SOCIAL POLICY & ADMINISTRATION ISSN 0144-5596

VOL. 33, No. 3, SEPTEMBER 1999, PP. 262-280

Needs Assessment, Street-level Bureaucracy and theNew

Community Care
Kathryn Ellis, Ann Davis and Kirstein Rununery

Abstract
In the wake of the Seebohm reforms of the personal social services, a number of studies were carried
out in the igyos to explore the role of frontline professionals in identifying and meeting social need.
A common finding was that social workers behaved like "street-level bureaucrats", using their
discretionary authority defensively to manage an otherwise overwhelming workload. In the iggos,
top-down assessment and care management systems were put in place as part of community care
reforms. Their aim was to reduce the scope of professional discretion so as to standardize responses
to need and control demand according to resources available. In this paper, the authors consider the
success of new systems in controlling "bottom-up" decision-making by drawing on a recent
empirical study of needs assessment practice in three types of social work team. They point out that
the assessment practice of those teams facing the highest bombardment rates was most obviously
criteria-driven, reinforced by the use of new technology. Rather than creating informal stereotypes to
manage demand, social workers could mobilize legitimate forms of rationing to protect their time
and other resources. Yet the sense ofprofessional identity, the level of frontline autonomy, and the
ways in which this was exercised, varied across the different types of team. The authors conclude,
therefore, that the scope of discretionary space available to frontline staff in social services
departments, and the practices to which it gives rise, are empirical questions only adequately
addressed by methodologies able to connect with "bottom-up" decision-making.

Key^vords
Community care; Social work; "Street-level" bureaucracy; New public management

Introduction
Following the unification of social services departments in accordance with
the recommendations of the Seebohm Committee, a spate of studies were
conducted over the 1970s to investigate the impact on social work practice
(Blaxter 1976; Rees 1978; Satyamurti 1981; Smith 1980; Giller and Morris
1981). In the style of seminal studies by Mayer and Timms (1970) and Hall

Address for correspondence: Kathryn Ettis, Department o/Apptied Sociat Studies, University ofLuton,
Park Square, Luton, LUi 3JV

© Blackweti Pubtishers Ud. iggg, 108 Cowley Road, Oxford, OX4 iJF, UK and
350 Main Slml, Matden, MA 0214.8, USA.
(1974)1 researchers tended to adopt a phenomenological approach to explore
the behaviour of social workers in their new environment. Their findings
were broadly in line with Lipsky's (1980) central thesis that the discretion
enjoyed by "street-level bureaucrats" working at the interface of public
agency and client meant that social workers did not so much implement as
make policy.
Research interest in the informal decision-making of street-level bureau-
crats and its attendant methodologies waned over the 1980s. Commentators
have pointed to the correspondence between the top-down managerialist
rationality dominating welfare restructuring in the 1980s and 1990s and
prevailing agendas and methodologies underlying research into quasi-
markets (Cutler and Waine 1997), community care (Twigg 1997) and social
work (Everitt 1998). However, a study of needs assessments for community
care conducted at Birmingham University, suggested that observing front-
line practice was a fruitful means of exploring the nature and extent of user
involvement (Ellis 1993). A second study, designed to explore the processes
governing access to assessment two years after full implementation of the
1990 National Health Service and Community Care Act (NHSCCA),
similarly involved the researcher observing social work teams. This paper
draws on previously unpublished observational data to review the continuing
value of analysing policy implementation from the bottom up. We wish to
argue that the insights generated from this method of research allow for a
fuller analysis of the scope for authoritative policy-making in new community
care regimes; an analysis which, to date, has been largely missing from
research in this area.

Seebohm, Social Work and Street-level Bureaucracy

The Seebohm Report on Local Authority and Allied Personal Social Services
(Cmnd 3703, 1968) was firmly rooted in the Fabianist model of social
administration dominating the postwar period of political consensus on
social welfare. The underlying purpose of local authority welfare bureau-
cracies was to meet social need by distributing resources equitably and in
accordance with democratically determined objectives. This was made
technically feasible by a faith in the concept of "objective necessity" (Hill
and Bramley 1986: 58), and professional managers and frontline staff were
charged by politicians with identifying and measuring need in line with
objective indicators (Piercy-Smith 1996: 5).
Seebohm's aspirations to establish a universalized service found expression
in the recommendation that social services departments provide local
communities with a "single door on which to knock". Accordingly, the
Local Authority (Social Services) Act 1970 brought together the hitherto
fragmented functions of local health and welfare departments in new and
enlarged social services departments, better able to anticipate and respond to
the needs of local families and communities (Sanderson 1996; 12). Adminis-
trative rationality was reinforced by a new professional coherence. Generic
social work would dissolve the boundaries between professional and client

