Sociology Mind
2011. Vol.1, No.2, 27-32
Copyright © 2011 SciRes. DOI:10.4236/sm.2011.12003
Towards a Sociology of Trust: Community Care
and Managing Diversity
Jason L. Powell
University of Central Lancashire, Lancashire, UK
Received January 21st, 2011; revised January 25th, 2011; accepted January 29th, 2011.
The paper is a critical review of the problems and implications of managing diversity in the British community
care system. It is a system in need of strong diversity management in the light of the world economic downturn
in recent years. Despite raft of policies on leadership in social care in the UK, the structural issues for why the
needs of diverse groups are not met are difficult to understand at particular levels of analysis. The central prob-
lem has been lack of “trust”.
Keywords: Community, Care, Trust, Sociology and Social Welfare
Community Care legislation has in the past decade received
scantily uncritical sociological acclaim. Community care policy
based on the triumvirate of “autonomy”, “empowerment” and
“choice” was endorsed by many commentators as the political
and philosophical panacea for alleviating the deep and destruc-
tive problems confronting the community care system in the
UK (Powell, 2009). This paper deconstructs the hagiography
surrounding community care policy. The broken relationship
between professionals and older people has been placated on
distrust. A close and cogent examination of the emergence of
community care policy in the UK raises serious questions about
its main intentions. Whose account was to count in the formu-
lation and implementation of community care policy was based
on a hierarchical vision of care truth in which the definition of
reality articulated by older people was secondary to reality
defined by “experts”/state servants such as policy advisors. In
other words, it is “expert” led with no understanding of diver-
sity and experiences of users.
This is not the place to explore the epistemological and on-
tological debates concerning definitions of reality that have
developed in social gerontology in recent years (Biggs & Pow-
ell, 2000). However, it is important to note that community care
policy fails to convey in any strong sense alternative definitions
of truth or different visions of care truth based on older peo-
ple’s subjective experiences (Biggs & Powell, 2000). Rather,
the agism of community care policy has perpetually directed its
gaze downwards towards older people thus reinforcing “an
overall impression that these are the people who need to be
researched, these are the ones who are out of step with ‘social
norms’ or who are causing the problems” (Smart, 1984, pp.
150-151). Conversely, community care policy rarely gazes
upwards to look at “the locally powerful” (Smart, 1984) who in
the case of older people would be care managers. The lack of
any critical analysis of the role and daily practices of care
managers constitutes a major weakness of the implementative
process of the policy process in the UK in terms of accountabil-
ity and sensitisation of diversity in managerial philosophy and
The confusion and conflict between different state servants
over the past 20 years provide clear illustrations of the fractured
dislocation within the state concerning community care policy
and muddled issues relating to managing diversity. However, it
also leads the space, whether imaginative or experiential, by
which care managers and older people interact. It is within that
space that an understanding of “trust” is the missing cement to
bind relationships based on managing diversity. “Trust” itself is
an essentially contested concept. Trust can extend to people
with a sense of shared identity (Gilson, 2003; Tulloch & Lup-
ton, 2003). Individuals produce trust through experience and
over time. It cannot be immediately and with purpose be pro-
duced by organizations or governments without dialogical in-
teraction with people on issues affecting their lifestyles and
life-chances such as care, pensions, employment and political
representation (Walker & Naeghele, 1999). Möllering (2001)
takes the relational theme further by distinguishing between
trust in contracts between individuals and the State in areas
such as pension provision; trust in friendships across intergen-
erational lines; trust in love and relationships, and trust in for-
eign issues associated with national identity. There is a multi-
plicity of ways that trust has been defined but the central para-
dox is how to creation of the conditions of building conditions
of trust across personal-organisational-structural tiers in an
increasingly uncertain world. The chapter explores community
care policy and navigates the ways trust relations can capture
stronger bonds and relationships between care managers and
user groups such as older people in the UK.
