Hidden realities, service users and social work practice within personalisation and wellbeing policy: using the critical realist review method to interrogate issues and ways forward with social inequalities and health

The proposed professional capabilities framework (Social Work Reform Board 2010) upholds social work’s commitment to empowerment, wellbeing and social justice. This resonates with the emergence, from the community care reforms of the 1990’s to today’s concern with health inequalities, of social, wellbeing and empowerment policy discourses in relation to people with long-term health conditions (Department of Health 2010). However, although these discourses form facilitators in some respects for social work values, they may also limit their realisation in practice through implications they carry for social work roles and resources, and for a reduced focus upon key dimensions of service users’ concerns. Nevertheless, research and alternative social theory has the potential to suggest approaches which could support workers in developing optimal practice in relation to these concerns. The paper initially discusses use of the critical realist review method to explore these themes. First it examines today’s health and social care policy discourses focussing upon ‘active’ approaches to empowerment including self-management, personalisation and ‘universal’ services and supports, while de-emphasising vulnerability. It then traces implications of these discourses for social work and service users, drawing out their limitations particularly for people from disadvantaged backgrounds whose voices often go unheard (Strier & Binyamin 2010). A discussion of research on issues for these service users follows, suggesting that although they seek citizenship, many also have major concerns with vulnerability involving the damaging impact of disadvantage. The paper goes on to consider how complexity approaches in social theory and research can offer understandings which do justice to vulnerability while also upholding citizenship. The paper finally suggests ways which these understandings could support efforts in social work education and practice to maximise the potential within policy mandates and the capabilities framework, to make full responses to service users’ concerns. References Department of Health (2010) A Vision for Adult Social Care. London: Department of Health. Social Work Reform Board (2010) Building a Safe and Confident Future: One Year on. Detailed Proposals from the Social Work Reform Board. London: Department of Education. Strier R & Binyamin S (2010) Developing anti-oppressive services for the poor: A theoretical and organisational rationale. British Journal of Social Work 40 (6) 1908-1926.