Review

Into the big wide world

COMMUNITY CARE FOR HEALTH PROFESSIONALS
Ann Compton and Mary Ashwin
Butterworth Heinemann, 1992

Community care has many meanings these days and writers on the subject can easily lay themselves open to misinterpretation. This book is about physiotherapists moving from the hierarchical world of the hospital to the insecurities of working outside it, in peoples’ homes. It does a very good job as far as it goes. There will be few health professionals who will not learn something from this book or find their ideas clarified in some way or another.

The first half of the book covers the essential knowledge base. It is strong on gender and ethnicity, issues which are often neglected in textbooks for practitioners. The chapter on legal issues gives a full run down on how staff may cover their backs but it is very brief on legal aspects of helping users - for example, using the law in adult protection work. Tougher editing was required in the psychology chapter which, though wide ranging and clear, is very weak on the influence of religious beliefs and of other cultures.

As far as this reviewer is concerned the strength of the book lies in the chapters on ‘Working with Individuals’ and ‘The Helping Process’. The emphasis is on differential power relationships and on self knowledge. This adds up to a book for professionals working in the community rather than a book on community care.

Community care implies co-operation between agencies and professions. A full discussion of interprofessional relations, boundary setting and interagency competition is essential in any modern textbook on community care. Respect and understanding of other professionals is needed almost as much as respect for users.

The discussion of social policy draws the reader’s attention to the confusing nature of current community care policies but does not draw conclusions about the impact on practice. Policy messages from above are confusing and it is difficult to combine professional values with the role of front line rationer of health care, at the same time improving service quality. These aims can be reconciled some of the time but not all of the time. Confusion results and practitioners need to be clearly aware of ways in which policy may distort their professional practice.