Community Care in the UK
Contextual Backdrop
Contemporary community care policy emerged due to three
significant factors during the dominance of the Conservative
administration in the UK from 1979 onwards and has seen a
resurgence in 2010 with more “financial reforms” in light of
world economic recession. Firstly, one of the central planks of
UK government policy throughout the 1980’s was the genesis
of marketisation into the public sector. Government reforms in
education and the health service, for example, constructed a
quasi-market with internal commissioning and provider roles to
stimulate the “buying” and “selling” of in-house services
(Means & Smith, 1997). Simultaneously, new legislation re-
quired local authorities to embark upon a phased programme,
determined by central government, through which many of its
services had to be subjected to compulsory competitive tender-
ing, with the strategy of decreasing the role of local authorities
and stimulating instead the private sector. The value which
underpins all of these policy initiatives is a belief that a com-
petitive market and a “mixed economy of welfare” will inevita-
bly provide better, cheaper services than a protected and bu-
reaucratised public sector (Means & Smith, 1997). This policy
essentially channelled public sector funds into the private insti-
tutional sector while leaving the domiciliary sector chronically
under-resourced and led to a “perverse incentive” that under-
mined the commitment to community-based care. Private resi-
dential homes flourished and in the absence of community ser-
vices, older people as “consumers” had little “choice” other
than the decision about which institution they might enter in the
“residential private sector plc”.
Community care has been used as a vehicle for the marketi-
sation of the public sector. Thus, a “contract culture” was to be
applied to the provision of personal social services and social
services departments would need to develop processes to spec-
ify, commission and monitor services delivered by other agen-
cies. The organisation of service delivery was to be instigated
through assessment and care management including devolved
budgets and decentralisation (Powell, 2010).
Care managers were seen as central in this process. Yet the
political issues for care managers to implement community care
policy has not focused at all on managing users groups with
leaderships sensitised to diversity. Worse, is that the trust proc-
ess has become in policy-practice-theory matrix so broken it
requires a novel way of theorizing trust to help bind profes-
sionals and users to each other to help leadership and commu-
nication flourish otherwise a fragmented community care sys-
tem will further fragment the broken relations between manag-
ers and users in the UK. Managing diversity requires diverse
understanding of different levels of trust.
Navigating Trust in Care Management with Users:
Individuals, Organisations, Community and Systems
The first key focus for theorising trust has been the interper-
sonal qualities of the individuals involved. Sztompka (1999)
challenges theorists who consider interpersonal forms of trust
as the primary form based on face-to-face encounters while
subordinating all other forms of trust, collectively referred to as
social trust. Rejecting any differentiation between interpersonal
trust and social forms of trust, he proposes that the ever-in-
creasing impersonal nature of relationships in systems is under-
pinned by our experiences of trust in face-to-face relations be-
tween care managers and users. This reliance on the interper-
sonal aspect of trust suffers from similar problems to Giddens
(1990) use of “ontological security”, a product of early child-
hood experiences, as a prerequisite for individuals being able to
form trusting relationships. This conservative element leaves
those without positive childhood experiences stuck in a psy-
choanalytic mire with no potential for trusting, or by implica-
tion being trustworthy, while also failing to offer any means of
recovery. A number of theorists (Davies, 1999; Giddens, 1991;
Mechanic, 1998) note the expectations lay people have of ex-
perts or professionals while at the same time this interpersonal
level provides the human aspect or “facework” for more im-
personal forms of trust. Expectations of professionals include
the following: specific competencies, specialised areas of
knowledge and skills, disinterestedness and disclosure. Of par-
ticular importance are communication skills and the ability to
present complex information. Alongside, run role expectations
that demand experts act ethically and with integrity as true
agents of their clients, requiring them to put personal beliefs
and interests aside and acting to maximise benefit and to do no
harm. Creating specialized spaces reinforced by fiduciary
norms arising from: the custody and discretion over property,
the opportunity and possession of expertise and the access to
information; regulates the power/knowledge relationship be-
tween expertise and laypersons (Giddens, 1991; Shapiro, 1987).