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group specialisms and offer a common response to individuals and families
approaching the single door.
Despite the legislative principle of universality, however, eligibility criteria
determining access to services remained highly selective. Moreover, the
reorganization of the personal social services coincided with implementation
of the 1970 Chronically Sick and Disabled Persons Act. In her study of the
organizational careers of a group of disabled people in a post-Seebohm
department, Blaxter (1976) points to the conflicting principles of normal-
ization and specialization underlying the push towards community care. The
more the scope of statutory services expanded, the more elaborate the system
of categorizing clients for eligibility became.
The principle of selectivity was further strengthened by the extent to which
the imperatives of rational administration were mediated by professionalism.
The Fabian principle of respect for the unique worth of the individual meant
treating people differently rather than equally, and the rationale for
professional discretion lay in the freedom to respond flexibly to the needs of
the individual client (Foster 1983). Social workers, in particular, were trained
to operate in a climate of ambiguity and uncertainty and to see need as
individualized (Blaxter 1976: 239). Whereas professional discretion involved
both power and choice—the power to make choices between different
courses of action or inaction (Young 1981: 33)—administrative categories
developed to demarcate eligibility for services were necessarily dichotomous
and prescriptive. This tension between administrative and professional
approaches to need therefore lay at the heart of the newly reorganized
personal social services.
The Seebohm reforms have been described as the "high tide" of
professional legitimacy for social workers (Langan 1993). At the centre of
social work practice lay the assessment, and the relationship which the
professional was able to build with the individual client was the medium
through which need was discovered and an appropriate response developed.
In his study of social work practice in the new Seebohm departments, Rees
confidently stated that "no matter how much governments rearrange their
national systems of social-work services or agencies change their local
policies, at the end of the day much of social work boils down to an encounter
between a social worker and a client or clients" (1978: 3). In that encounter,
the emphasis was as much on process—a problem-solving process of human
interaction—as outcome (Rees and Wallace 1982: 119).
Lipsky (1980), however, argued that street-level bureaucrats behaved
defensively in order to cope with the pressures of high levels of demand
coupled with the chronic shortfall in resources. Studies of social work
practice in the new Seebohm departments similarly suggest that professional
discretion was used largely protectively rather than to advance professional
ideals or respond flexibly to people's individual needs. Rising demand for the
personal social services following unification was identified as a key reason
for the development of what Satyamurti (1981) calls a "siege perspective".
Despite some increase in expenditure in the early 1970s, demand far
outstripped supply. The "single door" policy encouraged, indeed required,
much rationing to take place at the lower levels of the organization. Social

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workers were left to defend themselves against what they perceived to be
intolerable pressures by, for example, "choosing" clients from amongst those
bombarding the newly unified social services departments (Foster 1983: 78).
Both Rees (1978) and Satyamurti (1981) found that social workers attempted
to order the demands of the work according to their own priorities.
Threatened by cases which were demanding and time-consuming, they
would assess the risk of becoming involved in work primarily in terms of the
costs and benefits to themselves.
The failure of administrative reorganization to reconcile the contradictory
objectives of universalism and genericism on the one hand, and selectivity
and specialization on the other, left many unresolved tensions for frondine
staff in the new departments to manage. Lipsky points to the difficulty in
securing top-down control in street-level bureaucracies where ill-defined and
ambiguous policy objectives mean that neither operational guidelines nor
performance measures can readily be prescribed. In any case, the legitimacy
attaching to professional status justified relatively weak forms of bureaucratic
accountability and control, particularly in respect of qualitative aspects of the
work of "semi-professionals", such as teachers and social workers, in whom
Lipsky and his associates were particularly interested—a legitimacy strength-
ened by their ascribed role of advocate for the client of the public services
(1980: 159). Satyamurti (1981) found in her study that professional freedom
was heightened by an absence of clear guidance about priorities, standards of
work or an authoritative professional perspective. Combined with low levels
of managerial scrutiny, this led to "role-making" on the part of social
workers, exercised largely in terms of shedding or underperforming work
they found disagreeable (1981: 181).
Lipsky suggests that the behaviour of street-level bureaucrats is guided
primarily by the need to make their work more predictable and hence
controllable (1980: 86). As a result, contrary to the ideals of flexibility and
individualization legitimating professional discretion, street-level bureau-
crats adopt simplifying assumptions to categorize clients and respond in
stereotyped ways to their situations. This squares with the finding by Rees
(1978) that social workers were guided not by professional principles and
methodologies in their everyday work but by "practice-based ideologies".
These were sets of ideas about categories of cases and the means of dealing
with them which social workers used to typify people's problems and
routinize their responses (1978: 139-40). This not only enabled them to
make sense of their jobs but also to manage the hazard of large caseloads with
too little time and other resources to deal with them (Rees 1978).
Lipsky argued that "the decisions of street-level bureaucrats, the routines
they establish, and the devices they invent to cope with uncertainties and
work pressures, effectively become the public policies they carry out" (1980:
xii). So long as frontline discretion remained the sirte qua non of public services
(1980: xv), the street-level bureaucrat was a policy-maker fulfilling the
political role of determining "the allocation of particular goods and services
in the society" (1980: 84).
Unlike authors of other studies of social work in post-Seebohm depart-
ments, however. Smith (1980) points to the powerful influence of
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administrative rationality on professional practice. Although he too found
that the exigencies of frontline practice meant social workers were inspired
less by professional than pragmatic considerations, far from suggesting that
they subverted administrative rules, categories and procedures. Smith
argued that these played an integral role in standardizing social workers'
identification of and responses to "need". During intake, he found that duty
social workers would select information about clients and their situations to
fit administrative classifications of need. He concluded that it was not
possible for social workers to separate the concept of need from the
organizational methods used to measure the phenomenon.
The explanation for this discrepancy probably lies in the differing stages in
people's organizational career on which studies of social work undertaken in
post-Seebohm departments focused. Smith studied intake and allocation
procedures which, he argued, were "a distincdy corporate affair" (1980: 122).
Lewis and Glennerster similarly point out that the bombardment of referrals
following the setting up of social services departments led to experiments in
controlling the workload through intake teams, team managers who
monitored the fiow of work and group allocation meetings (1996: 71-2).
Other studies of the Seebohm reforms tended to focus on social work practice
following allocation when, as Smith argues, a professional social worker
remained highly autonomous (1980: 122). Even that autonomy came to be
challenged by the importation into social work training of corporate
management techniques, such as task-centred social work, contract social
work, systems theory and integrated methods (Dominelli 1996: 156), although
Satyamurti suggests that new managerial styles were more rhetoric than
reality and had litde impact on frontline practice (1981: 32). The radical
restructuring of social work by the introduction of "competencies" into
professional training and systems of assessment and care management under
the 1990 N H S and Community Care Act (NHSCCA) represented a
systematic effort to bring practice beyond allocation more fully under
managerial scrutiny and control.

