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clinmed/2001040001v1 (April 25, 2001)
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Conflict and Coercion: Working Together at the Interface of Continuing Health and Social Care?
This paper discusses recent changes that have taken place in the area of continuing health and social care in the UK. The impact of the changes are highlighted through the findings of a qualitative research study which explored collaborative processes between statutory health and social services, and the subsequent outcome for older service users. The findings show how the ideals and official rhetoric of continuing care policy, which include the notion of user-led provision, in the UK are undermined by tendencies toward professional dominance and rationing. To understand this we must appreciate that "provision" is a negotiated outcome involving managers, paid workers and service users, and that conflict and coercion among the various parties often replace the ideals of "collaboration" and "integration". Older people and their carers are the ones to lose out. They are relatively powerless to challenge bureaucratic machinery through which their care is processed. The paper concludes that real service user empowerment can only take place through a broad based political and cultural shift in the nature of provision both at agency and societal levels. This would involve the state adopting a more interventionist role in macro economic policy and assuming greater responsibility for its financial redistributive role - and interested parties intervening at the agency level to redefine narrowly imposed concepts of "needs" in terms of active "rights".