Working "between the idea and the reality" - ambiguities and tensions in care managers' work

Social work began, and has continued to exist, in a state of ambiguity and tension, experiencing the difficulties inherent in exercising both compassion and control, and mediating between the state and the individual. This article draws on recent research undertaken with care managers working with older people in two social services offices to argue that this uncertain and uncomfortable position has been exacerbated by changes since the inception of the NHS and Community Care Act 1990. Care managers are, for example, trying to reconcile spending more time on paperwork and computer work with having less time for making and working within relationships with people. While their work is becoming increasingly complex, many of the processes for dealing with it are becoming increasingly reductionist. The author argues that this increase in tension and ambiguity influences care managers' working conditions, thus contributing to increased stress levels and resultant staffing problems and affecting the quality of service given to older people. Some possibilities for optimism exist in re‐evaluating the importance of the core nature of the social work relationship and reconsidering links between training and practice.