Social Care Service Decision-Making - Essay Example

SERVICE USERS OFTEN REPORT THE DIFFICULTIES TO HAVE THEIR VOICES HEARD IN SOCIAL CARE SERVICES; A DISCUSS SOME OF THE MECHANISMS AND PERSPECTIVES THAT CAN BE APPLIED TO FACILITATE SERVICE USER INVOLVEMENT. (2006) INTRODUCTION Users of social services constitute majorly citizens of a state. Thus, government and its agencies, in conjunction with NGO, community development group, private organizations, self- help groups, all these constitute producers of social services. Sometimes the users do not get satisfaction from the services emanating from the providers of these social services. Hence, it becomes necessary that the users of social services take the views of the users into consideration in order that the best service would be rendered. In recent times citizen participation in the provision of social service has very well being advocated for. The importance of social service producer in listening to the voices of the users and incorporating this in policy formulation would not only lead to an efficient provision of these services, but also make the right choice of service that is dearly needed by the users. But in reality most service users of social service have no voice in the choice of service they desire, even when they do, no one cares to listen to their pleas and suggestions as ways of improving the provision of these services. The difficulties in which service users have in registering their voices and participating in service decision making have most time lead to poor service provision and dissatisfaction from the users. Since social service is a large scale provision of service to mass of people, it then requires that for an adequate and more satisfying service provision that service users are made to partake in opinion, voice out their views in social policy making. This write up will look at the need for service users in participating in social policy decision making,; the mechanism for effecting a better users participation in social policy, prospects for a better users or citizen participation in social service policies. CONCEPTUALIZATION OF TERMS Social service is a broad base service delivery to a large number of people, in a state. The generality constitute the beneficiary of social welfare services. Thus, social service is the provision of service to meet the needs of citizens in areas of health, education, social security, and programmes on housing and infrastructures provision, among others. Social service can be distinguished from welfare service in the sense that social service entails the provision of service to a large and broad category of people in the society, while welfare service is restricted to a specific segment of people in the society. Thus, welfare service constitutes services to the disabled in the society, the sick, the poor and needy, low- income earners, destitute, services for the old in the society. On the one hand social service is a compulsion, while the provision of welfare services is based on humanitarian ground; out of pity and sympathy. Thus, a government may choose to do away with the provision of welfare service, but not social service. The provider of the service, whether social or welfare, determines the how they perceives the users of these services. According to Cornwall & Gaventa (1999:1), "State- centred conceptions of social policy often view citizens a s recipients of state delivered programmes. Market- led versions focus on the clients of social welfare as consumers; who participate through exercising choice from a range of services". Consumer or citizen participation in service delivery entails the direct or indirect involvement of the service users in decision-making, concerning the policy framework, the structure of service to be delivered and information dissemination to bring about better service provision. Looking at the health care service, consumer participation would entail "the process of involving health service planning, policy development, setting priorities and quality issues in the delivery of health service" (participateinhealth.org.au, 2002). According to Craighead, et al (2000), "The term participation usually implies more sharing, not only of information and opinion, but also of decision making power. Real participation means joint problem solving, joint decision-making, and joint responsibility". USERS PARTICIPATION IN SOCAIL SERVICE POLICY The contemporary states in the global setting, where neo- liberals' ideas reign supreme, thus enforcing globalisation, privatisation, decentralization, a free market order and less government intervention in the active economy sector of the state, this has led to the change and lays a new reality on the provision of social welfare service delivery. According to Mishra (1998:485), "globalisation is dissolving the nexus between the economic and the social". It is perceived the great effect international civil society has on national service delivery. The influence of international bodies on states service delivery has a strong determinant force in sharpening the outcome of these services. Deacon, et al (1997), argues that the role of supranational institutions in shaping social policy in nation-states calls for an approach that treats these institutions not simply as the tolls of powerful state interests, but as political actors in themselves. The role of international civil society and the place that global, political, legal and social rights play in creating a socially just new world order. Thus, the contemporary world order in regards to the provision of services requires that "participation must be repositioned in light of current realities, which offer new spaces as well as new constraints for citizen engagement" (Cornwall & Gaventa, 1999:2). Effective participation in social policy requires looking beyond national institutions to enhancing the capacities of citizens to influence supranational, as well a s national policy. (Ibid: 3). Cr oft &Beresford (1996), point out a more radical version of people's participation, one that would go beyond the more paternalistic versions of welfare state and the narrow