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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. 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