The work that individuals must do to assert their candidacy in an interaction with a service professional Dixon-woods (2006) suggests that in order to assert their claim to candidacy for services, individuals have to do a certain amount of work in order to succeed:
Whatever the nature of the claim, making it clearly involves work that requires a set of competencies, including the ability to formulate and articulate the issue for which help is being sought, and the ability to present credibly
The use of this dimension of the candidacy framework for our purposes shows that the amount of “work” required to claim candidacy varies considerably depending on the service an individual is trying to access.
The focus of Dixon-woods’ work was access solely to health services,
More deprived people are at risk in these situations: they may be less used to or less able to provide coherent abstracted explanations, and may feel intimidated by their social distance from health professionals.
A reasonable extrapolation of this point would be that people for whom English is not the first language would struggle in similar vein. Among the participants in this study, there was, in fact, little evidence to suggest older people from ethnic minorities struggle more than people for whom English is the first language. 92% of the participants in this study, however, were either Pakistani or Indian in origin and found it reasonably easy to gain access to a Punjabi or Urdu speaking doctor on the south side of Glasgow. For people of other ethnic origin, difficulties did arise affecting their ability to claim candidacy.
Interpretation services are available and are used, but where this was required, a different issue arose:
For people who need to take an interpreter to, for example, doctor’s appointments, there was some concern about confidentiality especially where a family member was relied upon to interpret – Advocacy Connections Report
In Glasgow, where close knit ethnic minority groups are not extensive, there is potential for interpreters to know those who they are interpreting for from contact within their wider ethnic group and this can lead to difficulties when the content of discussions is sensitive or personal.
An area of health services which people often cited in this study as presenting them with a barrier – and extra work in terms of understanding what was required of them – was the presentation of written information.
Some people said their English is generally quite good but the language used in letters from the NHS is unclear and difficult to understand. They did not think it was necessary to have letters sent to them in a different language, but simply to have them written in plain English – Advocacy Connections Report
Drop-in services and day centres that do not require social work referral
The use of these services requires minimal preparatory work and does not involve complex negotiation in order to access a person within the service in order to have a conversation. In this sense, candidacy for this type of service is established easily.
However, once a staff member or other helping person is accessed within the service, a level of work is required to adequately explain the issue being presented. Where the individual does not speak English well, this can become complicated and this is often anticipated by individuals themselves, who frequently access these services in the company of someone else from their community who does speak English, so they can make themselves understood through this third person. The services are also experienced at managing these situations and will invariably be able to access an interpreter, although this may involve an anxious delay for the individual.
An important distinction needs to be made between the services considered under this heading and the others. All aim to provide an open door, supportive service to people who walk in off the street. Their very ethos is to address the needs – even if only by signposting them elsewhere – presented to them by whoever appears at their door. Therefore their interactions will be geared towards sympathetic understanding of individuals’ needs. They will work hard to ensure individuals do not have to work hard to establish their candidacy for the services they provide.
There are other places where I don’t feel comfortable going because they usually cannot serve immediately, only by appointment. I prefer The Well because the service is very good here – Older person speaking about a drop-in service in the south of Glasgow
Social work and other statutory services such as housing agencies
We have seen that most older people from ethnic minorities tend to avoid these services if they possibly can. Because they are serving an area where there are high densities of people from ethnic minority backgrounds, the services themselves are relatively well prepared to cope with presentations from this group. However, presenting issues are often complex due to the scope of these services and individuals are inevitably caught up in some difficult and at times frustrating discussions. This study found no evidence to suggest that, given the nature of these services, this experience is any different to the rest of the population in the area.
The nature of the environment in which these services are provided did generate some comment from individuals and there was some evidence of a lack of awareness of how to present for social work services and of a lack of cultural alignment.
