Download Improving services through a cross national approach

Journal of Health and Social Care Improvement, VOL 2, 2011
Improving services through a cross-national approach:
possibilities and pitfalls.
Graeme Simpson- School of Health and Wellbeing, University of Wolverhampton,
Correspondence: Graeme Simpson
Abstract:
Email: [email protected]
The improvement of services through cross-national
comparison is a topical theme. Drawing upon a
biographical account the paper examines the potential
pitfalls and the gains from such an approach. The
comparative social work/care literature is briefly
explored, before the paper’s methodological approach
of biographical narrative is developed. This enables the
exploration of a mother’s account of a visit to The
Netherlands, which allows for an examination of key
questions in cross-national comparison and its uses
and abuses in service improvement. It concludes by
suggesting that whilst cross-national comparison can
open up new possibilities, these should be greeted with
an element of caution and must always be
contextualized with their social and political framework.
Key words: Comparative enquiry; biographical
narrative; learning disability; service improvement
Submitted for Publication- June 2011
INTRODUCTION
itself is part of a wider narrative. It concludes by
suggesting that cross-national comparison has
a place, but that there are pitfalls as well as
potential gains in such an approach.
The claim that services can be improved by
drawing upon the experiences of other
countries is topical. This paper considers the
potential pitfalls and benefits of using crossnational comparison as a guide to improving
services in one’s host country in the field of
social work and/or social care. It begins by
establishing the contemporary nature and
current relevance of the phenomenon, and
offers a short examination of the comparative
literature in this area. Utilising the method of
‘biographical
narrative’
developed
by
Chamberlayne with other colleagues (2002:
2004) it draws upon a short account, which
COMPARATIVE ENQUIRY
Comparative enquiry has been a feature of
social policy for a number of years and since
the 1990s social work, and by extension social
care in all four nations of the UK, has gradually
embraced this dimension. More recently it has
become a feature of policy discussion and
actual development, to identify another country
as operating a more successful model. A clear
example in the field of social care is the
previous Government’s concern with the poor
1
Journal of Health and Social Care Improvement, VOL 2, 2011
educational attainment of children looked after
resulted in comparisons being made with other
EU countries (notably Germany) and to an
interest in the methods of social pedagogy
(Gentleman, 2009). Social pedagogy has its
origins in education and is common throughout
northern Europe (Lorenz, 2008; Stephens,
2009) as well as being part of a Scottish
tradition (Smith & White, 2008), yet was largely
overlooked in England. The comparative
interest, however, at policy level has led to a
number of pilot schemes and training centres,
turning policy development into a reality
(Cameron et al, 2010). The focus of these
developments is very clear: those who promote
them do so with a view to improving services
and service delivery in the area of social
welfare provision.
exchanges, and the interconnectedness of EU
policy can be a driver for policy makers. There
is also a substantial social policy based
literature, which has helped the development of
comparative inquiry within the specific area of
social work and social care, spurred by the
desire both to learn from others and engage in
analysis of our own provisions and practice
(Lawrence et al, 2009). Shifting the social policy
paradigms towards a more explicit comparison
of these areas has its difficulties. Social policy
research methodologies are rooted in
epistemological traditions of what can be
measured and quantified (Mabbet & Bolderson,
1999; Hantrais, 2009). By contrast social care
work is an activity, which is largely concerned
with “interpretation” (Sheppard, 1995), despite
the current preoccupation with ‘science’ and the
measurable (Parton and O’Bryan 2000). When
entering the realm of comparison for social care
work, both the measurable and the
interpretative have to be accommodated;
knowledge therefore becomes both subjective
and objective (Hetherington et al, 1996). Many
of these methodologies are complex and, as
Mabbut and Bolderson (1999) suggest, could
result in being only case specific – in that the
methodology used to compare two countries,
England and Spain in their example, may not
be transferable to others.