Deprofessionalization and the New Community Care

Although the implementation of community care reforms was presented in
official guidance as a series of logical steps leading to a prescribed set of
outcomes, the White Paper, Caring for People (DH 1989), incorporated a
fundamentally contradictory set of objectives. Local authorities were
required to develop needs-led services, offer greater choice and consumer
accountability, provide practical support for carers yet target resources only
on the most needy. Ambiguous policy expectations combined with another
key condition of street-level bureaucracy, a chronic shortfall in resources
compared with demand for support. As Baldock (1994) points out, "need"
has always vastly outstripped supply in respect of the personal social services,
and demand for community care over the 1980s and 1990s increased as a
result of raised expectations, a reduction in NHS facilities and an increase in
the number of older people (Hadley and Clough 1996: 195). Policy guidance

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accompanying the NHSCCA warned local authorities that their responsi-
bility for meeting need would:

sometimes involve difficult decisions where it will be necessary to strike a

balance between meeting the needs identified within available resources
and meeting the care preferences of the individual. (DH 1990: para.
3-25)

Central government had demonstrated its determination to play an unpre-

cedented part in shaping the course of those "difficult decisions". From the
appointment of Sir Roy Griffiths by Margaret Thatcher to the welter of
detailed guidance accompanying implementation, the Conservative govern-
ment adopted a determinedly top-down approach to community care
reforms (Lewis and Glennerster 1996). Local authorities were presented
with a highly rationalistic policy and operational blueprint which ignored the
contradictions inherent in new arrangements, and were left in little doubt
about which policy objectives were to be privileged. Moreover, their
compliance with core objectives was to be monitored centrally through
scrutiny of annual community care plans and through the activities of the
Audit Commission, Social Services Inspectorate and Regional Health
Authorities.
Top-down policy-making depended ultimately on diffusing discredited
forms of political, administrative and professional power concentrated in
local welfare bureaucracies (Newman and Clarke 1994: 23). Fiscal discipline
helped ensure local authority adherence to the primary objective of the
N H S C C A identified by Lewis and Glennerster (1996) as bringing social
security spending on nursing and residential care under control. Thus the
funding for social care transferred from the social security budget under the
Special Transitional Grant (STG) was cash-limited and linked to the key
secondary objective of promoting market forms of care. Transformed into
purchasers rather than providers of care, local authority social services
departments were obliged to spend 85 per cent of the STG in the private and
voluntary sectors. Stripping social services departments of their provider
function served to disperse the administrative power locked into the
Seebohm bureaucracies by reducing their role to that of specifying and
awarding contracts (Clarke and Stewart 1990: 5). In retaining overall
budgetary and strategic command, it was effectively central government
which remained the key principal in contracting arrangements.
Private sector orthodoxy permeated official prescriptions on the way in
which the internal markets of community care should be managed. Greater
productivity and value for money depended on dismantling the discredited
"bureau-professional" control systems of the Seebohm era (Newman and
Clarke 1994). Managerial discretion over the planning, resourcing and
monitoring of service delivery was increased whilst the scope of professional
discretion was simultaneously delimited. A raft of disciplinary measures,
such as performance indicators, cost centres, customer surveys, staff
appraisal systems and performance-related pay, were imposed to ensure
attitudinal and behavioural compliance amongst frondine staff (Newman
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and Clarke 1994: 20). Top-down budgetary control would be secured
through the widespread use of new technology as computerized management
and financial information systems replaced the cumbersome bureaucratic
mechanisms of the old "command and control" Seebohm bureaucracies
(Lawson 1993; Dominelli and Hoogvelt 1996: 52).
The introduction of devolved budgeting and care management offered
considerable scope for bringing professional discretion under managerial
control. Locating purchasing decisions as close to the consumer as possible
was represented in official guidance as central to the development of flexible,
consumer-oriented provision. More importantly, though, devolved budget-
ing controlled through new technology provided the means of turning
spenders into managers (Gray and Jenkins 1993: 12). Care management
formed part of the purchasing function and, even where budgets were not
fully devolved, care managers had to provide information for purchasers and
often had to authorize expenditure (Lewis and Glennerster 1996: 141).
The fragmentation and routinization of complex professional tasks in new
assessment and care management systems, further privileged managerial
over professional values and objectives (Dominelli and Hoogvelt 1996).
Social work theory suggested that the discovery of need and the development
of an appropriate response were inseparable aspects of a continuous and
interactive process of relationship-building, particularly in respect of long-
term work. Yet the purchaser/provider split underlying assessment and care
management systems separated the assessment of need from the provision of
services. In their concentrated role as assessors in new systems, social workers
were less able to engage in long-term work with clients (Hadley and Clough
1996; Lewis and Glennerster 1996). Given that, for social workers, " 'needs
talk' and 'services talk' cannot be rigidly separated" (Cheetham 1993: 167),
this amounted to a fundamental assault on professional identity.
The NHSCCA is a predominandy administrative rather than profes-
sional model of community care (Hughes 1995). Moreover, as Cheetham
points out, the determined reference to an all-embracing "practitioner" in
official guidance on community care represents a denial of the distinctive role
of social work (1993: 157). The introduction of "competencies" into social
work training had already enabled the government to define the core skills
required by social workers to undertake the work employers wanted them to
do (Dominelli 1996: 155). The skills and tasks of the practitioner in new
systems of assessment and care management were defined as largely
technical. The assessment task no longer centred on the professional/client
relationship, but consisted in gathering information in a prescribed format as
the basis for assembling packages of care in line with a fixed budget and
menu of available services (Hughes 1995: 142; Lewis and Glennerster 1996;
139-40). In this way, Aldridge (1996) suggests that professional claims to
knowledge have passed from being privileged a priori to being judged
pragmatically in terms of the demonstrable effectiveness of their outcomes. A
new emphasis on organizing practical services rather than providing
therapeutic support—the distinction made by Adler and Asquith between a
service which attempts to provide things for people and one which attempts
to do things to them (1981: 14)—has been taken as further evidence of a shift