The second level of trust is at community level. Evidence
exists of a positive correlation between levels of interpersonal
trust and levels of social capital (Putman, 1993; Rothstein,
2000), leading in part to calls for increasing the levels of civil-
ity and community responsibility in everyday life. However,
while theorists (Misztal, 1996; Putman, 1993; Taylor-Gooby,
1999, 2000; Sztompka, 1999; Rothstein, 2000; Dean, 2003)
support the idea of social norms and values overriding rational
models of human behaviour, they say little about how these
norms and values become established. Rothstein claims that the
link between interpersonal trust and social capital is weak, as
are propositions about the direction of community relationships
in managing diversity – care managers are bound up in this
process. Rejecting functionalist explanations linking norms to
the established configurations of power, he proposes a theory of
“collective memories” creating social norms in communities as
a strategic political process. The essential ingredient is the crea-
tion of conditions of community relationships built on common
values and aims of both care managers and users in communi-
The third key issue is on trust and organisational context.
Challenges to the “trustworthiness” in organisations, regardless
of whether they are public or third sector organisations, can
have profound effects on confidence in that system. Producing
increased demands for regulation, information and transparency;
that is, increasing the demands for distrust. Community care
organisations are central to this and need to facilitate trust so
that interactions with users are transparent and trust facilitated.
The fourth major area of concern for theorising trust has fo-
cussed on the declining trust in both state mediated social sys-
tems such health and social care and the professions embedded
therein (Davies, 1999; Phillipson, 1998; Welsh & Pringle,
2001). Conceived as impersonal or systems trust (Giddens,
1990, 1991; Luhmann, 1979) this form of trust is developed
and maintained by embedding expertise in systems that do not
require the personal knowledge of any individual by another.
Such systems employ a range of techniques of distrust i.e. audit
processes, target setting and third party inspections (Gilbert,
1998, 2005) which could alienate professionals and users.
Implications of Trust in Community Care
Part of the confusion concerning the different levels of trust
rests, according to Möllering (2001), with the failure to distin-
guish between the functional properties of trust and the founda-
tions of how trust is created in community care. The former are
the outcomes of trust i.e. expectations, concerning issues such
as: order, co-operation, reducing complexity and social capital.
While the latter concern the nature or bases of trust, which, due
to the assumption that they are rational, become lost and there-
fore not explored. Moreover, individuals make decisions on
partial knowledge, a mix of weak inductive knowledge and
faith regarding the consequences of an action. Möllering sug-
gests that in some circumstances relational aspects producing
either confidence or reciprocity might support decision-making.
However, this knowledge moves us close to confidence, which
according to Seligman’s (1997) is a different quality. Never-
theless, building on Möllering’s theory, Brownlie and Howson
(2005) argue that trust is relational and impossible to under-
stand in isolation. Trust occurs as individuals extract the known
factors while bracketing off or suspending the unknown factors
to avoid confusing decisions with uncertainty.
Gilson (2003) takes up this relational aspect of trust and
claims that relationship issues provide the main challenges for
community care practices and services. Making the link be-
tween systems and social capital, she compares UK and US
health care systems. Concluding that the general acceptance by
the UK population of the altruistic element of the UK health
system stands in stark contrast with the distrust, which accom-
panies health care in the USA where there is a belief that the
system is organised to maximize the benefits for the medical
profession. Gilson argues that trust involves both cognitive and
affective elements. The former relates to a risk calculation
where the costs and benefits of an action are calculated along-
side of the degree of uncertainty derived from the dependency
on the actions and intentions of another while the latter is
linked to the generation of emotional bonds and obligations.
Altruism provides a special case of trust where trusting and
trustworthiness promote the social status of those involved in
giving thus enhancing trust relations between care managers
and users.
Other writers draw distinctions between trust and hope. Both
Sztompka (1999) and Gilbert (1998, 2005) discuss trust and
hope, with hope representing a situation of relative powerless-
ness, a situation exemplified by Gilbert who concludes that
trust is a discourse of professionals and experts while hope is a
user discourse. Seligman argues that trust, conceived as it is in
this debate, is unique to modernity. In traditional societies, trust
has quite different bases. Moreover, sociological theories,
which suppose a general change in modernity (cf. Beck, 1992;
Giddens, 1994), assume that with the erosion of traditional
institutions and scientific knowledge trust becomes an issue
more often produced actively by individuals than institutionally
guaranteed. To resolve these tensions we propose Foucault’s
Governmentality thesis as the means to identify the role of trust,
along with the mechanisms for the deployment of trust and the
role of professional expertise. Social institutions such as com-
munity care disseminate a particular ethic of the self into the
discrete corners of everyday lives of the population. Supported
by a discursive framework promoting co-operative relations
between people, communities and organisations this ethic is
future orientated and promotes qualities and values that sustain
trust-based relationships and forms of action. In the process of
building co-operative relations, the role of professionals and
professional authority is established. The next section carefully
examines the conceptual possibilities for articulation of trust
and governmentality.