consumerist approaches to users involvement. "Growing from the struggles of the disability rights movement and others, this approach began to talk about participation not only in terms of having a say and being involved in the delivery of existing programmes, but also about more active participation in provisioning and in policy formulation. This approach sees the users as having fundamental claims to civil rights rather than being subjected to the discretion of the social service producer. In recent times there has been a convergence of concern with citizen engagement in policy formulation and implementation and with good governance, broadening political participation to include a search for new, more direct, ways through which citizens may influence governments and hold them accountable (Gaventa & Valderama, 1999). During the late 1960s, and the 1970s, there was a growing demand in many parts of the world for citizens to be involve in decision-making processes which affected their lives, including in the social policy arena. The form of participation that emerged focused largely on establishing, consultative mechanisms, often in the form of user committees. The spread of this new approach was rapid and far-reaching. Citizens became involve in thousands of community health councils, parents committees in schools, tenant councils, and countless other beneficiary committees. (Cornwall& Gaventa, 1999:5) By participating in decision making pertaining to the provision of social services citizens uses this medium as an avenue to seek accountability from those representing them in a democratic government. By seeing themselves as actors rather than simply passive beneficiaries, user group may be more able to assist their citizenship in a third sense through seeking greater accountability from service providers. One form of greater accountability is through increased dialogue and consultation of its leaders with forum of user involvement. In this avenue questions can be raised to the extent to which any group is being marginalized and ways to articulate their concerns and this will determine the form that the dialogue takes (ibid: 10). According to Gaventa & Valderama (1999), increasingly discussion of governance and accountability focus on forms of broader interaction of public and private social actors, especially at the local level. Citizen participation in this sense involves direct ways in which citizens influence and exercise control in governance, not only through the more traditional forms of indirect representation Citizen participation in service delivery has increasingly been used to enable citizens to express their concerns more directly to those with the power to influence the policy process. "While a number of participatory methods focus on enhancing direct participation of citizens in the governance process, others are focusing on maintaining accountability of elected officials and government agencies to the citizenry, through new forms of citizen monitoring and evaluating" (Cornwall & Gaventa, 1999) Citizenship participation in decision of social service avail them the opportunity in demanding and negotiating directly with government for greater performance and accountability other than they relying on self-provisioning through civil society. "Through such participation, users of services can potentially shape social policy not only as beneficiaries or consumers in pre-determined programmes, but as citizens exercising rights of agency, voice and participation (ibid: 18). TYPES OF USERS INVOLVEMENT The users of social care services can be involve in the process of social service delivery, this can be done in the following ways: 1. Consultation: the users of social care services like the disables can be consulted through forum, where they discuss issues burdening them and those they would like to see implemented. According to batty (2001), this has increased understanding among social workers of the impact of good and bad packages on disabled people's lives. According to Lindow (1999), quoted in Cornwall & Gaventa, (1999), one of the major achievements claimed for the national user involvement project is that the perception of disabled people as passive service users has been shifted. As a result of its activities, there was much more appreciation of disabled people as experts in their own support needs who should be consulted appropriately. To illustrate this, Barns & Mercer (2003), has it that "Southampton City Council's Health and Social care Directorate commissioned Southampton CIL's Disabled Person's Consultation Forum to consult with disabled people (including older disabled people with learning difficulties) on a whole range of issues. These include access, and consumer audits, designed to inform future commissioning plans and user consultations on social services support for independent living". 2. Participation and Partnership: this is another way of involving users in social service provision. In this instance users led association have entered into partnership with other local organisation and government agencies. "Since the 1970s, organisations of and for disabled people have be come an important feature of the service sector landscape. This is especially evident in the provision of information" (Barnes 1995, Moore 1995, quoted in Barnes & Mercer, 2003). User-led organisations have developed partnership with other agencies. A survey of Creating Independent Futures shows that more than half the organisation surveyed have formal link with or are members of, other local organisations. The majority has links with local organisations controlled and run by disabled people (75%) and with other voluntary organisations (62%). Around a third of groups have links with organisations of people with specific impairment (39%) and local groups for disabled people (31%) smaller numbers have links with organisation for people with specific impairments (21%) and different impairments (15%). Thirty-nine percent are formally attached to, local authority social services departments and twenty-one percent to a healthy authority. (Barnes and Mercer, 2003). According to Carr (2002), there is