Review

New caring for old

Changing services for older people: the neighbourhood support units innovation
Alan Walker and Lorna Warren
Open University Press, 1996, £14.99

New arrangements for the care of older people have encouraged new ways of working. Collaborative work between agencies has been essential, with more emphasis on the involvement and empowerment of users and carers.

This book describes the findings of a major research project evaluating the innovative Neighbourhood Support Units in Sheffield, which introduced a new approach to the care of disabled older people.

The project is placed in the context of changing social services in Europe, particularly looking at user involvement, and the pressures for change in social care provision. One interesting debate is on the difference between consumerism and empowerment.

Neighbourhood Support Units are described in detail with a history of the development of the philosophy of care and the implementation process. They were developed because of a preference for community rather than institutional care for older people, increasing recognition of the right of users to be involved in the determination of their needs and the provision of relevant services, and the growing interest in patch-based working.

The unit itself was a building containing communal facilities, which could service a wide range of community groups, not just frail or severely disabled older people. The unit ran three teams of support workers, replacing the wardens and home helps of a traditional service. Alongside them were a team of community health personnel, still employed and answerable to the NHS.

The book documents the work of social services organised in this new way, and examines the attitudes of older people and their carers towards the service. The role of the support worker — which broke the traditional boundaries of a social care worker — is also described in detail.

This community development approach to providing social care has many strengths and the book draws lessons from its successes and failures. The involvement and empowerment of users and carers was a key, and partially successful, aim. The difficulties of team work and work across inter-agency boundaries are described, problems which are well recognised as barriers to providing a ‘seamless’ service for older people.

The book will interest those working with older people and those involved in developing innovative services within tight financial constraints. The detailed evaluation of a single project has implications for other service models, and this account is worth reading both for its description and its analysis.