Empowerment and care management: swimming against the tide

This paper is concerned with the policy and practice of care management, that is, the system for assessing care needs and arranging services to meet them, developed under the legislative framework of National Health Service (NHS) and Community Care Act 1990. The paper takes as its starting point the contrast between the rhetoric of service user empowerment in professional training, particularly of social workers, with the disempowering realities that arise in practice. It examines some of the sources of this conflict, looking in particular at contradictions inherent within the development of care management as a policy, conflicts contained within the legislation and associated guidance and contradictions evident at the level of practice. It argues that organizational processes and procedures consequent upon care management as it is evolving in practice are decreasing the possibilities for empowering practice and reinforcing the power of care managers at the expense of service users. It suggests that the power of the care manager is based on increased administrative and managerial responsibility, counterbalanced by diminishing professional autonomy and discretion. Some possibilities for future development if empowerment is to survive as a meaningful concept within care management are outlined. The paper concludes that there are serious limitations on the scope for empowerment within care management and that the real hope for empowerment lies in the encouragement and support of user-led initiatives in service planning, evaluation and provision.