a long- standing debate about the distinctions to be drawn between the different types and levels of users' participation. It ranges on a continuum from consultation on an individual level including feedback about services, surveys and complaints through participation in the planning and development of services to user control and management of services. Then the need to distinguish between consumerist and democratic approaches and agency led and user- led initiatives becomes significant; as both have implications for power and control. "Democratic initiatives involve service users influencing and making decisions at strategic levels, while consumerist approaches focus more narrowly on consulting people about the services they receive" (ibid). Gradually in recent time there have being the shift on just mere consultation of users about agency-led proposals to the notion of developing services in active partnership with those who use them. In the view of Barnes &Mercer (2003), it is evident that much attention has been given by service providers over recent years to the process of user consultation but relatively less concern about why to consult or to what end. If the reason for consulting disabled people is not clearly thought then the form of consultation becomes more important than the content or outcome. Participation needs to be aligned with the context and take account of the issues, objectives sought and the people who make up the target group. Thus, different kind of participation might be appropriate for different parts of a project or at different stages in its development (Carr, 2004). In the health care sector of social service delivery, there exist diverse range of strategies available to make any users of these services with interest to participate to do so. Thus, the level of participation available include: Service delivery- consumers can have an active role in their own health care Strategic planning- what services/ programs an agency should develop Service planning- how services/ programs should be provided Review and evaluation- consumers should participate in deciding what is successful and what is not, according to what consumers think are important. Hence, from the above level of participation available to users of health care service, they can carry out the participation through the following strategies: Consumer satisfaction surveys Complaints mechanisms Public meetings Focus groups Community representatives on boards of management and management committees Phone- in sessions Toll- free information and Referral service Approach community groups (participateinhealth.org.au, 2002) BARRIERS TO EFFECTIVE USERS INVOLVEMENT There are constant complaints of users of social services that they are not being involved in the process of the services formulation and their delivery. These have been linked to plethora of barriers; either from the servicing organisation or personal problems associated with the users themselves. The following barriers to user involvement are identified by Barnes and Mercer (2003) i. Financial or organisational barrier: on the financial aspect, user- led organisations consistently report that accessing and maintaining core funding is a major problem. Instead most funding is short term and, in the most time s limited to specific services and projects. Also, current-funding strategies that encourage competition from non- users- led organisations hampers the continuity and further development of the user- led organisation. This is further exacerbated by the growing emphasis on formal and bureaucratic procedures by funding agencies. The aspect of organisational barrier has dwell on the issue of how management and organisational practices have helped in constituting a barrier to the effective users' involvement in social service delivery. A significant barrier emanating from the organisational structure has to do with how user interests have been relegated in importance. The reasons for relegation of users interests "ranges from too little time for meaningful discussion, little access to senior staff, the value of disabled people taking on the preparatory training of service users, and the need for clear guarantees of confidentiality and codes of practice on conducting business and monitoring outcomes. Concerns are also expressed that user representation is too closely regulated by managers" (Fletcher 1995, Ross 1995, quoted in Barnes and Mercer, 2003). According to Carr (2004), sometimes what a service user wants and what professionals or organisations want are different. Sometimes there is not enough money or staff to carry out the ideas that service users come up with or to change things to the way service users have suggested. ii. Professional barrier: Professional values languages and practices most times privilege the practitioner. Hence, a clear division between the expert- provider and lay-user exist to reinforce their enhanced status. Sometimes professionals tend to treat the user as dependants who are restricted to the care they receive from them. This does not go down well with some users. A further problem from the professional angle is that their claim to expertise and self- regulation does not sit easily with user participation. All too often the end result is a range of initiatives in which user involvement is little more than tokenistic or seen as an exercise in user education: where agendas dominated by professional jargons are confined to existing services or predetermined decisions in which user experience is denied or minimised. According to Carr (2004) there can be differences in power and influence between service users and social care professionals which make it hard for service users to be listened to seriously. Things are not always structured so that service users feel that they can make a difference. There may be ways of working or jargons that make it difficult for service users to join in. some service users who feel to confidence in what they are saying are seen as not typical of service user group, hence they are ignored. iii. Personal barrier: Users mental and physical posture sometimes constitutes a barrier to an