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from a professional to an administrative mode of service delivery (Lawson
1993; Hughes 1995).

New Assessment and Care Management Systems

As Hugman, amongst others, has pointed out, such industrialized models of
professional practice have emerged across contrasting welfare states and can
be linked, in turn, to the development of a globalized economy (Hugman
1998). Yet, in Britain in the 1990s (as in the 1970s) administrative restructur-
ing was heralded as the means of making social services departments more
responsive to local need. By separating the function of commissioning
services from that of assessing need—at both population and individual
levels—the N H S C C A promised to transform a service-led into a needs-led
approach to service provision. Yet identifying need outside the parameters of
available services risked generating uncontrollable demand. At the legislative
level at least, there had been an open-ended commitment on the part of the
Seebohm departments to meet the needs of local families, individuals and
communities. In reality, a chronic shortfall of resources had made rationing
inevitable. Nevertheless, the mediation of administrative categorizations of
need by professionals devolved difficult decisions to frontline staff and
avoided the necessity of making explicit unpopular allocative principles
(Foster 1983). New systems of assessment and care management, however,
required tight gatekeeping at the point of access. The potentially risky
ambiguity inherent in the concept of need had to be eliminated at the outset
if the primary objective of cost-efficiency was to be accomplished.
Despite the rhetoric of needs-based assessments, the concept of need was
indistinguishable from criteria defining eligibility for services. Local autho-
rities were instructed to make public their definition of eligible need which,
the Audit Commission counselled, should be based on priorities (1992: 31).
Pilot case management systems developed in Kent suggested that social
services departments' priorities were to identify those people whose vulner-
ability put them at risk of entering institutional care but who could continue
to be supported in a less dependent setting with home-based services (Challis
1992). Effective targeting depended on controlling access to care manage-
ment in a way which maintained budgetary discipline whilst ensuring the
most vulnerable received substantial services. Local authorities were encour-
aged to set their criteria in such a way as to "allow through just enough
people with needs to exactly use up their budget (or be prepared to adjust
their budget)" (Audit Commission 1993, para. 15).
Assessment itself was a resource to be rationed. The White Paper
presented the preliminary stages of assessment both as the point at which
the identification of need began, and as an "initial screening" to determine
whether a formal assessment was required and, if so, in what form.
Subsequent guidance from the SSI (1991) outlined six possible types and
levels of assessment, although these were reduced by most local authorities
during implementation to just three (Lewis and Glennerster 1996). Social
services departments were encouraged to adopt procedures which allowed a
determination of the most appropriate type and level of assessment to be