Comparative work and enquiry has, not
surprisingly, its own controversies. For some
the straightforward acquisition of knowledge is
an important end in itself, whether this comes
from reading, virtual inquiry or actual visits
(Pringle, 1998). The process of comparing
illuminates our own practice and welfare
system, something which has become an
orthodoxy within comparative work, allowing for
new windows of understanding to be opened
upon our own set of assumptions (Hetherington
et al, 1996: 29). Esping-Andersen (2002)
explores the question of developing policy
initiatives at local, national or EU levels. More
recently, Hantrais (2009) has provided an
overarching
analysis
of
comparative
methodologies, which develops many of the
ideas advanced by Mabbut and Bolderson
(1999).
BIOGRAPHICAL NARRATIVE
A useful and more accessible methodology has
been advanced by Chamberlayne and
colleagues (1999; 2002; 2004) which focuses
upon people’s experiences and narratives and
attempts to generalise from them. Although this
may lack some of the quantitative rigour of
other methodologies (Hantrais, 2009), it widens
the base of comparative enquiry to a range of
potential stakeholders, including students,
practitioners, service users and/or their carers.
The latter group belong to a relatively
It is not difficult, therefore, to establish that this
is a field dominated by academic researchers
and policy makers. European Union grants and
allowances are intended to facilitate such
2
Journal of Health and Social Care Improvement, VOL 2, 2011
underdeveloped area in the literature, although
there are those who occupy ‘dual spaces’ for
example as academics and carers (Race, 2007;
Price, 2011 are examples in the field of learning
disability, who have engaged in a specific
cross-national
approach).
Chamberlayne’s
biographical work extends the work of Bradley
& Firth (1998) and also Aymer & Bryan (1998),
who set out their arguments for using case
studies as comparative devices. The alliance
between academics, students and more latterly
service users is strong and has a lengthy
history. Within social work, recent alliances
have developed – notably in the UK – which
have emphasised service user involvement
(Beresford and Croft, 2004). A key feature for
this group is that which preoccupies policy
makers: the desire to improve service provision
and delivery.
wider application into practice and policy
development.
The methodology utilised here is influenced by
the concepts of reflexivity and hermeneutics,
and also draws heavily upon Chamberlayne
(1999), Chamberlayne and colleagues (2002)
and Chamberlayne and colleagues (2004),
introduced earlier. In more details, she identifies
what can be termed the “cultural sphere”
(Chamberlayne, 1999). She argues that there is
a European tradition, which suggests that social
systems have become dislocated from people’s
lived experiences (Habermas, 1987), and she
develops this to explore ways in which people
are not only socialised by the societies in which
they live, but also through how their
experiences impact upon those same social
structures. Biography becomes crucial to a full
understanding of welfare provision in both the
formal and informal (i.e. familial) settings. In the
arena of social care, it is these policy arenas
which assume crucial importance. In the later
analysis of biography and social exclusion there
is an attempt to extend the methodology to
include service provision and practice, and the
emphasis upon life stories promotes a degree
of reflexivity (Chamberlayne et al, 2002). For
social care this offers a methodological insight
into the life worlds of service users, who tend to
be
neglected
in
comparative
work.
Chamberlayne et al’s (2004) methodological
development brings the question of comparison
into contact with people’s actual lived
experiences and the application of this for
services is twofold. First it allows an exploration
of both the service and its delivery through the
biography of those who have experienced it.
Second, it places these experiences in the
centre of a policy analysis. If then, the purpose
of comparison is to improve service delivery (as
opposed to a mere gaining of knowledge about
provision in another place) Chamberlayne’s
methods shift the researchers gaze away from
Academics, policy makers, practitioners and
service users all have their roles to play in
developing understandings around comparative
work. To perpetuate a simple expert/user divide
seems to be neither useful nor accurate. What
is clear, however, is that the experience of
service users is rather more restricted than that
of the other groups identified (Shardlow, 2003).
The importance of engaging in a process of
comparison, which extends to visits and faceto-face meetings is underscored by Baistow
(2000:12), who suggested participants can
learn about others, learn from others, learn with
others and ultimately within a reflexive process,
“learn about themselves” (Baistow, 2000:12).
