RPP 19 1 Book Reviews

Research Policy and Planning: The journal of the Social Services Research Group – Vol 19 (1) 2001

Book Reviews

Housing, Social Policy and Difference: Disability, Ethnicity, Gender and Housing

Harrison, M. with Davis, C. (2001) Bristol, Policy Press, £17.99 paperback, 252pp.

Aimed at students, practitioners and researchers in housing, social policy, planning and other disciplines, this book examines how housing policy and practice respond to ‘difference’. While most of the text is written by Malcolm Harrison, the chapter on gender is produced by Cathy Davis (both based at the University of Leeds). In an introductory chapter, Harrison discusses the practical and academic importance of understanding diversity, highlights the interaction between individual actions (agency) and social forces (structure) and provides an overview of housing policy from 1979 to New Labour. After this, the book is divided into two main sections, with an overall conclusion. Chapters One to Four are predominantly theoretical and consider the relationship between difference, agency and structure. After charting changes in household structures and the growing recognition of diversity amongst policy makers, practitioners and academics, Harrison warns of the dangers of oversimplifying people’s complex identities and returns to an earlier discussion of the way in which individuals and social forces interact to shape people’s housing choices, sometimes excluding particular groups of people. Chapters Five to Seven focus on disability, ethnicity and gender, outlining the way in which policy and practice have responded to the housing needs of such groups. Although each chapter focuses on slightly different issues, there is an overriding sense of the discrimination which certain social groups face within the housing arena, coupled with discussion of some of the strategies being pursued to overcome existing barriers to full participation within society.

Overall, Housing, Social Policy and Difference is an important contribution with a number of key strengths. Throughout, the authors emphasise the complex interplay between different social divisions, recognising that gender, physical ability and ethnicity can all interact to produce multiple forms of discrimination. Thus, a disabled black person may face particular difficulties arising out of the dual impact of ethnicity and disability, while black women may have different experiences to white women. Within a discussion of ethnicity, African-Caribbean, South Asian and Chinese groups may again have markedly different needs. At the same time, the book makes a concerted attempt to link detailed theoretical debates to policy and practice developments, referring to recent initiatives such as Supporting People, direct payments and lifetime homes.

Despite this, Housing, Social Policy and Difference has three main limitations. First, some of the more theoretical chapters can appear a little abstract and some practitioners may feel more at ease with later sections of the book that link theory to practice in a more explicit manner. The occasional use of unexplained academic jargon also serves to make certain sections of the book more difficult to engage with than others. Secondly, the absence of a detailed consideration of the needs and experiences of older people detracts from an otherwise excellent discussion of gender, disability and ethnicity. While several references to older people are made, a specific chapter would be useful in light of the age discrimination and poverty which this group has suffered and the tendency of older people’s needs to span traditional boundaries between health care, social care and housing. Finally, discussions of ethnicity make the common mistake of focusing predominantly on skin colour, thereby overlooking groups such as Irish people who may have particular housing needs and may still face discrimination on the grounds of difference, despite the fact that they are white.

However, none of these limitations should detract from a well-written and thought-provoking book.

Jon Glasby

University of Birmingham

What Works: Evidence-based Policy and Practice in Public Services

Davies, H.T.O; Nutley, S.M. and Smith, P.C. (eds) (2000) The Policy Press, £17.99, paperback, 380pp.

This is a wide ranging book on evidence-based policy and practice across eight key areas of public services – healthcare, education, criminal justice, social care, welfare (ie. financial benefits), housing, transport and urban policy. My initial reaction was to wonder whether many people would be interested in a book covering such diverse fields. However as I read it, I could see its value to policy makers, practitioners and researchers in each of these areas, as well as to the more obvious potential audience studying or teaching social policy.

This is a well-written text, thorough yet readable. After introductory chapters setting the scene, Part 1 comprises eight chapters by appropriate authors giving overviews of the ‘current state of play’, and thought provoking analyses of achievements, trends, strengths and weaknesses in each of these different areas. The five chapters in Part 2 pick up themes across service areas, such as research methodologies, the nature of evidence and the challenges faced in making a reality of evidence-based policy and practice within organisations.

