisor spoke up and suggested that know
one knew what he would be able to understand.

Denise was complaining that one of the other members was a pain. The advisor reminded her that the person had a lot of problems at home and she
should bear that in mind.

Virginia explained problem behaviour as when people have a bad day or get upset and might feel angry, and one of the members of the group asked if
that included hitting her.

Rudi said it wasn’t always easy to stick up for yourself against nasty people. The supporter agreed and said that some people don’t listen.

Campaigning in K202- Unit 22, campaigning – P&I/R&R/D&I Dave Goodman - “Campaigning and the
pensioners movement - ”Unit 22, campaigning -
Tinsley residents campaign to improve the quality of air and to reduce the traffic – target Reader article 8
Sheffield City Council. P&I/R&R

Mavis Murphy in Middleton for support for carers – target health authority. Discussion of a successful campaign in Stoke-on-
Trent by pensioners for the restoration of the link
Campaigning by disabled people for accessible transport and against negative imagery – between pensions and earnings. The Labour council
targets were transport providers and ITV. supported them.

Community Care campaigning for the continuing contribution of a social care perspective Chrissie Maher - Unit 22, personal campaigning –
following publication of NHS Plan in 2000 – target was government and social care workers. P&I/T&B

The campaign by NAPWF which resulted in the 1913 Mental Deficiency Act – target general Discussion of individual campaigning. Chrissie
public and MPs. Maher founded Plain English campaign to have
benefits forms etc written in plain English for ordinary
Local campaigns against the provision of a mental health unit – target local politicians. people to be able to understand she now runs a
worldwide operation to do the same.
Carers campaigning for recognition – target general public and government.