Such a model has considerable application for
social care, with its emphasis upon the reflexive
process. Simpson and Schoepf (2006)
developed a model for “learning through
comparing” by utilising the hermeneutic
tradition, which is based upon the key concepts
of understanding and interpretation of a range
of factors. This model was primarily directed at
student participation, but the principles have a
3
Journal of Health and Social Care Improvement, VOL 2, 2011
the ‘top-down’ nature of policy, to one which
engages those on the receiving end. The
research subject is that of a personal
biographical narrative of a parent, who utilised a
trip to The Netherlands to meet another parent
who faced a similar situation. Some minor
changes to her account have been made to
ensure anonymity.
was inclusive, but innovative. In his enthusiasm
to find something better he had not appreciated
the innovative aspect of it.
He therefore
generalised his views from such a visit and
assumed that such good provision was
widespread in the England”.
THE MOTHER’S ACCOUNT
PITFALLS……
“During a visit to The Netherlands, a meeting
was set up with someone who was described
as having expert knowledge in the field of
learning disability I was interested in. I thought
this would provide me with an opportunity to
meet someone who could tell me about
provision is in his country, so that I could take
home new ideas and draw inspiration from
them. My experience in England had been
frustrating and negative. As a parent I
desperately wanted to see a vision of a better
way, which could give me some hope for the
future.
There are several ‘pitfalls’ which have been
identified in the comparative literature.
Cochrane (1993) notes the difficulties of
translation, citing words, which are virtually
untranslatable, yet a more perilous task is being
aware of different meanings attached to words
and concepts. Within this context, in English the
terms “learning difficulties” and “learning
disabilities” are interchangeable. Yet for most
Europeans the former, would mean children
who have difficulties learning, perhaps because
of dyslexia. In short, the terminology can be
problematic and the use of language and its
differently layered meanings needs to be fully
acknowledged.
During our meeting, something altogether
different happened. Rather than tell me how
good provision was in The Netherlands he in
fact told me how bad it was but how some
improvements were taking place. His main
point was to tell me how much better services
were in England.
An obvious difficulty arises from an overreliance upon legislation. An example would be
what level of discretion is given to the local
authorities, within an overall framework.
Although Walsh and colleagues (2000: 294)
state that The Netherlands offers a different and
a “better way” with regard to integration in
education, and Wilson (1996: 176) identifies the
potential for localised differences, in their
reconfigured system. A more recent evaluation
of Dutch provision (Vlaskamp and Poppes,
2004) indicates a patchier picture with some
improvements, but still much to be done,
perhaps underlining the Dutch parent’s
experience. On their visit to England, however,
they had witnessed a leading example of fully
integrated provision, fully supported by the UK
This was not what I was expecting, and it made
me revisit all the assumptions I had made prior
to my journey to The Netherlands.
It also
made me realise that when we start on this
‘journey’, we place great store on there being a
satisfactory outcome, and we are not
necessarily prepared to cope with any
disappointment.
The disappointment can
undermine our confidence and question what
we thought we knew, and can take us to a
place we do not want to be.
His view of provision in the England resulted
from a visit he made to a city where provision
4
Journal of Health and Social Care Improvement, VOL 2, 2011
legislative framework, notably “Valuing People”
(DoH, 2001). There is also no question that
other Local Authorities offer far less of an
integrated and inclusive service, since UK
legislative framework gives enabling powers to
local providers. Thus, the assumptions they
made are only partially “true”. The general
‘pitfall’ of relying upon a legislative comparison
is that it is primarily, ‘enabling legislation’ and
many countries allow for considerable local
variations.
in the literature were simply put to one side in
this search.
POSITIVIES AND INSPIRATION
There is an important corollary to this
discussion, drawn from the narrative. Whilst the
“knowledge” discovered in England was flawed
as a basis for a comparative analysis between
the England and The Netherlands, it provided a
positive example of “good practice”.
This
confirms Wilson’s (1996: 168) definition of good
practice being “innovatory”, even though overall
provision in The Netherlands is probably more
advanced than England (Vlaskamp and
Poppes, 2004). The inspiration, however,
gained from the visit was considerable and
acted as a motivational factor for further
campaigning.
Finally two further points needs to be made.