For those of us involved in social and health services research, the familiar debates about the value of quantitative and qualitative methodologies are put in a new perspective by the distinct emphases and methods in other public service areas such as transport and urban policy. The limitations imposed by a particular context on the types of research that are feasible and ethical becomes more apparent in a broad-ranging overview such as this. It is particularly interesting to see the very different approaches of the various government departments.

The chapter on Healthcare authored by the first two editors provides a concise summary of the growth of evidence-based practice, highlighting the development of the NHS Research and Development Strategy in the 1990s. While celebrating the achievements of the strides towards an evidence-based culture in health over the past two decades, the authors recognise that lessons can be learnt from other fields, and that methodologies other than randomised controlled trials may be more appropriate for evaluating other types of interventions.

Professor Geraldine Macdonald’s chapter on Social Care maintains her usual clear and well-argued style. She explores the possibility of developing rigorous approaches similar to those used in healthcare, and delineates the difficulties inherent in the complexities of social work practice and the evaluation of social services. The nascent impetus towards evidence-based practice in social care is considered in the context of the obstacles to appraising, synthesising and using evidence for decision-making. She highlights the need for adequate resources, clear leadership and wider consensus among the policy and the research communities in order that evidence-based policy and practice may become more of a reality across social work and social care.

The thematic analysis in Part 2 is a series of balanced and thoughtful chapters, including an exposition of the strengths and limitations of (respectively) experimental methods, quantitative non-experimental methods, and qualitative methods. In the conclusion the editors pick up the tension between the pressures on researchers towards ‘pure research’ and the pressure on policy makers to take decisions. By teasing out debates and putting them in context, this book will help to develop understanding between these different worlds.

This book is helpfully structured around policy areas and themes, and has been well edited to give a reasonably even style of writing appropriate for the readership. There is good use of section headings within the chapters, and significant use of boxes, tables and diagrams to enhance the text. I thought that the index could have been more extensive, as it is the type of book that readers may dip into to find a reference point in an unfamiliar area. Each chapter is well referenced, making this a useful source for study and teaching.

A major strength of the book is that the chapters are written in a very positive tone, analysing strengths and weaknesses without being polemic. Perhaps the main weakness is the other side of the same coin – that there is little direct learning drawn from direct comparisons between the different areas. Although some key examples of the development of evidence-based policy are used as case studies in Part 2, it is largely left to the reader to pick up on interesting possibilities and pointers for the future.

Overall, this is a readable, interesting and thought-provoking book for managers, professionals and researchers in any area of public service who are interested in the evidence base for decisions, as well as a valuable resource for social policy teaching.

Brian Taylor

Queen’s University Belfast

Equity and Efficiency Policy in Community Care: Needs, Service Productivities, Efficiencies and their Implications

Davies B, Fernández J and Nomer B (2000) Aldershot: Ashgate, £50, hardback, 488pp.

This is not a book for the faint hearted. It is a challenging read but recognises this by prefacing the text with a glossary of terms and consistent efforts to structure the book. Even here though the less than committed may take fright. The preface, introducing the introduction, suggests readers may find it useful to consider the book in the context of three more books (two of which are forthcoming) and two earlier texts. Claims that this particular book is an essay do not sit comfortably with its 458 pages.

Having said this, the book is full of interesting points – although naturally the level of interest will probably accord with the readers’ own knowledge of the subject. Possibly many readers will be those who have followed this research and its contribution to community care over ten years. They will be familiar with PSSRU’s (Personal Social Services Research Unit) key methods and its members’ diligence in reporting and interrogating their data. The number of tables and footnotes in the text confirm such precision.

For those who manage to keep pace with the authors’ complex points, the book will repay the difficulties of the read. For me, the sections on carers and on the value (or otherwise) of social work have provided useful material. I should be wary, however, of referring students to this text and will probably be rather doubtful if it is cited in their references.

