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1 - From a collaborative and integrated welfare policy to frontline practices
- Edited by Kirsi Juhila, Tampere University, Finland, Tanja Dall, Aalborg Universitet, Christopher Hall, Juliet Koprowska, University of York
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- Book:
- Interprofessional Collaboration and Service Users
- Published by:
- Bristol University Press
- Published online:
- 21 December 2021
- Print publication:
- 06 April 2021, pp 9-32
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- Chapter
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Summary
Introduction
During recent decades, Western welfare states have gone through a number of substantial transformations. One such transformation was the turn to active welfare states, based on the neoliberalist ideas of limiting the role of the state in welfare provision and emphasising citizens’ responsibilities instead of rights. Along with this, there has been a transition to a managerialist mode of governance, calling for more effective and efficient welfare services, and an increasing demand to understand service-using citizens as active participants in service provision. Common to these kinds of transformations is that they travel across countries and are often defined as indispensable steps to maintaining welfare states and to securing effective, fair and flexible responses to citizens’ wishes and needs. In other words, these are globally promoted and shared policies of welfare states, which are then realised in national legislation and guidelines.
New managerialist modes of governing have, among a range of other features, facilitated an increasingly specialised organisation of work in health and social care services. The idea is that specialised units of professionals will be able to develop more effective and productive service delivery due to both a specialisation of professional skills and an optimisation of procedures guiding work. However, this specialisation has produced fragmented services, which lack coherence and coordination in individual cases and between services more broadly. This has led to a call for collaborative and integrated welfare services across service sectors and national contexts. The resulting collaborative and integrated welfare policy and its accomplishments and implications in frontline social welfare service practices are at the core of this book. This policy stems from the aforementioned welfare state transformations, but it also has specific roots and justifications. It is promoted as a solution to overcoming the challenges of ineffective, dispersed and professional-led health and social care services. ‘Collaboration’ in this book refers to both collaboration between different professionals and organisations, and collaboration between professionals and citizens as service users. ‘Integration’, for its part, refers to the view that health and social care services should be seen as a whole, responding comprehensively to people's complex problems and service needs, in contrast to segmented sections concentrating solely on strictly targeted issues (Cameron et al, 2014; Fenwick, 2016, p 112).
6 - Sympathy and micropolitics in return-to-work meetings
- Edited by Kirsi Juhila, Tampere University, Finland, Tanja Dall, Aalborg Universitet, Christopher Hall, Juliet Koprowska, University of York
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- Book:
- Interprofessional Collaboration and Service Users
- Published by:
- Bristol University Press
- Published online:
- 21 December 2021
- Print publication:
- 06 April 2021, pp 141-170
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- Chapter
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Summary
Introduction
One of the key tenets of this edited volume is that the study of communication patterns during multi-agency welfare meetings is pertinent to the understanding of current social policies and their implementation and practices in everyday life. In this chapter, multiagency return-to-work meetings are explored with a focus on the emotional underpinnings of institutional practice assembling various parties of the rehabilitation process. In particular, attention is paid to alliances and the ways in which various alliances may or may not reflect sympathy towards service users and their troubles. To this end, the chapter leans on the concept of ‘sympathy’ as an emotion that bonds, especially in difficult times. However, as Candace Clark (1997) elaborates, sympathy or rather its lack thereof can magnify differences between those who are better off and those who are worse off. The aim is to discuss the context of multi-agency welfare meetings via the prism of sympathy and the role of alliances between service users, professionals and employers in promoting or discouraging spells of sympathy during such meetings.
The following section sheds light on the context of the Swedish work rehabilitation process and the institutional as well as emotional character of return-to-work meetings. Thereafter, the theoretical grounding based on the work of Candace Clark and her concept of ‘sympathy’ is presented. Following the presentation of methods is an analysis of several situations from two return-to-work meetings and a discussion about the place of sympathy and alliance in the institutional context.
The institutional and emotional landscapes of multiagency welfare meetings
The introduction of multi-agency return-to-work meetings in 2003 is written into wider changes regarding the social insurance system and the work rehabilitation of people on sick leave in Sweden. Critics conceive of it as an extension of the ‘intensified work-line strategy’ (Junestav, 2009), which brought an increased emphasis on activation and self-sufficiency among sick-listed persons and the tightening of sick leave entitlements (Melén, 2008). In parallel, the public discourse regarding sickness absence has changed. In contrast to previously being dominated by work conditions, stress and burnout as the reason for long-term sick leave, the media coverage has now become dominated by stories of the overuse and abuse of the generous social insurance system (Johnson, 2010).