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made before need was assessed. Yet, so long as the identification of need and
the screening for eligibility were governed by a common set of prioritization
criteria, the two were not in practice separable.
It was clear from operational guidance issued by the local authority social
services departments included in our study, that a decision about eligibility
for assessment was effectively a decision about ehgibility for services. At the
screening stage, for example, staff were advised that a "straightforward"
need should receive a straightforward assessment (probably consisting in a
telephone call offering advice or information). Individuals identified as
having only a limited need for a service of a practical nature should receive
a "direct" assessment, that is, an assessment for a particular service such as
home care. Access to a comprehensive assessment was governed less by the
inherent complexity of presenting need than by the extent to which an
individual seemed likely to require a range of services. As elsewhere, new
arrangements were consistent with the overarching objective of keeping a
check on the number of comprehensive assessments in relation to financial
resources (Lewis and Glennerster 1996: 148).
Nevertheless, top-down control depended on the compliance of frondine
staff in new arrangements. The introduction of competencies already
provided the basis for quantifying, measuring and controlling the work of
professional social workers (Dominelli and Hoogvelt 1996: 56). Departmental
directives on eligible need and the proliferation of proformas in new
assessment and care management systems, offered further opportunities for
standardizing practice (Hugman 1994; Newman and Clarke 1994: 20). The
work of the practitioner was also closely monitored. Lipsky recognized that,
in part, the discretionary space afforded to street-level bureaucrats was
created by the extent to which much professional work took place beyond
managerial scrutiny, leaving managers very largely reliant on frontline
workers to provide information on their own performance (1980: 163).
Bureaucratic accountability could therefore only be achieved by clarifying
expectations, finding ways to measure and compare workers' performances,
and introducing incentives and sanctions more powerful than those gener-
ated in informal practice (1980: 160-1).
New technology offered the means of disciplining the practitioner to an
extent unimagined by observers of street-level bureaucracy. Practitioners'
entries to computerized client information systems made their actions far
more visible to managerial scrutiny than ever before (Lewis and Glennerster
1996; Newman and Clarke 1994: 20). New technology not only offered
managers "invisible monitoring systems" (Newman and Clarke 1994: 20),
but played a key role in targeting resources according to managerial
objectives. Lipsky wrote that

[t]he essence of street-level bureaucracies is that they require people to

make decisions about other people. Street-level bureaucrats have
discretion because the nature of service provision calls for human
judgement that cannot be programmed and for which machines cannot
substitute. (1980: 161)
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Such "bottom-up" decision-making was too risky in new community care
arrangements. Professional judgement, moreover, was delegitimized by the
subordination of need to budgetary priorities. SSI guidance to practitioners
made it clear that

[t]he professional argument that a more comprehensive assessment may

be justified on the grounds that it may uncover other needs loses weight
in the context of departments struggling to meet even presenting needs.
It is further diminished by the new emphasis on trusting in the
judgement of users and carers about their own needs. (DH 1991: 45)

In practice, of course, the latter justification is considerably weakened by the

extent to which users' and carers' judgements would also be measured
against eligibility criteria. However, frondine staff could not be left to
manage the problematic tension between emphasizing needs-led assessments
and the promotion of choice on the one hand, and testing eligibility and
restricting access on the other. Client information systems offered the means
of scrutinizing, shaping and monitoring frondine activity so as to privilege
top-down definitions of need in terms of eligibility criteria.
In exploring the use of computers in the Australian social security system,
Henman (1997) suggests that their capacity to store and process the high
levels of client information required to determine eligibility has made greater
selectivity possible. In the case of new arrangements for community care in
the UK, the computerization of assessment and care management systems
similarly ensured that the progress of would-be service users can be
automatically checked at a set of logically-ordered "gates", allowing through
to comprehensive assessment only so many as can be accommodated within
budgetary limits. Naming them "client resource management systems" (the
system used by one of our study authorities) signals their primary purpose.
Yet Henman argues that new technology has not simply served political
objectives but has also helped shape the directive of policy implementation
('997- 336-7)- From a Weberian perspective, he suggests, computers are the
ideal bureaucrats: executing their orders exactly, efficiently and objectively,
giving full attention to the job, and having no personal interests in the
organization (Weber 1968 cited in Henman 1997: 333). Because new
technology is unable to cope with ambiguity, arguably the scope for
discretionary judgement on the part of frontline professionals is correspond-
ingly delimited, particularly at the initial stages. The extent to which social
workers have arguably been brought under managerial control in new
arrangements is discussed next.