The book is divided into 27 chapters and three main parts. An introductory chapter outlines the massive machinery of the data collection and the research design. The authors provide their ‘advisable route’ for the remainder of the book, suggesting the reader hops from chapters 2 and 3 to 12 to consider productivities of community care services. Part II of the book, chapters 14 – 21, might also have benefited from such a route map. At times, the text becomes particularly difficult with large sections of bullet points and continuous use of acronyms. It is hard going to read, for example, that collateral output levels lay below 40 per cent for ‘IMPIADL, IMPEMP and WKSAT for users with critical interval needs and PICs’. Some judious editing might have summarized such findings in a more accessible form.

Fortunately, other chapters are written in a more discursive style. Chapter 24, for example, presents a very interesting discussion of some ‘self evident truths’ that low level services are better than targeting. As the authors observe, such arguments start from a presumption of unconstrained resources. If resources are accepted as limited then, they argue, the issue becomes a matter of choice or trading benefits. In their view, the benefits of low level services are not always substantiated and you can almost hear them muttering that it is all a bit ‘woolly’ as to who would benefit or lose from such services, in what way and at what cost.

This book represents one particular form of research and writing. Many might wish that the authors could have realised their aims of making their work relatively accessible. Overuse of bullet points and acronyms may be as difficult as none at all. Nonetheless many researchers of community care will doubtless use this text to build upon and it offers a broad perspective for those who toil in limited sections of the field. Davies and his colleagues have provided a major overview which will be drawn upon for many years, both in respect of its detailed comparisons of social services departments and, its reflections on pre – and post community care reforms.

Jill Manthorpe

University of Hull

User Involvement and Participation in Social Care: Research Informing Practice

Kemshall H and Littlechild, R. (eds) (2000) London and Philadelphia: Jessica Kingsley Publishers, £16.95, paperback, 256pp.

Although readers may wonder whether action rather than words is needed in user participation, the focus of this collection on research experience does add to the field. Bray’s overview gives a summary of the legal and policy background to the expectation of partnership working between social care staff and service users, and she points out the challenge to professional dominance inherent in this way of working.

Shaw follows with a chapter about participatory research and its difficulties. Particularly difficult, it seems, is for researchers to write plain language, and this chapter bears this out. That said, the discussion of dilemmas arising when trying to work in a more equal way, without dishonestly disguising the real power differences between researcher and researched, is interesting. He also comments on the dangers of translating (i.e. analysing) and colonising people’s experiences in writing up research.

After this comes a series of researchers’ personal experiences of differing levels of participatory research. The chapter about group work by Ward makes some pertinent points about the way many ‘participation’ schemes have been but another management tool leading to very little change. Fleming, writing about action research with several stakeholders for children’s services in Ukraine, gives an interesting account of recognising and minimising the dominating position of outside consultants that is pertinent for consultants anywhere. In their account of family involvement in child protection, Morris and Shepherd give good practice examples of evaluation work with families whose first language is not English. They are also open about the fact that some things are too private to be evaluated without unethical intrusion on people’s lives.

Ellis and Rummery give one of the few accounts here of using the social model of disability to inform research and development work. They are explicit about a theme touched on in several papers here, of the conflict between being accountable to both research funders and the participants and beneficiaries of research. Rogers, writing about research to determine the needs of older people with mental health problems, also discusses openly some of the difficulties she encountered. Refreshingly, she acknowledges the unpleasant nature of the term ‘carer’, denying as it does the mutuality of family and friendship relationships.

The various writers in this collection start in different places. Some aim to involve service users in deciding what will be evaluated and continue through to the process of discussing and controlling the research report. At the other end of the spectrum, some researchers have not involved service users in the research process at all, considering that their product brings the voices of participants into the policy making arena. Littlechild and Glasby, in their piece about older people as ‘participating patients’, have an interesting discussion of ethical issues, including their decision to advocate on behalf of participants after the interviewing, when required.

The advantages (and difficulties) of using community members as interviewers are brought out in Dyson’s account of working with sickle cell/ thalassaemia support groups. The constraints on participation are made explicit here, and Dyson does not balk at discussing the complexities of power issues for researchers wanting to undertake participative research. McCabe and Ross write about involving patients and primary health care workers in planning health care services. A special contribution of this chapter is the account of empowering people to make informed decisions by giving information as part of the research process. Rumgay, working in the Probation Service, describes the difficulty of getting service users’ voices heard in a traditionally prescriptive service, not least because service users themselves are reluctant to speak out.

