Professional adjudication – What moral and social judgements and interpersonal systemic are at play which influence candidacy?
The study produced limited data to analyse this aspect of the candidacy framework. The absence of cultural alignment that was identified by many of the older people in the study as a barrier to both their access (in practical terms of communication, for instance) and their motivation to promote themselves as candidates for services, does suggest that such judgements were at play in some of the negotiations that took place over candidacy.
A recent study in the same part of Glasgow analysed access to the local library in Govanhill using the candidacy framework (Bynner, 2012(21)). In this, a library staff member made reference to her colleagues’ behaviour in relation to access issues:
People are dismissive when they see people of a different cultural background and they are just tired, they are tired of dealing with different people day in day out, so people […] become dismissive and judgemental. Local authority staff member – Equity, Austerity and Access to Public Services , C Bynner, 2012
This is consistent with findings of other studies of the influence of the attitudes of front-line staff on whether candidacy is successful or not. (M Lip sky, 1980; Dixon-Woods 1996).
At times of high rationing of services, this process of adjudication is particularly pronounced (Lipsky, 1980). In Glasgow in 2013, budgetary restrictions are very acute and managers confirm that social work staff are under a great deal of pressure to provide services against a backdrop of diminishing resources and increasing demand.
This leads to a “rationing of energy directed at individual needs” (Bynner, 2012) and a jaded approach, as described in Bynner’s quote above. Social work as a service already has relatively low permeability to protect it from stretching its resources too thinly, so the adoption of personal approaches that reduce further the demands placed on the service can be rationalised as both logical and desirable in this context by those who adopt them. Moreover, the growing perception of social workers more as “gate-keepers” than providers of support services is well chronicled.
This distance between white social workers and their minority ethnic clients has to be seen in the context of a more generally increasing distance between all service users and social workers, whose roles have been shifting towards more managerial jobs under community care arrangements (Lewis and Glennerster, 1996 (22)); for minority ethnic clients, additional factors were compounding this process -Bowes and Dar,1996 (23).
The main “additional factors” found in this study relate to the low levels of awareness among older people from ethnic minorities of services on offer and the lack of cultural awareness of staff and a more general sense among older people of a lack of cultural alignment with the wider organisation and system they are being asked to negotiate – this includes communication difficulties.
One person added they would only like to have a social worker if they can find one who speaks the same language as them – Advocacy Connections Report
As previously stated, the use of, or intention to use, social work services by the group studied was limited. Those who gained access to the social work controlled day centres were, by definition, less likely to have experienced particular access difficulties and could be described as having received “positive adjudication” during their candidacy negotiations.
Health services were generally seen as a potentially hazardous range of encounters with professionals who lacked the time to make themselves understood clearly. When necessary, however, it did appear that the majority of participants were able to get the service they needed, often through resourceful recourse to health professionals from within their own cultural networks. Some health services were also available through attendance at day centres and it is revealing that participants claimed they would not access these services if they were not provided in this way.
Some health workers, such as nurses and chiropodists, visit the centres and provide direct services. Some people said they wouldn’t access these services if they had to go to them on their own – Advocacy Connections Report
There was no evidence to suggest participants suffered from negative adjudication or that staff attitudes barred access to health treatments. However, this has to be placed in a wider context: “For many years there has been a pattern whereby people from black and minority ethnic groups are over-represented among those consulting their GP, but under-represented among those using secondary health care (Acheson, 1997) (24).
Taking this into account, older people who were able to access a GP from the same culture as themselves, as many said they could in the south of Glasgow, may then not have gone on to take up secondary services, even if their GP had deemed them as necessary and the reasons for this are likely to be related to those described above.
There was a view among those working in the field that many older people lacked the confidence to negotiate the “system” by themselves. In the case of older women from ethnic minority backgrounds, this was felt to be particularly acute. Many older women have been involved in raising families over a long period, very much within their cultural traditions, and have lacked the same exposure to mainstream society as males.
Not only has this hindered them in communication, it has also left them lacking in the knowledge and confidence to undertake the work of presentation and negotiation claiming successful candidacy of statutory services requires. In many cases, it has also undermined their confidence in interacting with other older people as part of a group.
There are skills associated with these interactions which older women from ethnic minority backgrounds may not have learnt. These issues are exacerbated when these women are asked to interact with those from other cultures.
Integrated services were not viewed very positively overall by women. Some were worried about language barriers and communicating with other service users and staff and some felt they want to be with people from the same cultural or religious background – Advocacy Connections Report
(21) Equity, Austerity and Access to Public Services , C Bynner, University of Glasgow, 2012
(22) Implementing the New Community Care, Lewis, J. and Glennerster, H. (1996), Buckingham, Open University Press.
(23) Researching Social Care for Minority Ethnic Older People: Implications of Some Scottish Research, AM Bowes, NS Dar (2000) BJSW: 30, 305-321
(24) Independent Inquiry into Inequalities in Health Report, Acheson, D. (1997), London: The Stationery Office. Quoted in The health and social care experiences of BME older people, Moriarty, J. (2008) Race Equality Foundation