Linking Care Management with Trust and Govern-
Conceptually there are tensions but also interesting theoreti-
cal possibilities between late [high] modern and post-struc-
turalist conceptions of society. Both identify the fragmentation
of traditional forms of authority and expertise, and acknowl-
edge the increasing complexity this produces through the
availability of multiple sources of information and different
lifestyle choices. As noted earlier late [high] modern concep-
tions of trust, acknowledge uncertainty and risk as the basis for
necessitating trust and point to the failure of rational choice
theories as evidence of the existence of social trust. Likewise,
governmentality theorists, discuss risk and uncertainty at length
(Rose, 1996, 1999; Osborne, 1997; Petersen, 1997), but leave
the discussion of [social] “trust” to an observation that trust,
traditionally placed in authority figures, has been replaced by
audit (Rose, 1999). The problem of creating co-operative rela-
tions between individuals and within groups and communities,
both in the present and for the future, is left unresolved. Fou-
cault’s summary of the working of the state provides a useful
starting point for this discussion:
“It is the tactics of government which make possible the con-
tinual definition and redefinition of what is within the compe-
tence of the State and what is not, the public versus the private,
and so on; thus the State can only be understood in its survival
and its limits on the basis of the general tactics of governmen-
tality.” (Foucault, 1979, p. 21).
Our contention is that the “governmentality thesis” as it has
been developed by writers such as: Rose and Miller (1992),
Burchell (1991), Rose (1996, 1999), Osborne (1997), Petersen
(1997) holds the potential to overcome many of the problems
experienced in theorising trust. It provides a means of extend-
ing the critical debate over trust. Linking discussions concern-
ing the bases of trust: the conditions Möllering (2001) describes
as essential for trust to happen with discussions focusing on the
outcomes of trust i.e. social capital, systems or impersonal trust
and interpersonal trust (Putnam, 1993; Seligman, 1997;
Luhmann, 1979; Giddens, 1990, 1991; Sztompka, 1999; Roth-
stein, 2000).
Moreover, governmentality provides the means for identify-
ing the mechanisms for deploying particular rationalities across
the social fabric. In particular, the interplay between state in-
tervention and the population that institutionalizes expertise as
a conduit for the exercise of power in modern societies (John-
son, 2001). Institutionalizing expertise establishes a range of
specialized spaces: at once both hidden and visible, providing
opportunities across the social landscape for a range of care
managers. Experts who work on individuals inciting self-
forming activity and individual agency, producing the self-
managing citizen central to neo-liberal forms of government,
“enterprising subjects” or what Burchell (1991, p. 276) terms
“responsibilisation”. Thus enabling an explanation of trust that
avoids resorting to a functionalist argument or an overly deter-
ministic approach limited to either class action or the mean-
ing-giving subject. Furthermore, governmentality can overcome
the condition laid by Sztompka (1999) that trust cannot exist in
conditions of discontinuous change. Indeed, in the context of
discontinuous change, particular rationalities and their associ-
ated technologies become politicized, leading to increased con-
flict in the relationship between the state and expertise making
trust an evermore valuable commodity.
In analysing the activities of government, Rose and Miller
(1992, p. 175) argue, we must investigate “political rationali-
ties” and technologies of government – “the complex of mun-
dane programmes, calculations, techniques, apparatuses, docu-
ments and procedures through which authorities seek to em-
body and give effect to governmental ambitions”. In this case,
rationalities, operating as discourses and social practices em-
bodying a particular practical ethic, work to reproduce the
norms, values and obligations associated with trust. Producing
a subject position that values trustworthiness as both a personal
characteristic and a characteristic sought in others. Both ex-
perts/professionals and the user/customer of health services
emerge as the self-managing ethical subjects of neo-liberal rule
(Miller, 1993; Davidson, 1994; Rose, 1999).