People said they would prefer to speak to a social worker in a more informal setting such as the day centre. One woman said she knew she needed to contact social work to get the support she needs but didn’t know how to go about it. Another person said they would only like a social worker if they could speak the same language and came from the same cultural background – Advocacy Connections Report
There was also evidence to suggest that the length of time people have to wait for appointments – and the fact that appointment systems exist at all – can have an impact on whether the older people we studied were prepared to undertake the job of establishing their candidacy for that service.
Day Centres that require social work referral
Once people had accessed the Day Centres themselves, they were very happy with their situation and had no difficulty in articulating their needs. However, waiting lists were in place for these services and access to them was controlled by social work. Given the antipathy towards social work services that was identified in other aspects of this study, it is perhaps surprising that the level of overt demand that clearly existed for these services was high, despite the fact that they necessitated compliance with the various requirements of social work, such as assessment processes.
Clearly, many older people are prepared to put this work into their candidacy if they feel the outcome will be worth it. It should be noted, however, that the study did not gain access to those older people who may have excluded themselves from access to services such as this for these very reasons of reluctance to become involved with social work. The size of this group is not known, but will form part of a wider group which workers in the field indicate does exist in sizeable numbers, of older people from ethnic minorities who are both isolated – i.e.; they live remotely from family members or have no remaining family – and hampered by communication issues, lack of awareness of services or health issues, or a combination of these.
This is supported in other research in this area (Bowes and Dar, 1996 (19)). This particular group of older people, who appear to be no less in evidence than they were 17 years ago when the Bowes and Dar study was conducted, is at greatest risk and at the same time most remote from the services they need.
Research for this study did uncover situations where tensions had undermined the traditionally strong family support networks that ensured older people received care from their families, leaving the older person involved very isolated. Nor is it a coincidence that those older people who were accessing these day centres were overwhelmingly people who lived alone.
Across all these service delivery areas, the issue of cultural alignment is persistent. Older people from ethnic minority backgrounds are presented with obstacles to their candidacies that do not exist for those from the dominant culture in Scotland. They are therefore required to work harder; to put in more effort when it comes to negotiating their needs with service providers.
One person said; “a purpose built centre would be much better”. The person thought that integration with people from other backgrounds would be good as long as specific cultural needs such as having a prayer room and access to washing facilities were met – Advocacy Connections Report
There was a clear sense among older people we spoke to and professionals working in the area that this issue of cultural alignment between services and their ethnic minority service-users would be greatly assisted by the presence of more staff working in services who were from the same ethnic backgrounds as users. This issue is discussed in detail in Identification but is worth underlining in the context of Appearance and presentation of potential candidates for services, because it has such a direct impact in this area. The following finding from a 2000 study, conducted in Glasgow, highlights the issues here.
Interviews with white staff revealed a lack of knowledge of the minority ethnic communities and difficulties were expressed by these white staff about approaching work with minorities; they spoke of being afraid to do the work, of not knowing how to approach it, and of their fear of offending (20).
The staff interviewed for the present study were mainly from community based small organisations providing ethno-specific services. They did not complain of any lack of confidence in dealing with people from ethnic minority backgrounds, but they were all white and some indicated things would be easier if there were more people from ethnic minority backgrounds working alongside them. Within social work, a level of perplexity was evident that highlights the lack of alignment between their services and the people from ethnic minority backgrounds they are trying to reach.
We’ve come across communication blocks. The knowledge is out there, but doesn’t seem to be taken in. With older people, we often only seem to get involved when someone has a stroke or something serious – we get involved at the point of crisis – a social work manager in Glasgow
Clearly, the lack of cultural alignment of some services with older people from ethnic minority backgrounds is presenting people with a barrier at the point of presentation that is beyond those experienced by their counterparts from the mainstream, predominantly white culture to which the great majority of the professionals involved in the field adhere.
(19) Pathways to Welfare for Pakistani Elderly People in Glasgow, A Bowes and N Dar 1996 Scottish Office, Edinburgh
(20) Researching Social Care for Minority Ethnic Older People: Implications of Some Scottish Research, AM Bowes, NS Dar (2000) BJSW: 30, 305-321