First, despite EU guidelines, not all countries
view people with learning disabilities in the
same way (Knust-Potter, 1997).Second, even
allowing for differences in history and provision,
all of this is provided within a country specific
framework. As Salomon (1937, in Wieler, 2000)
commented social work is essentially a
national, not international enterprise, in that it
responds to ‘local’ conditions with ‘local’
solutions.
The narrative account confirms the desire to
improve practice through comparison, if not for
the mother, certainly for the Dutch parent.
Within the narrative the outcome was positive
since it resulted in potential gains for a distinct
service user group (French and Baldwin, 1997),
confirming Pitts’ (1994) view that there should
be a benefit to actual practice and policy
development. Nevertheless, the inspirations
that can be drawn from coming into contact with
innovative practice and new sets of provisions
will ultimately only bear fruit if these are
addressed through political measures, be this at
local or national level. The challenge is to
ensure that service improvement through
comparative means is to form genuine alliances
to bring about change for the benefit of service
users (Beresford and Croft (2004). The gains
from comparative analysis and collaboration
cannot be left to the selective accounts of
politicians and a ‘top-down’ approach. It opens
up new forms of activism and engagement with
the policy processes at local and national level
(Weiss et al, 2006; Simpson and Connor, 2011)
The aim of this paper is not to develop a
comparison between the Netherlands and
England, but to draw out the potential ‘risks’ in
the desire to utilise cross-national comparisons.
There are two key points in the narrative
account which underscore these. First, the
Dutch person had seen a rather isolated
example of innovative practice, which was not
generalised throughout England and had been
developed in a relatively small area, where
there was a political will to act in response to
specific parental and campaigning pressures.
This does not diminish the experience, but
rather it questions the generalisable view that
this is English provision. This is closely related
to a second point: both parents had a genuine,
one could even describe it as ‘heartfelt’ desire
and arguably ‘need’ to discover something
‘better’. Thus, many of the pitfalls documented
5
Journal of Health and Social Care Improvement, VOL 2, 2011
Practice: An International Perspective. Bristol.
Policy Press
CONCLUSION
Comparative work can, and should open up
possibilities for new developments, involving
not only academics, but also practitioners and
service users.
Chamberlayne P, Rustin M & Wengraf T (eds)
(2002) Biography and social exclusion in
Europe: Experiences and Life Journeys Bristol.
Policy Press
As social work throughout Europe faces up to
the realities of welfare retrenchment, it is
necessary to re-emphasis the importance of the
political and economic sphere in shaping
services. Alliances formed within comparative
analyses can become an important part of reestablishing this, and promoting services which
seek to re-emphasise the importance of human
need.
Chamberlayne P., Cooper A., Freeman R.,
Rustin M., (1999) Welfare and Culture in
Europe: Towards a New Paradigm in Social
Policy. London. Jessica Kingsley Press.
Cochrane A. (1993) Comparative Approaches
and Social Policy in Cochrane A. & Clarke J
(eds.) Comparing Welfare States: Britain in an
International Context. London. Sage.
Department of Health (2001) Valuing People: A
New Strategy for learing Disability for the 21st
Century. London. The Stationery Office.
REFERENCES
Esping-Andersen G. (1990) The Three Worlds
of Welfare Capitalism. Cambridge. Polity Press
Aymer C. & Brian A. (1998) Investigating Intercultural Communication Within and Between a
British and Dutch Social Work Course. Social
Work in Europe, 5(3) pp 59-66.
Esping-Anderson G., (1999) The Social
Foundation of Post-Industrial Economies.
Oxford University Press.
Baistow K. (2000) Cross-national Research:
What Can We Learn from Inter-country
Comparison. Social Work in Europe, 7(3) pp813.
Esping-Andersen G (2002) Why We Need a
New Welfare State Oxford. OUP.
French S & Baldwin S (1997) Who can
legitimately carry out research into disability?
Dialogues in Disability, Theory and Policy, 29
September 1997.
Beresford P. and Croft S. (2004) Service Users
and Practitioners Reunited: The Key
Component for Social Work Reform British
Journal of Social Work 34 (1) pp 53-68
Gentleman, A. (2009) Children in Care: how
Britain is failing its most vulnerable. The
Guardian. 20 April, 2009
http://www.guardian.co.uk/society/2009/apr/20/
care-system-failures?intcmp=239 [last
accessed: 11 February, 2011]
Bradley G. & Firth R. (1998) Translating the
European Dimension into Training Social Work
in Europe, 5(1) pp49-53.
