Posts from the ‘Social Work.’ Category
Why are the Needs of Social Work clients trampled upon?
Dr Lynne Wrennall published this year on the conflicts that arise between sectional economic interests and the achievement of the interests of Social Care Service Users. She engages with the concern that sectional interests have gained dominance over the interests of clients in Social Care, identifying the mechanisms through which the ascendency of sectional interests over clients’ interests is secured and reproduced.
Wrennall addresses common themes concerning the ‘corruption of care’ that affect service provision to a diversity of Service Users. Previous studies address the problem in terms of conflicts related to the role, values and ethics of Social Workers whereas Wrennall elucidates the economic factors that underpin these conflicts. Conflicts about role, values and ethics, predictably reflect conflicts over resources. Wrennall outlines the abstract theoretical points at issue with practical examples from the lived experience of diverse Service Users. It is because access to resources is at stake that these conflicts are bitterly fought out, often with savage consequences for Service Users.
From Orphan Trains to ‘Pindown’ to Magdelene Laundries to Winterbourne View, centuries of exploitation and institutionalised abuse have created an appropriate caution about claims of helping others, most especially when ‘help’ is imposed through coercion. Arguably, discovering how the interests, needs, wishes and feelings of services users have been failed and discerning how Service Users can best be supported, is the central ethical task facing Social Work today.
Wrennall argues that three of the most significant distorting factors in Social Care are (i) economic conflicts of interest, (ii) perverse financial incentives and (iii) NOMBism (an acronym for Not On My Budget). These inter- related distortions give ascendency to sectional economic interests over the interests of clients. They explain how external agendas that are contrary to clients’ best interests are imposed on Social Services.
Wrennall also deploys the concept of ‘captive consumption’ to explain why economic forces are eclipsing the needs of Service Users. There is a well- known dysjunction between the services that Service Users request and the Social Services that Local Authorities provide. The bank of services from which Social Workers make their choices concerning referral decisions is meagre and is distorted by sectional interests in the direction of expensive, coercive, Out of Home Services, even though this emphasis is not in accord with the interests, wishes and feelings of Service Users. Arguably the single most powerful cause of resentment by Service Users towards Social Workers concerns the coercive imposition of Out of Home Care services at the expense of In Home service provision.
Ultimately if the problem lies anywhere, it lies in commissioning. Small disaggregated Local Authorities are unable to commission the appropriate type and range of services because they lack the size necessary for diversity and they are at too much of a disadvantage when negotiating with large corporations. They are swayed by what the market provides rather than showing the necessary initiative and leadership to commission the services that Service Users regard as necessary. Even more seriously, their decisions can be influenced by corruption, which can consist of many forms but essentially involves the misappropriation of money and other resources.
What remedy then? Wrennall argues that Social Workers need to be organised into settings where they can work together to promote the best interests of their clients, unlike their current settings that hugely impinge on their ability to meet the needs of Service Users.
Wrennall, L. 2013 Economic Conflicts of Interest, Perverse Financial Incentives and NOMBism: Why it all goes Wrong. In Carey, M. & Green, L. ed 2013 Practical Social Work Ethics: Complex Dilemmas within Applied Social Care, London, Ashg.