Priorities, “street level bureaucracy” and the community mental health team

Wells, John

doi:10.1111/j.1365-2524.1997.tb00130.x

Cited by 50 publications

(31 citation statements)

References 44 publications

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“…Organisational and other differences, including the exercise of individual agency [60] and the activities of professionals at 'street level' [61], mean that the consequences of change may not be as intended. Interventions can never truly be trialled or declared as objectively the 'best' approach across all contexts, and evidence and outcomes remain open to differential interpretation.…”

Section: On Problems With Problem Formulation and Waves Of Consequencesmentioning

confidence: 99%

Where the wicked problems are: The case of mental health

Hannigan¹,

Coffey²

2011

Health Policy

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ObjectiveTo use systems ideas and the concept of 'wicked problems' to frame examination of a decade-and-ahalf of UK mental health policy. MethodsTheoretically informed policy analysis. ResultsModern health care is complex, and mental health care particularly so. In the UK the mental health system has also become a policymaking priority. Features of this system mean that many of the problems policymakers face are of the 'wicked' variety. Wicked problems are resistant. Problem formulations and their solutions are contestable. Solutions which have 'worked' in one setting may not 'work' in another, and evidence to guide change is open to challenge. Actions trigger waves with widespread system consequences. In the case of the UK's mental health field significant shifts have taken place in formulations of 'the problem' to which actions have been directed. These have included assessments of community care failure, formulations emphasising problems with the professions and, most recently, the need for action to promote mental health and wellbeing. ConclusionsIn their efforts to secure improvement in a neglected field UK policymakers have unleashed a torrent of top-down actions. Attention needs to be paid to constructing strong, system-wide, partnerships and to examining the cumulative impact of policy actions.

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Section: On Problems With Problem Formulation and Waves Of Consequencesmentioning

confidence: 99%

Where the wicked problems are: The case of mental health

Hannigan¹,

Coffey²

2011

Health Policy

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“…Practice teachers have indicated limited confidence in their legal literacy and argued that the performance indicator and assessment culture in which they work ironically encourages departures from good practice . Similarly, Wells (1997) has also suggested that professional practice and moral responsibility is being compromised by social workers' accountability to their employing agency and by the emphasis on following procedures. Rummery and Glendinning (1999) found that service users' legal entitlements were seriously compromised by organisational procedures.…”

Section: Review Evidencementioning

confidence: 99%

On the evidence for viruses in social work systems: law, ethics and practice

Preston‐Shoot¹

2010

European Journal of Social Work

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The purpose of this paper is to explore an apparent disjunction between espoused professional ethics and ethics in practice, and between law in statute and law in action. Social work in England is used as the main case study, however, research from other jurisdictions is drawn upon to demonstrate wider concern about departures from moral and legal rules. The evidence of the disjunction is presented, drawing principally from judicial review cases, investigations by the Commissioner for Local Administration (Ombudsman), inquiry evidence and government reports. The article critiques the current regulatory apparatus in England and the mechanisms by which staff and service users can hold public organisations, particularly councils with social services responsibilities, accountable. The interface between law and ethics is reviewed. The paper concludes with observations about strengthening legal and ethical literacy in practice.

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“…Although Michael Lipsky's theory (1980) might still hold some currency in relation to certain groups, in certain contexts (Wells 2007) greater emphasis on top-down management, target setting and care pathways has 'liberated' healthcare professionals from many street level dilemmas.…”

Section: Scandal and Concernmentioning

confidence: 99%