Bringing Street-level Bureaucracy under Control: Frontline

Practice and the NHSCCA
The study on which this paper is based was conducted between 1995 and
1996 in two local authorities; one a metropolitan city council, the other a
large county council. From each authority we selected three social work
teams involved in assessment under the N H S C C A . Research into assess-
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ment practice was carried out in two main ways—through observation of
social workers' assessment practice, and through interviews with disabled
people and carers who had experienced assessment. The findings of the latter
are reported in full in Davis et al. (1997).
The paper draws direcdy on the researcher's notes which were written up
after each day of observation. The researcher spent periods of time in each
team observing assessment practice across the range of settings. At the end of
each observation period the teams were offered feedback sessions to check
the validity of the data gathered, and results were written up as part of the
research data. In addition, contact was made with key informants in both
local authorities, and policy and practice documentation relating to assess-
ment from each team was analysed.
Five community-based social work teams and one hospital team were
included in our study. The community-based teams included one responsible
for older people and one for older and younger disabled people (the generic
teams); the other three were specialist teams for people with physical and
sensory impairments.
Across all six teams social workers appeared to wrestle with the feeling that
the introduction of the new assessment procedures represented an attack on
their professional identities. A shared sense emerged in the observational
data that "good social work" encompassed activities such as acting as an
advocate, promoting self-determination, building relationships, exploring
need qualitatively and developing responses which took account of the
particular circumstances of individuals and households. Social workers
struggled to pursue such activities given the expectations and priorities of
the new assessment procedures. Their success in reconciling professional
aspirations with organizational exigencies depended in no small part on the
position of the team within new assessment and care management systems.
The generic teams acted as "gatekeeper" to other parts of the assessment
and care management systems, including the specialist teams. The hospital
team similarly acted as a filter both for the long-term hospital team and for
other teams within the authority. Screening was consequently a significant
element in the overall workload of the generic and hospital teams. In
contrast, the specialist teams tended to offer an assessment to anyone
requesting one. They also took direct referrals, and the proportion of self-
referrals to the specialist teams, frequently from long-term service users, was
much higher than to the other teams.
On the generic teams, enquiries were first scrutinized by a receptionist to
make sure they were "appropriate" referrals, the object being to screen out
as many as possible at this stage. The hospital team lacked a receptionist at
the time of the study but only hospital staff could make referrals, and they
were clearly expected only to refer patients whose needs could be accom-
modated within departmental prioritization criteria. Once a referral had
been accepted by the generic and hospital teams, a further screening was
carried out by a duty social worker. This "initial assessment" was the point at
which the process of needs assessment officially began. Staff saw their
primary task as determining whether a further assessment was required
and, if so, its type, level and relative priority according to departmental
272 © Blackwelt Publishers Ltd. iggg
needs/risk matrices. Hospital social workers carried out a particularly
intensive screening at this stage. Faced with the additional pressure of
avoiding "bed blocking", they tended to determine the relative priority of
referrals in terms as much of date of discharge as of departmental eligibility
criteria.
To the extent that many subsequent decisions were based on written
records rather than face-to-face interaction. Smith saw the reduction of
clients' needs to documentary form during intake and allocation as part of
the process of reconciling administrative and professional definitions of need
(1980: 128—30). Similarly it was not unusual for the initial stages of assessment
on some of the teams included in our study to be carried out wholly or
partially without the participation, or even the knowledge, of the person
being "assessed". On the generic teams, social workers would frequently
form a judgement about the type and level of any services required, whether
to assess and, if so, the appropriate type and level of assessment, on the basis
of scrutinizing the paperwork. It was only if the type and level of assessment
could not be determined by scrutiny of referral information or follow-up
phone calls that the third tier of screening came into play—the "screening"
or "duty" visit.
Screening was not regarded as particularly rewarding or "real" social
work. Formal prioritization criteria undermined the professional imperative
to probe beneath the presenting problem and were criticized as fostering a
service-led approach to assessment, unresponsive to the fiuidity of human
situations. Whilst social workers on the generic teams frequently hinted at a
degree of autonomy to negotiate official criteria when determining access to
assessment, observation of practice actually suggests a high level of con-
formity. Referral information was routinely tested against eligibility criteria,
and presenting need tended to be seen in terms of the predicted type and
level of services provided or funded by the department rather than any
professionally-derived construction of need.
The commonly expressed view of the generic team was that only face-to-
face initial assessments could overcome the dangers of stereotyping referrals.
Occasionally, when issues such as family dynamics or grief seemed to call for
the specialist skills of a social worker, a referral would prompt an assessment
visit even if the situation did not appear to match prioritization criteria. More
usually, "low-level" assessments would be passed directly on to home care
teams, who expected to refer back any clients requiring more specialist
investigation. Social workers believed this prevented them from having to
"rush around doing visits unnecessarily" and ensured that "proper"—that
is, comprehensive—assessments were targeted on people whose needs went
beyond personal care into the more complex territory of "social care" which
their professional training equipped them to tackle. Yet the team acknowl-
edged that the notion of a social worker embarking on a comprehensive
assessment in order to uncover need was something of a myth as the only
time a very detailed assessment was carried out was if a case was to be
referred to another team.
Social workers on the hospital team were openly sceptical about the
possibility of distinguishing in advance between differing types and levels of

