Constructing care management : policy implementation as a participative learning process.
This thesis is a record of research exploring the limitations to
successful policy implementation. Using Community Care as the
illustrative example, it asks what these limitations might be, casting
a particular light on the part played by care managers, the front-line
policy implementers responsible for "needs assessments" which is a
key activity in the implementation of Community Care. There is a
tension in care management between the influence of procedures and
the degree of discretion necessary for needs assessment to be
completed effectively. In what ways, then, are policy intentions
affected by the activities of care managers?
Community Care is an illustration of a public policy imposed by
central government through a top-down process of implementation in
what is argued as a rationalist endeavour to simplify the complexities
of community care and reduce it to questions of technique and
structure. This attempt to present a unified conceptualisation of
community care is backed by managerial procedures referred to in the public management and policy literature as "managerialism".
Social work practice theory provides a third example of the rationalist
attempt to simplify processes involving complex social interactions.
The limitations to rationalist explanations of community care
implementation and the necessity for a different kind of analysis are
explored. There is a parallel with the research methodologies
employed for this research. The initial interviews were helpful in
revealing the degree to which policy implementation was being
thwarted by care managers, but this resistance was mirrored in their
rejection of my interpretation of their practice.
The common thread running through the normative approach to
policy implementation, management, social work practice and
research methodology is an adherence to positivist forms of
knowledge. The implementation of Community Care raises questions
of epistemology and ontology that undermine these powerful forms of
knowledge. The claim is that a different epistemology suggests
practices more likely to lead to effective outcomes. An organisational
orientation to effectiveness is revealed in the degree to which outcome
has become wedded to techniques of scientific rationalism. A service
orientation would define outcome by the degree to which the needs of
vulnerable adults were met through reflection upon key relationships.
The first of these is an exercise in objectivity which is not well equipped to take account of the subjective experiences of
practitioners exploring needs in relationship with vulnerable adults.
The service orientation suggests an experiential and participative
epistemology in which people engage in the process of learning and
understanding most successfully when it is collaborative rather than
The second phase of fieldwork was an experiment using a method
built upon a participatory epistemology and gives the reader a
glimpse of what might be possible in direct contrast to rationalist
approaches. Work with two co-operative inquiry groups has led me to
new understandings about the nature of learning for individuals and
organisations. The thesis concludes that an effective learning
environment facilitating positive and reflective use of discretion can
be created through co-operative inquiry, although any approach
would need to include other important participants, notably
managers and service users, if it is to maximise its effectiveness in
the long term.