Caring neighbourhoods: maintaining collective care under neoliberal care reforms

ABSTRACT

Welfare decentralisations have increased the importance of local neighbourhoods as context for care. As welfare reforms largely rely on increased citizen participation, local infrastructures facilitating participation, especially in disadvantaged neighbourhoods, become a focal point for understanding neighbourhood care. We studied professional and citizen led forms of care in two low-income neighbourhoods in the Netherlands. Our analysis of collective care as practices of repair and maintenance highlights the collective losses that neighbourhoods suffer within an institutional context of care as self-management and individual responsibility. The sustenance of collective neighbourhood care as a context and practice of social work requires recognition of the epistemic and relational work carried out by citizens and professionals in maintaining and repairing local care infrastructures.

SAMENVATTING

Met de opkomst van de zogenoemde participatiesamenleving werd voor informele zorg een groot beroep gedaan op buren en bekenden. Niet de staat zou burgers moeten helpen, maar ze zouden elkaar moeten helpen. Critici van dit beleid betoogden echter dat deze vorm van burgerparticipatie te veel gevraagd is voor sociaal kwetsbare buurten. Geïnspireerd door theorieën over reparatie en onderhoud in zorgethiek en wetenschappen en techniek studies, deden we etnografisch-participatief onderzoek naar twee vormen van collectieve zorg in lage inkomensbuurten in Nederland: zorg door een netwerk van bewoners en door een team van professionals. Uit het onderzoek bleek dat collectieve zorg vraagt om nauwkeurige kennis van buurten en het onderhoud van sociale infrastructuren. Een gebrek aan geïnstitutionaliseerde samenwerking tussen beleidsmakers, professionals en burgers, in de context van ‘eigen regie en verantwoordelijkheid’ staat het succes van collectieve zorgpraktijken in lage-inkomensbuurten in de weg.

KEYWORDS:

• Care theory
• collective care
• low-income neighbourhoods
• citizen participation
• welfare reform

TREFWOORDEN:

• Zorgtheorie
• collectieve zorg
• lage-inkomensbuurten
• burgerparticipatie
• decentralisatie van zorg en welzijn

Introduction

In the wake of the decentralisation of health care in many European countries, neighbourhoods play an increasingly important role as ‘landscapes of care’ (Milligan & Wiles, 2010). Decentralisation policies promise more caring and progressive local environments enabled, amongst others, by citizen participation (Verhoeven & Tonkens, 2013; Williams et al., 2014). For example, de-institutionalisation of mental health care is understood as part of a historical trend renewing the citizenship of former patients within neighbourhoods (Pols, 2016). Similarly, decentralisation of elderly care goes hand in hand with a widespread ideal of ‘aging-in-place’, aiming for maximum independence of people in old age (Wiles et al., 2012). At the same time, many promises of local care remain unfulfilled. Rather than empowering individuals and communities, welfare reforms are understood as austerity measures that have made the position of vulnerable individuals and social professionals working with these groups more precarious (Garrett & Bertotti, 2017; Lavalette, 2017; Marmot, 2020).

In the Netherlands in 2015, three new laws transferred care responsibilities from the national to the municipal level. Municipalities have become largely responsible for long-term care, like district nursing and psychiatric care (WMO), for supporting vulnerable citizens to participate in the labour market, and for the organisation of local youth care for children until the age of 18. In the Dutch context, concerns have been voiced that neoliberal reforms would place uneven burdens on specific groups. Inhabitants of low-income neighbourhoods, experiencing a higher burden of, amongst others, chronic diseases, are likely to be worse off as they lack the resources or infrastructures facilitating participation (Kleinhans et al., 2007). Citizenship and independence, ‘participation and self-management’ in (Dutch) policy language, therefore arguably require not less, but different forms of care that stem from neighbourhoods’ local care arrangements and social infrastructures (Klinenberg, 2018). The question arises how low-income neighbourhoods sustain collective forms of care that mitigate or remedy their disadvantage.

In this article, we study how citizens and professionals provide collective care, understood as the maintenance and repair of (social) infrastructures in low-income neighbourhoods. Much literature addresses questions of social care in neighbourhoods under the heading of ‘community care’. However, as community care scholars point out too, the word community lends itself to much misuse and misinterpretation (Bulmer, 2015). First, the notion of community invokes the existence of intimate ties where they might be absent. Secondly, the notion community focuses mainly on people and social relations, while a collective also includes mundane aspects of the socio-material infrastructures (Langstrup, 2013) that bind people together, like buses, shops and street signs. Finally, the notion of community care does not recognise that care is part of broader urban infrastructures that might enable or disable care practices (Buser & Boyer, 2021). Hence, we will focus on ‘collective care’, as it articulates the socio-material character of care without taking the limitation of ‘community care’ on board.