© Blackwell Publishers Ltd. iggg 273

assessment in the manner prescribed by operational manuals. A judgement
could only be made retrospectively. In other words, if an assessment resulted
in a full package of care then it must have been comprehensive. Managerial
distinctions between "initial", "direct", or "comprehensive" assessments
were esoteric irrelevancies in the context of this team's daily practice
experience. Lacking the facility to pass referrals on to the home care team,
and operating under the ever-present threat of "bed-blocking", the team was
obliged to conduct a high level of assessment visits on the ward.
The specialist teams similarly appeared to enjoy a degree of freedom in
negotiating administrative categorizations of priority and need. On one of
the teams, social workers were supported by their manager in assuming that
need should be assessed from the point of referral, even though the
procedures manual suggested that this stage should primarily consist of
testing eligibility. Social workers on these teams could act on their prpfes-
sional instincts and allocate referrals for a comprehensive assessment even if
the only evidence was a "gut feeling" that this was appropriate. On teams
where the rationing imperative operated strongly at the point of referral,
discretionary judgements were as likely to be exclusionary as inclusionary.
On the generic teams, for example, eligibility criteria around risk and
dependency could become entwined with moral judgements of deservingness
in cases where people seemed to show evidence of an elective "dependency"
(Davis et al. 1997).
Social workers across the three types of team both viewed greater formaliza-
tion as a threat to good practice and identified with its objecdves. The value of
being able to identify the stage of assessment and care management reached, to
make frontline actions more explicit and to clarify accountability, was acknow-
ledged, yet the categorical allocation of cases to a designated worker and team
once an initial contact had been recorded on computerized systems was also
seen to undermine collaborative working. Certainly there was a marked
reluctance by some to deal with enquiries from users "open" to another
member of the team. Others regretted the extent to which new duty systems
discouraged any member of a team other than the duty social worker from
handling enquiries, even if a user was known to a particular worker.
Moreover the programming of assessment and care management as a
linear sequence of "discrete" events on computerized systems was experi-
enced as an assault on professional identity. The professional con-
ceptualization was a loop with no necessary end stage—a continuous process
of new assessments and new care plans. Administrative systems were
problematically predicated on the assumption of an end goal of stable care
management, described by one social worker as "an unattainable myth". In
the light of Smith's findings on the disciplinary role of written records some
twenty years earlier, it is interesting to note that manual systems were
regarded nostalgically by some workers as connecting more closely to
people's needs. From this perspective, manual systems would more readily
allow assessment and care management to be managed as a continuous
narrative which unfolded according to its own logic and to which several
workers could contribute. Moreover, it would be easier to add data such as
relevant details about a carer to existing files, satisfying the social worker's
274 © Blackwett Pubtishers Ltd. iggg
traditional concern to locate the individual in the context of wider family
dynamics.
New systems were also criticized for adding to the workload of frondine
practitioners. No new details could be added to a computerized file before a
case was allocated, nor could details of any additional services be simply
added to the existing file—a fresh referral had to be made. Other studies
have pointed to the considerable increase in paperwork and administration
to which the purchaser-provider split had given rise, particularly in respect
of financial assessments, as well as the extent to which this is both resented
and resisted by qualified workers (Hadley and Clough 1996; Lewis and
Glennerster 1996). As Satyamurti found in the wake of the Seebohm
reorganization, administration work or routine task-based work, including
paperwork, was not seen as "real" social work (1981: 39, 190). Social workers
on the specialist teams, in particular, complained that the amount of time
spent form-filling or inputting details into client information systems limited
the time available for the real work of carrying out assessments. On the hard-
pressed generic teams, it seems likely that social workers' resistance to
carrying out comprehensive assessments was only reinforced by the amount
of paperwork involved.
Yet a sense of professional identity still survived on the front line. The
shared conviction amongst hospital team members was that their assessments
were needs-led, comparing favourably with the service-led approach of
formal procedures or home-care organizers. Observation of practice sug-
gested that most ward visits centred on personal care. When other needs
were articulated by patients, they tended either to go unacknowledged or to
be converted into the need for home care or other services provided or
funded by the department, yet social workers were resistant to the idea that
ward assessments merely constituted a further test of eligibility. This
apparent paradox might be explained by the extent to which meeting
patients' "needs" was defined in terms of providing the appropriate level and
type of service to avoid bed-blocking and enable patients to be discharged
safely and expeditiously.
Hospital social workers also saw themselves as fulfilling a traditional
advocacy role. Constant vigilance was required to counter the tendency of
hospital staff on the one hand to overestimate the level of assessment or
services required, undermining self-determination, and on the other to tackle
bed-blocking by discharging patients—or pressuring relatives into taking
family members home—without the appropriate clinical or social assess-
ments having been carried out. In the opinion of the team leader, the job of
hospital social workers was to "empower the citizens" of the authority who
happened to be in hospital. Despite its apparently narrow scope, the hospital
team clearly found the efficient performance of their role a source of
considerable professional pride.
With greater time and other resources at their disposal, social workers on
the specialist teams also had greater autonomy. They were freer to enter into
an open-ended discussion about needs and resources on assessment visits
rather than attempting to shape need to services available. This tendency to
engage in more elaborate assessments is in line with the findings of other
© Btackwett Pubtishers Ltd. iggg 275
comparative studies of generic and specialist teams; social workers on one of
the specialist teams in our study routinely recorded unmet need as part of a
systematic attempt to draw attention to perceived gaps in services, such as the
child-care needs of parents of younger children. Whereas other studies have
found that practitioners see little point in spending time providing informa-
tion which is unlikely to be made use of in a climate of budgetary restraint
(Hadley and Clough 1996: 186; Lewis and Glennerster 1996: 162), recording
unmet need fitted with the perceived role of the specialist team as advocates
for the client group, committed to enabling disabled people to live ordinary
lives in the community.
Moreover, as Rees and Wallace discovered in an earlier study, accepting
agency regulations and procedures as the standard enables social workers to
feel they are operating competently and efficiently (1982: 127). Thus some
social workers in our study found conformity with new procedures a source
of job satisfaction in and of itself. More pragmatically, there was a frequendy
expressed concern about not "clogging up the system": the imperative for
street-level bureaucrats under bombardment is the efficient processing of
work to maintain its fiow. That computerized client information systems in
particular were designed to collect a minimal amount of information in a
standardized format articulated with the frontline practitioners' objective of
maintaining a rapid throughput of work.