For governmentality theorists an analysis of neo-liberal re-
gimes reveals individuals as inculcated with values and objec-
tives, orientated towards incorporating people as both players
and partners in marketised systems including health and social
care. Participation in markets along with the potential for un-
bounded choice are inextricably entwined with a creative ten-
sion, an ethical incompleteness, where private [selfish] desire
and public [selfless] obligation produce the rational self-man-
aging actor of neo-liberal rule. In a dialectical relationship that
works to form individual identity through the exercise of a
modern consumerist citizenship (Miller, 1993). Such regimes
exhort individuals; indeed expect them to become entrepreneurs
in all spheres, and to accept responsibility for the management
of ‘risk’. Government is concerned with managing the conduct
of conduct, the processes through which people ‘govern’ them-
selves, which includes an obligation to manage one’s own
health (Petersen, 1997).
Theorists of modernity such as Putman (1993), Sztompka
(1999) and Rothstein (2000) leave trust to arise organically
through the interaction of individuals within groups and com-
munities. The idea that increasing the levels of social interac-
tion to effect a positive consequence on the levels of social and
individual trust has a benign attraction, but it tells us little about
how or why these norms, values and obligations associated
with trust exist in the first place. Alternatively, the analysis of
governmentality recognizes these discourses and social prac-
tices as the outcome of something more ordered. Not ordered in
the sense of designed and managed but the consequence of
what Foucault described as strategy: loosely connected sets of
discourses and practices that follow a broad trajectory with no
necessary correspondence between the different elements
(Dreyfus & Rabinow, 1982).
One tactic, increasingly used within the strategy of govern-
ment as they struggle with the challenge of managing popula-
tions across an ever more complex range of social contexts, is
the promotion of co-operative relations within different pro-
grammes and technologies. This works to promote, establish
and maintain an ethic of co-operation and trustworthiness pro-
ducing the trusting subject as a version of the disciplined sub-
ject, socially valued and malleable. Evidence of this can be
found in a range of policy initiatives disseminated by national
and local government drawing on communitarian discourses
and including an endless array of devices promoting partner-
ships and active citizenship e.g. Caring about Carers (DoH,
1999), Choosing Health (DoH, 2004), Independence, Well-
being and Choice (DoH, 2005). Devices targeting communities
and neighbourhoods through initiatives promoting community
activities often focussed on a variety of locally based inde-
pendent and autonomous groups. In areas where co-operative
relations have failed and require rebuilding the deployment of
discourses of empowerment is evident, inciting “damaged sub-
jects” to self-manage (Rose, 1996). Located in initiatives such
as Health Action Zones, Community Development Projects and
Public Health activities a range of experts and lay volunteers
work on individuals encouraging them to take responsibility for
their health and engage in self-forming activities, self-care and
self-help (Rose, 1999).
Alongside this promotion of co-operative relationships, neo-
liberal rule increasingly repositions the state as the co-ordinator
of activity rather than the provider [cf. Modernising Social
Services (DoH, 1998), Every Child Matters (DoH, 2003b),
Choosing Health (DoH, 2004) and Independence, Well-being
and Choice (DoH, 2005)], progressively drawing communities
into the provision of welfare and the management of social
problems (Clarke & Newman, 1997; Rose, 1996, 1999). New,
often contradictory, rationalities of competition and co-opera-
tion, of participation and consumerism, substitute for earlier
forms of public provision. Nevertheless, these contradictory
rationalities maintain sufficient coherence to provide the basis
for state intervention through professional and lay activity.