effective user involvement in social services delivery. Faced with constraints with physical and cultural environment that generally demands impairment, functioning limitations and presumed dependence, for many people these acquired impairments constitute a traumatic experience. Also, the problem of institutional discrimination; the consequential internal oppression or psycho-emotional dimensions of disability, all these often leads to lowered self-esteem and self- confidence, and a significant withdrawal from everyday social interaction. According to Carr (2004), "qualitative studies and accounts from service users suggest that exercise of choice as a n individual 'welfare consumer' remains restricted, particularly if you are black or minority ethnic group or are lesbian or gay. There still appears to be a lack of opportunity for people to have a say in their own services. iv. Another barrier stem from the professional and managers of user- led organisations that relegate basic needs of users for the exhibition of good practices. These professionals and managers concentrate on core questions like: How committed they are to user involvement The manpower builds up on ground The level of preparedness These and other questions tend to becloud the minds of these managers and professionals and prevent them from greater awareness of basic needs of users such as the disabled people. Stating barriers associated with consumer participation in health care services, Participateinhealth.org.au (2002), pointed out two major impediments, which include: Power differentials between consumers and providers/ administrators, and Structural and practice barriers. Example exist where organisations have identified and built the capacity of consumers and communities to participate in service planning and evaluation, a swell as identifying and building an organisations capacity to make needed changes to culture and practice. The power differences that exist between providers and administrators of social services and service users, as explained earlier, tend to sometimes make these professionals to relegate the interests of the users and due to the influence they posses, these professionals tend to determine the outcome of the service that is made available. The structure and practical barriers are those financial and organisational hindrances that impede the effective delivery of social services in the health care sector. The introduction of direct payments in 1996 made a constitute meaningful advance for the extent to which entitled service users can exercise control over their support and assistance in order to live independently. Disabled people, people with learning difficulties, mental health service users and now older people are entitled to use local authority funds to purchase their own personal assistance. But the problems associated with this direct payment is that though Direct Payments are very positive development, their implementation by local authorities and the extent to which they are published remains inconsistent. Moreover, there is the limitation of cash. Once the cash ceiling is reached users are at risk of having their support withdrawn (Carr, 2004:12). MECHANISM FOR AN EFFECTIVE USERS INVOLVEMENT IN SERVICE DELIVERY As a way of improving the level of users involvement and making the process an effective one, it becomes necessary that a consultative mechanisms that tends to produce feedbacks to users, and the ability to integrate them in every stage of service delivery is put in place. "Users need to get feedbacks on their participation, but this does not always happen. This can have a bad effect on how people feel about being involved in participation and the difference they can make" (Carr, 2004). Social policy- making have characteristically tended to employ consultative mechanisms to seek greater citizen involvement in generating information for policy formulation. According to Gaventa (1993), the renewed focus on agency in the politics of policy- making offers the scope for recasting the role of citizens in the policy process. Rather than simply the passive recipients of decision made by those who are presumed to know better, participatory approaches redefine 'expertise' in terms that both reveal the realities of power involved and assert the legitimacy of knowledge claims by those on the receiving end of policies. The imbalances of power position between the professionals and administrators of service and the users have been observed to be a basis for the relegation of users interest to the background. Thus, for an effective mechanism, it then requires that the gap between users and the provider of service be closed down. This can be done when some of these users, who are fit enough, can be trained to become occupiers of the administrative positions for service delivery. Also proper dissemination of information and enlightenment would go a long way in positioning the users and making them know their rights and thus, preventing intimidation and any form of coercion. The importance of proper consultation and feedbacks in users involvement would make the users having a sense of satisfaction and the belief that they are actually being involved in the service delivery process. This will create a sense of belonging and even encourage more participation and reduce the level of relegation and disregards of users voice in the policy outcome and decision making during service policy formulation and implementation. In Wales, the Joint Review Team argues that new mechanisms are now in place to champion the cause of the users. The emphasis is on a culture of involvement through adequate feedbacks to users enhancing users involvement in service delivery. According to Cornwall & Gaventa (1999), one form of greater accountability is through increased dialogue and consultation of core users and their involvement. This raises questions about the extent to which marginalized groups are able to articulate their concerns and about the form that dialogue takes Proper conflict resolution that manages conflicts during users involvement is necessary in bringing about the effective service delivery and