Conclusion
In some limited respects, community care reforms recreate the conditions
under which street-level bureaucracy flourished in social services depart-
ments in the 1970s and 1980s, when frontline staff had ultimate responsibility
for managing infiated and confiictual policy objectives with inadequate levels
of resources relative to demand, yet were subject to low managerial scrutiny.
However, whereas the play of local democracy and professional expertise
tempered the centrists' rationalism of Fabian administration, control over
strategy and rationing was more determinedly top-down in new community
care regimes. Restructured assessment and care management systems are
designed to ensure that decisions about need and eligibility are made in
accordance with formal prioritization criteria rather than professional
judgement. The ambiguities of frontline decision-making on which profes-
sional claims to autonomy had traditionally rested were to be squeezed out,
particularly by the application of new technology.
Given their concentrated involvement in the initial stages of assessment
and care management, it is unsurprising that assessments undertaken by the
generic teams in our study were criteria-driven in the manner anticipated by
official guidance. The managerialization of their assessment practice
appeared to be reinforced by new technology. Social workers' actions were
shaped by the completion of a series of computer screens based on formal
priorities during the initial stages of assessment. On the hospital team, where
screening also constituted a significant proportion of the overall workload,
this was more usually accomplished off-line rather than through simulta-
neous contact with referral agents. Moreover, social workers and team

276 © Btackwetl Publishers Ltd. iggg

leaders alike were openly sceptical about the relevance of departmental
prioritization criteria to the exigencies of practice in a hospital setting.
Although assessments by both the hospital team and the generic team in the
same authority were theoretically governed by the same operational guide-
lines, in practice social workers in the former were actually guided by the
immediate pressures of ensuring a rapid throughput of patients.
Contrary to the rationalizing thrust of both central and local authority
guidance, then, no common approach to the task of determining access to
assessment existed amongst the teams included in the study. Interestingly,
central government guidance to managers on instituting new arrangements
ignores the issue of user group specialization (Fuller and TuUe-Winton 1996:
280). The specialist teams in our study were not only protected from the
bombardment rates affecting the generic and hospital teams, but had greater
access to resources outside the narrow range of departmentally funded
services. They were therefore in a stronger position to acknowledge the legal
entidement of disabled people to access a comprehensive assessment,
reinforced by a greater awareness of, and commitment to, disability rights
(Davis et al. 1997). Departmental prioritization criteria therefore tended to be
used to decide the order in which people would be seen rather than to
determine eligibility.
Many social workers in our study believed new arrangements posed a
threat to professional autonomy and identity. Yet studies of social work
practice following implementation of the Seebohm reforms suggest that the
personalized response to need on which professional legitimacy has tradi-
tionally traded is something of a myth. In much the manner observed on the
generic teams. Smith found that social workers' typifications of "need" at the
intake and allocation stage were largely based on administrative categoriza-
tions. Although professional practice beyond allocation was less amenable to
managerial prescription, responses to need were no less stereotypical as social
workers struggled to manage unmeetable demands with limited time and
other resources. This throws open to challenge the current view amongst
social workers that the linear sequencing of assessment and care manage-
ment as a series of discrete tasks undermines professional constructions of
assessment as a continuous, collaborative and interactive process.
Studies of street-level bureaucracy suggest that frontline workers used their
discretionary power not to advance professional ideals but to manage
otherwise overwhelming demands. Given that the gearing mechanism of
new systems of assessment and care management is rationing, they actually
perform a similarly protective function as that formerly achieved informally.
Although social workers on the generic teams expressed concern about
deprofessionalization, observation of practice suggests they complied quite
willingly with formal procedures designed to ration their time and other
resources and to maintain an even fiow of work. Where informal judgements
continued to shape decision-making, these tended to reinforce rather than
challenge dominant rationing imperatives. At times, social workers on both
the generic and hospital teams explicitly identified with the managerial
objectives underlying new arrangements and apparently derived satisfaction
from operating efficiently and effectively within new systems. Where the
© Btackwetl Pubtishers Lid. iggg 277
smooth management of their overall workload was undermined by the sheer
weight of bureaucracy, then the evidence is that shortcuts would be taken to
maintain an even throughput of work.
Unsurprisingly, the sense of professional autonomy and identity was
strongest amongst the specialist teams where social workers were able to use
their higher levels of discretion to negotiate official priorities and engage in
more detailed assessment work. Yet although assessment practice on the
hospital team, as on the generic teams, conformed closely to departmental
prioritization criteria, social workers had developed a sense of professional-
ism based on local exigencies. So long as patients were discharged speedily
and safely, often at very short notice, they believed they were conducting
needs-based assessments and practising effectively as social workers. At the
same time, their sense of professional identity was bolstered where they were
able to protect the interest of an individual social services client against an
overbearing hospital management or member of staff.
These findings arguably reinforce the value of observation as a research
method. Our study was primarily concerned with exploring the impact of
new arrangements for accessing assessment on older and disabled people
(Davis et al. 1997). This, we believed, required direct observation of people's
encounters with frontline workers so as to understand the space available for
negotiating access. A scrutiny of official documentation or interviews with
senior managers, even frontline workers, would be unlikely to have revealed
the variety of methods used to test eligibility, the differing constructions of
professional identity developed since full implementation of the N H S C C A ,
or the varying extent to which, and the ways in which managerial agendas
have been incorporated into frontline practice in different types of teams.
Whether frontline "practitioners" make or implement policy, and the impact
of their activities on service users, are empirical questions requiring "bottom-
up" methodologies. They are not adequately addressed by top-down
evaluative studies using the same performance indicators to assess outcome
as those designed primarily to measure efficiency and effectiveness in policy
outputs.

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