One such example is the restructured relationship between
the private health sector and the British National Health Service
[NHS] (DoH, 2002; Lewis & Gillam, 2003). Until recently, the
private health sector distanced itself from the NHS arguing
quality and choice while those committed to a public health
service rejected private sector values. Now, a range of policy
initiatives such as the use of private sector surgical facilities,
the ability to have particular treatments at a facility chosen by
the patient (DoH, 2003a) and Private Finance Initiatives [PFIs]
have blurred the boundaries between the public and private
health sectors. Fixing large sections of the private sector as the
reserve capacity of the NHS expanding and contracting on de-
mand without the political consequences of public hospital
closures. Furthermore, the use of private capital shifts fiscal
liabilities from the present to the future while at the same time
distancing the state from responsibility for the maintenance and
refurbishment of hospital and other health service facilities and
Such developments suggest a re-articulation of the discursive
structure of private, voluntary and statutory sector organisations
in what Clarke and Newman (1997) describe as processes of
colonisation and accommodation. Alongside State interventions
aimed at provoking co-operative and trust-based relationships,
such movements point to the way major institutions of society
can become repositories of trust, providing both the example
and the experience of trusting while also building the capacity
for trust-based relationships across the social fabric. However,
in contrast to functionalist conceptions of social institutions as
repositories of trust e.g. Misztal (1996), we need to identify the
dynamic interplay between the state and the means of interven-
tion at its disposal.
The challenges faced by the state over the last twenty-five
years or so such as the increasing health costs of an ageing
population (Rose, 1999; DoH, 2005) have been matched by
rapid social change. One effect of this has been the fragmenta-
tion of welfare away from a monolithic state organisation to
one co-ordinated and financed by the state but disciplined by
market mechanisms such as commissioning and competitive
tendering (Clarke & Newman, 1997; Lewis & Gillam, 2003).
Another effect has been the politicization of the technical i.e.
professional expertise (Johnson, 2001), where a variety of
forms of expertise competes for dominance. Under such condi-
tions, trust is also politicized (Gilbert, 1998). Trust becomes a
commodity for exchange (Dasgupta, 1988). Demanding new
forms of governance and producing a paradox, autonomy for
organisations and professionals released from direct manage-
ment by the state is matched by ever more-complex forms of
surveillance and control (Rose, 1999; Gilbert, 2001).
Since the 1980s, claims of a decline in the authority of the
professions accompanied this process. Public perceptions of
failures of professional self-regulation articulate as institution-
alized self-interest (Davies, 2000), paralleled by the increasing
power, or resistance, of health service users and welfare con-
sumers to discipline professional activity. Managerialist tech-
niques such as contracts and demands for transparency in ex-
changes unite managerial and user based discourses in an un-
comfortable marriage (Rose, 1999; Shaw, 2001; Stewart &
Wisniewski, 2004; McIvor et al., 2002), frustrating the radical
voice of user movements (Clarke & Newman, 1997). Alongside,
a massive increase in the access to the information, particularly
through the internet, further complicates the situation. Special-
ist information, once the sole privilege of the professions, is
now widely available, changing the relationship between pro-
fessionals and laypersons once again challenging professional
authority (Hardey, 2005).
For Rose and Miller: “governmentality is intrinsically linked
to the activities of expertise, whose role is not weaving an
all-pervasive web of ‘social control’ but of enacting assorted
attempts at the calculated administration of diverse aspects of
conduct through countless, often competing, local tactics of
education, persuasion, inducement, management, incitement,
motivation and encouragement” (Rose & Miller, 1992, p. 175).
This web of activity and the specialized spaces created for ex-
pertise, work to construct professional authority, condensing
the different levels of trust: interpersonal, systems and social
capital; into the facework of experts. The fragmentation of ex-
pertise, once embedded in the directly managed institutions of
the state, has enabled the dispersal of this expertise throughout
the third sector leading to a re-articulation of the discourses that
support professional activity and trust in expertise.
It is notable that despite the conflicts of the 1980s, the care
managerial professions appear to carry on relatively unscathed
leading to the conclusion that the decline in the authority,
power and popularity of the professions has been overstated.
One key factor is that certain tasks and activities demand pro-
fessional competence especially in circumstances where the
outcome cannot be pre-determined (Clarke & Newman, 1997).
