A case study of the statutory review system for older people in care homes in one local authority

Scourfield, Peter (2013). A case study of the statutory review system for older people in care homes in one local authority. PhD thesis The Open University.

DOI: https://doi.org/10.21954/ou.ro.0000eec0


A case study of the statutory care home review system in one Local Authority. Statutory reviews of older people's care home placements are a legacy of the Community Care reforms of the 1990s in the UK. Using a mixed method approach this small-scale qualitative study was designed to explore how the statutory care home review system operated from the perspectives of its multiple stakeholders, but paying particular attention to the role played by the older person. The study also set out to assess the relevance and usefulness of the concept of 'street-level bureaucracy' as developed by Upsky (1980) in understanding how discretion was used in operating the system. It is argued that, in a context in which the adult social care sector has been 'transformed' by processes of privatisation, marketization and 'modernisation', the exercise of discretion is no longer the sale preserve of 'street-level bureaucrats' (front-line practitioners), but rather, it is dispersed among the various statutory and non-statutory actors in the review system, including managers, care home providers relatives and older -people themselves. The study revealed a system which had undergone multiple reorganisations in response to a variety of national and local policy initiatives and, against this context, was struggling to cope with the implementation of ambiguous and, often, conflicting policy agendas. Overall, the system was compromised by the need to balance ensuring care standards with the need to meet performance targets, often leading managers, practitioners and care providers to have to tolerate sub-optimal standards of care. It is proposed that, generally, in order for review actors to manage the tensions inherent in the system, it was helpful if the older person either voluntarily adopted or was steered into a position of passive participation in care reviews, suggesting that reviews can be as much a source of disempowerment for older people as empowerment.

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