users involvement at the long run. Some articulate service users are branded as unrepresentative therefore be in risk of being ignored. "Service users who articulate the need for changes that agencies may not be willing or able to implement have sometimes being labelled as 'unrepresentativeimplementing changes that require reallocation of resources becoming more difficult especially if these conflict with nationally defined service priorities". Discrepancy between what management want of user involvement and what users want may be a major source of dissatisfaction for service users, since managers definitions tend to prevail. Some reviews note that dissatisfaction and even conflict may be an inevitable part of the user participation process (ibid). Thus, it requires as a proper resolution of areas of differences that they are adequately taken cared of. Those who usually contact the users should be trained and coached on how to interact and listen to their views and opinions in order to ward off any form of conflict breeding. As Carr (2004), puts it, "the research suggests that front- line practitioners who have most contact with service users could be usefully engaged in user participation strategies and benefit from user- led training focusing on the practice and principles of user participation". The front liner practitioners should be equipped with the knowledge of how to handle com0plaints when service users forward it to them. According to Debighshire County Council (2004), there are three stages of dealing with a complaint: Stage 1- Local level: where a problem arises it should be possible to resolve it before it becomes a formal complaint. Whenever there is a problem or dissatisfaction or someone has a concern, difficulty or worry, the first thing to do is to try and sort it out- locally, quickly to everybody's satisfaction Stage 2- Formal complaint: this is a stage where the Directorate Complaints Officer becomes involved. The Councillors for the area that the complainant lives in or is complaining about, along with the chair of the relevant committee, will be informed at this state by the Directorate Complaints Officer unless the complainant has requires this not to happen. Stage 3- Appeal: if the council's officers are unable to satisfactorily resolve a complaint following action through the local and the formal stage, then an Appeal Panel stage, involving members will be followed. Where the council has been unable to re solve a complaint, the complainant may refer to the Local Ombudsman. In addition, to further ensure that best practice of users involvement it requires that users are made to act on their own. They should be actors in cases of social services that directly affect them. Hence, it requires that "the concept of citizenship should be expanded to include not only concepts of social rights, but also of social responsibilities exercised through self-action, and of social accountability achieved through direct form of democratic governance" (Cornwall & Gaventa, 1999). The reposition of citizenship participation in social service would encompass the multi dimensions of citizenship- including a focus on agency based on self- action and self-identity, as well as the demand for accountability amongst actors may provide a way to move out of the impasse (ibid). BENEFITS OF USERS INVOLVEMENT IN SERVICE PROVISION Users involvement in service provision has helped in creating a satisfactory provision of services to the user. Since the users know the extent to which they desire this service and how they desire it to be, their involvement then makes the provider of the services know how well to produce them in order to obtain the most satisfactory result for the users. According to Barnes & Mercer (2003), "user involvement has increased over the years. Whilst this has been welcomed by disabled people and their organisations, it has also exposed the limitations of the rhetoric of empowerment within a social 'care' environment that is subject to fight budgetary control". User involvement thus, calls for proper accountability by those public officers in charge of the provision of services. According to participateinhealth.org.au (2002), benefits for consumers in health service include: Increased control over their health status and disease management Improved health outcomes Increased understanding of health issues and health services Greater sense of influence over the health services they use Opportunity to have positive input to local health activities. Benefits to users participation in service should not only be based on what the users have personally gained from their involvement but must also look at the change that has occurred in the process of service delivery; how effectively the status has become. CONCLUSION Users involvement in service has given them the confidence and pride of having a say in the determination and outcome of what is provided to them. But report has it that some users feel consulted rather than involved and others have a sense of powerlessness as regarding the complex and confused system in which the participation is structured on. While a sense of stereotyping is being carried out in some quarters, where discrimination and marginalization based on race, minority ethnic has hampered the proper participation of some users. Some professionals relegates users' interest, this is mostly done due to the huge lacuna of power positioning between the managers and professionals of service provision and the users. It then requires that a proper mechanism for users involvement be put in place. Hence, it is advocated that a proper feedback mechanism is available; proper conflict resolution be provided for interest clash' the users of service should be integrated into the service provision activities, where they are perceived as getting services as rights and not privileges; the gap in the power control between the service provider and the users should be closed down through integration of users into management positions. REFRENCES Batty, D. 2001: Social services benefit from audit by people with disabilities. 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