Once again, revealing the paradox of autonomy and increasing
regulation in the relationship between the state and professional
activity. Returning to the earlier quotation from Foucault, what
has occurred in this period is the re-articulation of government
objectives and a re-structuring of the realms of professional
jurisdiction and authority (Johnson, 2001). Regulation and con-
trol of expertise through audits and contracts are disciplinary
techniques that have modernized the tricky issue of governing
professional activity. Accompanied by a re-articulation of pro-
fessional discourse objectifying the activity of expertise ren-
dering it both manageable (Rose, 1999), and enabling the sur-
veillance of professional activity across a landscape no longer
defined by institutions and buildings of the poor law. At the
same time policy documents such as “Choosing Health” (DoH,
2004) and Independence, Well-being and Choice (DoH, 2005)
are unashamedly consumerist, demonstrating shifts in the way
community care is managed.
Central to this process is a paradox where the need for ex-
perts to manage complex and unpredictable situations has led to
trust in professional autonomy becoming almost exclusively
located with the management of risk (Rose, 1996, 1999; Peter-
sen, 1997; Kemshall, 2002). Competence in the management of
risk is therefore the central basis, which maintains the profes-
sional status of health and social care professionals. Failure in
this respect can lead to very public examinations of the compe-
tence of individual professionals, in particular where there is
danger of a legitimation crisis. Professionals who, despite evi-
dence of system failure, experience a form of symbolic sacrifice
and public humiliation, recent examples include Dr Marietta
Higgs [Cleveland Child Abuse Inquiry], Lisa Arthurworrey
[Victoria Climbie’s social worker] (James, 2005) and Professor
Sir Roy Meadows [expert witness in child death cases (Laville,
Challenges to traditional or institutionalized expertise by new
or non-conventional forms of expertise also demonstrates this
re-structuring of the objectives of government and the jurisdic-
tion of professionals. Some problems have persistently frus-
trated traditional forms of expertise in health care and social
welfare at the same time widely dispersed and contract based
activity enables entry for alternative approaches. Here again the
dynamic quality of Governmentality, demonstrates processes of
colonisation and accommodation. Lee-Treweek (2002) explores
this process in the context of a complementary therapy, cranial
osteopathy, describing how traditional medicine accepts ele-
ments of complementary practice on condition that the alterna-
tive approach accepts particular rituals and the primacy of the
existing medical hierarchy. The need to manage chronic condi-
tions such as skeletal and muscular pain, areas where traditional
medicine has failed to provide a reliable treatment, enables a
new form of expertise to institutionalise itself with the state.
Securing trust in this specialized space enables this form of
expertise to contest the hegemony of risk to its advantage.
This article has reviewed the emergence and consolidation of
community care policy in the UK and impact on relations be-
tween care managers and user groups underpinned by diversity.
One of the central problems of facilitating any leadership or
rapport for care managers with older people in the UK has been
the issue of “trust”. As we have seen, here is a multiplicity of
ways that trust has been defined but the central paradox is how
to creation of the conditions of building conditions of trust
across personal-organisational-structural tiers in an increasingly
uncertain world. The chapter has assessed community care
policy and navigated the ways trust relations can capture
stronger bonds and relationships between care managers and
user groups such as older people in the UK. This is an immense
conceptual and experiential challenge. What emerges is a fu-
sion of consumerist, traditional, alternative and complementary
discourses articulated with discourses of co-operation, partner-
ship and trust in health and social care providing an matrix of
spaces where a wider range of expertise, in both type and nu-
merically, than ever before is embedded. At one level, experts
identify risk at the same time as providing a general surveil-
lance of the population, at another level they work within sys-
tems legitimated by a myriad of mechanisms of distrust while
simultaneously working at another level on individuals to pro-
mote a general ethic of trust. Thus, the mechanisms construct-
ing the contemporary authority of expertise are established.
Managing diversity is inextricably linked to trust. Condensing
trust in the facework of care managers places users of health
and social care in a dynamic context. Community care policy
continually redefines previous patterns of social relationships
both within health and welfare agencies and between those
agencies and their customers. Gilbert et al. (2003) identified
professionals in health and social care agencies responding to
policy pressures by managing the expectations [trust] of differ-
ent individuals and groups with potentially conflicting interest’s
e.g. individual users, parents/carers and the local community.
These experts engaged in a process of change and consolidation
managing conflict while furthering both organisational and
political aims related to community care. Hence, this process is
needed to be further sustained to have a better understanding of
how users and care managers can actually understand, listen
and respect each other.
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