Social work in the Netherlands involves a great range of roles in an increasingly complex social landscape (Jansen et al., 2021). Social workers in a neighbourhood context are likely to act in different capacities, as case manager of individual clients, supporter of citizen initiatives, strategic partner of housing corporations and member of multidisciplinary teams, to name a few. In this article, we offer an orientation to social work and citizen participation that incorporates different entanglements within a neighbourhood context. By providing a theoretical lens that foregrounds neighbourhood care as practices of maintenance and repair, we take a step back from policy-trends of individualised activation (Van Berkel & Valkenburg, 2007) and self-management, and ask how professionals and citizens are part of collective care practices that make neighbourhoods caring environments.

In the next section, we will introduce the theoretical background of the study, namely theories of care that originate in Feminist and Science and Technology Studies (STS). Next, we will introduce two case studies, a neighbourhood network of citizens and a neighbourhood team of professionals and explain the methodology. Then we present the analysis of both cases as practices of collective care and discuss the results in the context of relevant scholarly debates.

Theorising collective care: repair and maintenance

Theories of care are hugely indebted to feminist care studies that critique understandings of care as a natural and primarily feminine act of love. Reformulating care as a practice of labour, care theorists have freed care from self-evidence and a designation to the private realm (Sevenhuijsen, 1998). In line with this, ethics of care has been put forward as a practice of moral reasoning that revolves around nurturing and responsiveness in contrast to dominant ethical approaches centred on autonomy and independence (Gilligan, 1993; Held, 2006). A central insight of care theories is that care is a relational accomplishment, rather than a primarily individual disposition. The work of scholars like Tronto and Sevenhuijsen moreover shows that caring is not only an ethical practice, but forms an analytical lens to understand the maintenance and repair of a shared world, including our socio-political and physical environments.

Care is ‘a species activity that includes every- thing that we do to maintain, continue, and repair our “world” so that we can live in it as well as possible’ (Tronto & Fisher, 1990)

Tronto distinguishes different dimensions of care (Tronto, 2013). The first is attentiveness or ‘caring about’, which refers to the sensitivity to recognise caring needs. The second is responsibility, taking up the burden of meeting those needs. The third and fourth dimensions of care are competence (of the caregiver) and responsiveness (of the care receiver) respectively. Finally, care involves the need for plurality and communication, described by Tronto as ‘caring with’. For Tronto these dimensions of care are relevant both in the ‘daily routines of hands-on care’ as well as in institutional contexts.

Urban STS scholars share with feminist studies the aim to ‘surface the invisible work’ (Star, 1999) and study urban care work as practices of repair and maintenance that often go unnoticed. More than care for individual citizens, maintenance and repair imply care for infrastructures that enable social order and mobility. In their study on Paris subway systems, Denis and Pontille show how care for directory signs (Denis & Pontille, 2014) performs and maintains ‘spaces of flows’ (Knox et al., 2008). Similarly, Hall and Smith’s study of forms of urban kindness by social professionals reaching out to the homeless shows how their maintenance work upholds crucial social infrastructures (Hall & Smith, 2015). Both the feminist care literature and urban STS scholarship provide a re-valuation of care, repair and maintenance as ongoing and substantial contribution to a world where things seemingly run smoothly. These studies make clear that infrastructures need care to prevent breakdown. Traditional characterisations of maintenance and repair consider this work as dull and repetitive: Arendt for example compared the activity of her ‘animal laborans’ with the work of Sisyphus, rolling the same stone up the hill every day (Arendt, 2013). Challenging this view, Graham and Thrift point out that maintenance and repair can be ‘a vital source of variation, improvisation and innovation’ (Graham & Thrift, 2007). Close attention to maintenance and repair uncovers the fragility and instability of socio-material networks (Denis & Pontille, 2014), and the need for tinkering by care-workers, patients, citizens or technical personnel (Jackson, 2014; Mol, 2008; Pols, 2013) to sustain and improve important infrastructures.

In line with urban STS studies, feminist and STS scholar Puig de la Bellacasa puts the transformative power of maintenance and care work centre stage. In her book Matters of Care: Speculative Ethics in a more than Human World, Puig de la Bellacasa builds on Tronto’s idea of care as a ‘life-sustaining web’ of affective practices and calls for an active role for researchers in caring with their research subjects (Puig de La Bellacasa, 2017). De la Bellacasa adds an ontological dimension to Tronto’s work by showing how needs are not out there waiting to be found, but are constructed. Therefore, needs do not only require attentiveness, but an active commitment to collecting neglected things. Instead of thinking and acting when needs have presented themselves as needs, ‘thinking with care’ is required to make things into ‘matters of care’ (Puig de la Bellacasa, 2017).

