1.4 Service users' views: What services?
When people are consulted about the services they have received they express strong views not only about access to services but also about what those services are. For example, the shift from a home help service to a personal care service has raised many concerns. The consultations for the book this course was based on and other research (see, for instance, Sinclair et al., 2000) both indicate that (unknown to managers) workers sometimes go beyond their allotted tasks in order to meet service user-defined needs. A regular, though informal, agreement between care workers and older people may develop. For example, a care plan that includes some form of personal care might in reality entail the care worker doing housework – because that is what is important to the service user. However, housework would not meet most eligibility criteria.
The manager's understanding of the priorities are not actually the priorities that the people want. That's where it varies: the manager thinks ‘Oh, that's what they want’, but it's not so. What they want – they might not want to be washed, they might want to have the windows done.
(Barry, service user consultations)
Service users are not usually arguing against professional expertise or discounting the problems of managing complex care systems. Rather, they are insisting that there has to be a much closer relationship between their own understanding of their needs and the social care response. For example, the families who had received services from Homestart – a service provided for families by volunteers – appreciated the difference between this kind of support and local authority social work services:
[Homestart] seems to be more understanding of situations when you tell them what's going on. They are a lot more sympathetic because a lot of them are a parent themselves.
The volunteer support is supportive to the family. When you ring up you know that your message is going to get through, whereas with social services and health you can't guarantee it.
Service users have specific insights into, and experience of, effective and quality responses from workers and service providers. The style and approach of workers – whether paid or unpaid – may make all the difference to a service user. For example, social workers who are supportive and sensitive and who listen are valued (Aldgate and Bradley, 1999). However, some people may feel reluctant to be critical of what little service they receive for fear that they will lose it altogether. As a result of their experience of the service setting and its delivery, users can play a central role in monitoring and evaluating the quality and effectiveness of services. That will include relationships with workers.