The book is rounded off by a theoretical chapter by Ellis about disability politics and theory as a background to inclusive research. This is a valuable discussion of the ironies of attempting empowering research when many aspects of social care are being stripped back to their social control functions. The short concluding chapter by the editors, as one would expect, confirms their view that despite the hurdles, the recognition of many kinds of knowledge can lead to empowerment through the research enterprise.

A chapter by user-researchers about the dilemmas they face, and a little more about user participation in dissemination to ensure that practice changes in line with research findings would have been valuable additions to this collection. The detailed and open way in which so many of these writers have described their difficulties and failures as well as their successes makes this a valuable resource for anyone planning research in social care.

Vivien Lindow

Independent consultant and researcher working from the service user perspective

Communication and Consultation – Exploring Ways for Staff to Involve People With Dementia in Developing Services

Allan, K. (2001) Bristol: Policy Press, £14.95, paperback, 141pp.

This research study is one of a series of undertakings designed to explore the ways in which staff working with people with a dementia can consult them about their views of the services they receive and how these methods for consultation can be incorporated into the care regimes employed with a view to promoting person centred models of care.

This was achieved by exploring how mostly unqualified workers, in a variety of service settings, encourage service users with dementia to express their thoughts and feelings about the support they are receiving. The study is ‘descriptive and impressionistic’ in form with its approach evolving during the course of the study as staff collaborated with the author and reflected on their own practice.

The use of the organisation’s own staff to develop both the rationale and undertake the fieldwork, supported by the author, makes the findings more credible in the sense of their transferability to provider organisations. Allan has made significant inroads into achieving the main purpose of the study, exploring the use and usability of the approaches adopted.

Allan recognises the need to start from where people are at and the limitations to validity that imposing artificial conditions onto service operations would bring about. The adoption of a developmental, interactive approach to the methods for communication used by staff as the research progressed is an appropriate choice. However, I feel that by not being more systematic about the nature of the impairments of the service users together with the consequences for their capacity to understand, it may be difficult to distil effective approaches and subsequent generalisation to different individuals or settings.

Chapters three and four detail the preparatory work undertaken with participating staff and illustrate approaches that were found to work. One of the major strengths of the study is the valuing of the skills and experience of the staff which lead to genuine and extensive collaboration throughout. The report makes clear to provider organisations considering taking on this agenda most of the main issues and dilemmas that are likely to need to be addressed. This increases its credibility to those agencies it is aiming to bring on board in terms of the dissemination of good practice.

One of the most important points brought out was the importance of time out for reflection on practice that this study afforded staff. This had a strong link that this to professional and personal development and translated itself into more sensitive and person-centred approaches to work. In terms of outcomes for service users, I would like to have seen more emphasis on the importance of completing recording of sessions contemporaneously to assist in the production of full and accurate records. The tendency of service users to be able to express their own feelings about a situation through projecting them as those of a person in a picture was particularly illustrative of the benefits of taking an oblique approach to exploring people’s views.

In chapters five and six, Allan pays attention to factors relating to the individual with dementia, situational variables, staff and organisational factors and the effect each of these will have on the nature of responses and the apparent effectiveness of approaches taken. The report brings to the fore real dilemmas often overlooked or minimised in operationalising research knowledge in practice settings, such as the role of the organisation’s value base.

The author attempts to tackle the knotty issue of consent as part of the process of research. It remains problematic to judge how successful this attempt has been given the uncertainty concerning the types and severity of dementia experienced by participating service users. However, within the context of the study, the tackling of this issue had many positive side effects. It raised the profile of the importance of involvement in all decision making in care planning activities.

The final chapters make sense of the findings and pull them together to identify key messages. Levels of staff confidence grew significantly, as did their awareness of the service users as individuals, capable and willing to express their views, given the opportunity. Their own wish to engage more with service users was apparent. The benefits of recognising and valuing the skills and qualities of frontline workers are an important lesson often forgotten by service providers of all sectors.

This study is a valuable addition to the literature and provides further evidence that meaningful communication with those with a dementia is entirely possible and desirable for both the cared for and their carers.

Keith Sumner

The Centre for Policy on Ageing, London