Stories of stabilisation: creating, implementing and resisting the National Care Homes Contract in Scotland
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Date
01/07/2015Author
Stocks-Rankin, Catherine-Rose
Metadata
Abstract
In
Scotland,
as
in
many
other
welfare
states,
the
organisation
of
care
homes
for
older
people
takes
place
in
a
highly
contested
space
where
debates
about
demographics,
limited
financing
and
changing
expectations
of
the
state
compete
with
questions
about
choice,
rights,
equality
and
models
of
care.
These
services
intersect
the
formal
boundaries
of
the
public
and
private
sectors
as
well
as
the
lines
between
public
and
private
life.
The
production
of
care
home
services
crosses
several
policy
spheres,
including
local
governments,
the
devolved
Scottish
administration
and
the
UK
government
and
includes
numerous
organisational
bodies,
such
as
care
home
providers,
the
care
regulator
and
the
voluntary
sector.
At
the
centre
of
this
intersection
lies
the
work
of
contracting
and
the
production
of
a
national
framework
agreement
for
care
home
services
in
Scotland
called
the
National
Care
Homes
Contract
(NCHC).
This
contract
is
both
the
bridge
between
the
public
and
private
sector
and
a
formalised
link
between
the
individual
and
the
institution.
In
this
thesis,
I
depict
the
NCHC
document
as
an
artefact
which
links
these
spheres
and
the
work
of
contracting
as
the
practice
of
maintaining
that
relationship.
I
take
up
the
concept
of
boundary
objects
and
suggest
that
the
NCHC
functions
as
a
bridge
between
multiple
fields
of
practice
and
is
a
useful
tool
for
understanding
the
competing
perspectives
of
people
who
plan
and
deliver
care
home
services
in
Scotland.
In
this
thesis,
I
reveal
the
different,
and
at
times
competing,
perspectives
which
surround
care
home
services
for
older
people
and
the
stabilising
work
that
is
undertaken
to
manage
these
differences.
This
research
utilises
an
interpretive
approach
to
examine
the
creation
and
ongoing
implementation
of
the
NCHC.
Fieldwork
for
this
research
was
conducted
over
12
months
and
includes
interviews
with
local
authority
planners
and
contract
managers
as
well
as
care
home
owners
and
managers
from
the
independent
and
third
sector,
each
of
whom
do
particular
kinds
of
work
to
create,
implement
and
use
the
text.
A
textual
analysis
of
the
framework
agreement
is
also
used
to
support
this
research.
I
examine
the
work
of
making,
re-‐making
and
using
the
NCHC
at
three
levels:
national
policy
actors,
local
government
contract
managers,
and
managers
of
local
care
homes.
Each
group
undertakes
a
kind
of
policy
work:
first
to
create
the
NCHC,
then
to
implement
it
in
local
jurisdictions
and
finally
to
use
it
within
local
service
delivery.
Stabilising
work
takes
three
primary
forms:
text
work
designed
to
stabilise
meaning,
relational
work
designed
to
translate
meaning
across
boundaries
of
practice,
and
ethical
work,
a
value-‐
based
emotional
work
that
underpins
the
first
two
kinds
of
everyday
labour.
I
suggest
that
this
work
is
first
and
foremost
driven
by
a
need
to
stabilise
the
care
home
sector
and
that
it
is
deliberative
in
nature
and
conflict
ridden
such
that
the
use
of
the
contract
in
practice
is
often
resisted.
In
working
to
stabilise
this
system,
the
values
of
this
work
come
into
conflict
–
triggering
both
caring
and
resistance
responses
within
the
sector.
In
giving
an
account
of
stabilisation,
I
provide
a
micro-‐sociology
of
the
meaning
making,
relationship-‐building
and
conflict
which
underpins
policy
work.
I
draw
conclusions
from
this
about
the
discretion
of
policy
actors
at
all
levels
of
the
system,
the
rational-‐technical
and
emotional
nature
of
their
work,
and
the
unexpectedly
deliberative
policy
space
of
contracting
in
Scotland.