New paradigms from the past: How far can the active citizens of today's health and social care policy realise empowerment without welfare approaches from the past?

H Barnes

    Research output: Chapter in Book/Report/Conference proceedingConference contributionpeer-review

    Abstract

    Social models emphasising active empowerment in policy and service responses to long-term health and social care concerns, are hailed as pivotal by UK policy in the promotion of citizenship rights and effective interventions. These policies treat individual capacity-building, social participation, self management of health, and emphasis on community supports in preference to dependence on services and professional care, as the best route to positive outcomes. Significantly, however, these developments carry echoes of the historical Poor Law assumptions of the normal human being as completely in control of self and environment, seeing vulnerability to the impact of social and biological forces as marginal in human society. This has led policy to view as counterproductive, earlier welfare state arrangements which recognised the damage and suffering implicated in the human impact of these forces and prioritised entry to the ‘sick role’ and specialist professional and service interventions to alleviate these concerns. How far, however, may today’s policies based on such assumptions, really be effective in addressing these health and social care issues? In seeking to explore this question, the paper will, in accord with approaches to policy critique exemplified in current policy studies in the area of frailty, and in emancipatory social theory and service user-led New Social Movements, examine service users’ concerns and consider how far the policy assumptions regarding the nature of these concerns can support an adequate response to them. This then forms a basis for paradigm change – considering alternative understandings which can be more responsive to these concerns. The paper will therefore review research evidence pertaining to the concerns of people facing multiple long-term health problems and social exclusion. Exploration of these findings suggests that although these service users seek recognition of their citizenship rights in accord with current policy principles, they also have major concerns with suffering and damage to capacity resulting both from health concerns and the impact of social discrimination, leading them to place enormous value on many aspects of traditional welfare state approaches to vulnerability. Research concerned with the damage implicated in these vulnerability experiences, and evaluations of services responsive to these concerns, can also support the value of such approaches to achieving positive outcomes. This review therefore points to the importance of older welfare policy models in developing empowering health and social care policy, suggesting new approaches which can respond both to citizenship and to the devastating impact of service users’ concerns.
    Original languageEnglish
    Title of host publicationhost publication
    Publication statusPublished - 2009
    EventSocial Policy Association Conference: Policy Futures: learning from the Past - Edinburgh
    Duration: 29 Jun 20092 Jul 2009
    http://www.social-policy.com/conferences.aspxaspxhttp://www.crfr.ac.uk/spa2009/spa_index.html

    Conference

    ConferenceSocial Policy Association Conference: Policy Futures: learning from the Past
    CityEdinburgh
    Period29/06/092/07/09
    Internet address

    Keywords

    • Long term conditions
    • Social models of health and wellbeing
    • Social exclusion
    • Vulnerability
    • Active social welfare

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