Cameron, C., Jasper, A., Kleipoedszus, S.,
Petrie, P., Wigfall, V. (2010) Implementing the
DCSF Pilot Programme: The work of the first
year: Social Pedagogy Briefing Paper II.
London. Thomas Coram research Unit.
Habermas J (1987) The theory of
communicative action, Volume 2. Boston.
Beacon Press.
Chamberlayne P, Bornat J & Apitzsch U (eds)
(2004) Biographical Methods and Professional
Hantrais, L. (2009) International comparative
research: theory, methods and practice.
Basingstoke. Palgrave-MacMillan.
6
Journal of Health and Social Care Improvement, VOL 2, 2011
Hetherington R., Cooper A., Smith P., Wilford
G., (1997) Protecting Children: Messages from
Europe. Lyme Regis. Russell House Publishing.
Sheppard M (1995) Social Work, Social
Science and Practice Wisdom British Journal of
Social Work 25(3) pp265-294.
Knust-Potter E (1998) Behinderung Enthinderung. Die Community Living Bewegung
gegen Ausgrenzung und Fremdbestimmung.
Köln. KNI Paperbacks.
Simpson, G. and Schoepf, M. (2006) Learning
by Comparing: Reflections on International
Student Seminars. International Social Work.
Vol 49(2).
Lawrence, S., K. Lyons, G.Simpson & N.
Huegler (Eds) (2009) Introducing International
Social Work. London. Learning Matters.
Simpson, G. and Connor, S. (2011) Social
Policy for Welfare Professionals: tools for
understanding, analysis and engagement.
Bristol. The Policy Press.
Lorenz, W. (2008) Paradigms and Politics:
Understanding Methods Paradigms in an
Historical Context: The Case of Social
Pedagogy. British Journal of Social Work
(2008) 38, 625–644
Smith, M. and Whyte, B. (2008) Social
education and social pedagogy: reclaiming a
Scottish tradition in social work. European
Journal of Social Work. 11 (1) 15-28
Stephens, P. (2009) The nature of social
pedagogy: an excursion in Norwegian territory.
Child and Family Social Work 14, 343–351
Mabbut and Bolderson (1998) Theories and
methods in Comparative Social Policy in Clasen
J (ed) Comparative Social Policy: Concepts,
Theories and Methods. Oxford. Blackwell.
Vlaskamp C & Poppes P (2004) The
Netherlands. Tizard Review, special edition,
January 2004 (1).
Walsh M., Stephens P., Moore S. eds (2000)
Social Policy and Welfare. Cheltenham. Stanley
Thornes.
Parton N. & O’Byrne P. (2000) Constructive
Social Work: Towards a New Practice.
Basingstoke. MacMillan.
Weiss, I., Gal, J., & Katan, J. (2006). Social policy f
social work- A teaching agenda. British Journal of
Social Work, 36, 789-806.
Pitts J (1994) What Can We Learn From
Europe? Social Work in Europe, 1(1) pp48-54.
Price, V. (2011) ‘I never thought things could
get worse for my son’ a carers perspective on
English policy for learning disabled adults'.
EASSW Conference, 10-13 April. Brussels.
Wieler J. (2000) Social pedagogical Family
Help in Germany: New Wine in Old Vessels
New vessels for Old Wine? In Canavan J.,
Dolan P. and Pinkerton J. eds Family Support:
Direction from Diversity. London. Jessica
Kingsley Press.
Pringle K. (1998) Children and Social Welfare in
Europe. Buckingham. Open University Press.
Wilson, V. (1996) People with disabilities, in
Munday B. & Ely P. eds Social Care in Europe.
London. Harvester Heatsheaf
Race D. (2007) Intellectual Disability: social
approaches. Maidenhead, McGraw-Hill Open
University Press.
Shardlow P (2003) Comparative Social Work –
A Useful Enterprise? A Forensic Social
Worker’s View. Social Work in Europe 10 (1)
20-25
7