In our study, we use the notions repair and maintenance, collecting neglected things and caring with as analytical tools to identify and understand often un- or under recognised practices necessary for the sustenance of a shared world. These concepts serve as the analytical lenses to describe modes of care by citizens and professionals in knowing, relating and acting in their neighbourhood.

Method and setting

We studied a group of citizens and a team of professionals that operate within three bordering low-income neighbourhoods in Maastricht, the Netherlands. The group of around ten different social professionals, among which a social worker, district nurses, municipal officers and professionals in disability care, operates in the neighbourhoods since 2016 as a neighbourhood team. Their task is both to provide care to vulnerable individuals, as well as to contribute to neighbourhood wellbeing and support collective neighbourhood needs. The group of citizens, organised as a so-called neighbourhood network since 2018, consists of a board of five and around seven ‘loose’ members. Their main task as formulated by the municipality is to support local citizen’s initiatives.

Both citizens and professionals form part of a changing landscape of social welfare arrangements in which responsibility and self-management of individual citizens in matters of health and wellbeing are central values. Whereas in the neighbourhood under study some municipal support for care infrastructures remains, like a lunch café where inhabitants can eat a cheap meal, funding is largely expected to be generated by ‘inhabitant initiatives’. For an ‘initiative’ to receive municipal funding, a group of citizens needs to organise itself and demonstrate support from larger parts of the neighbourhood. Neighbourhood networks, that have seen municipal support drop since 2017, are expected to support these kind of inhabitant initiatives. However, in the three neighbourhoods under study, citizen participation is low and community life has diminished over the last decades. The relative low rate of citizen participation is reflected in the cities public health statistics that show large differences between the neighbourhoods under study and the city average (GGD Zuid-Limburg, 2018). Around 40% of all neighbourhood inhabitants have a chronic disability and are thereby restricted in undertaking activities (city average 26%). The percentage of inhabitants above 65 experiencing good health is around 30% (city average above 50%) and over 50% of inhabitants indicate that they are lonely. The professionals of the team under study work 16 h for the neighbourhoods in their area, next to their job for their ‘mother organizations’. This is double the amount of social teams in different neighbourhoods and stems from the high percentage of inhabitants categorised as recipient of special care-arrangements.

The data collected for this article forms part of a broader ethnographic study on health and resilience in low-income neighbourhoods. We conducted exploratory fieldwork at different neighbourhood networks and social teams and studied one of the social teams and one of the neighbourhood networks in-depth. After obtaining participants’ consent, weekly professional team meetings were attended for four months in 2018, followed by the attendance of monthly meetings for another half year and three follow up interviews with social team members in 2020. Monthly neighbourhood network meetings were attended for a period of two years, complemented by numerous individual conversations, three individual interviews with network members and an audio-recorded group interview in April 2019. Next to the fieldwork, a content analysis of neighbourhood newspapers, municipal documents and websites served to contextualise the data. Data were stored and coded in the software programme QRS NVivo11. Analysis proceeded through an iterative process of open coding, identifying recurring themes and thematic coding guided by the theoretical concepts of ‘maintenance and repair’, ‘collecting neglected things’ and ‘caring with’.

Results

In the following, we outline how practices of collective care developed through the actions by the neighbourhood network of citizens and the neighbourhood team of professionals. We analyse how ‘webs of care’ (Tronto, 2013) and local care infrastructures were affected by policy changes and repair and maintenance work was performed (Denis & Pontille, 2014, Graham & Thrift, 2007). Tracing how citizens and professionals constructed (collecting neglected things) and attempted to address collective needs (caring with), we found that this involved collective ‘epistemic work’ from different epistemic positions by network and team.

Neighbourhood care by a citizen’s network

In the context of welfare-reforms, the municipality encouraged the dismantling of existing citizen-organisations such as neighbourhood platforms to make space for the participation of more diverse groups of citizens. Before 2015, neighbourhood platforms represented the neighbourhood in regular meetings of municipality and other institutions: they would put forward inhabitants’ concerns and negotiate solutions with the institutions involved. In a controversy about neighbourhood platforms, municipality and citizens pointed out that these platforms had become quite powerful. In some cases, ‘neighbourhood mayors’ made it difficult for other citizens to become active in the neighbourhood. A new structure of ‘neighbourhood networks’ was drafted in response to this controversy, in gear with the reform-rhetoric of increased citizen participation. In practice, the loss of neighbourhood platforms in the neighbourhoods under study proved to be a loss of resources for collective care: ‘We used to sit around the table with everybody (…) now everything is fragmented’ (old platform member, field notes).

The new network structure did not only cut the institutionalised ties to parties like the municipality and housing corporations, it transformed the networks’ relationship with inhabitants. Networks were encouraged to present themselves as the ‘facilitator’ of citizen-initiatives, not taking initiatives themselves but supporting others. In practice however, there was little to facilitate, as citizen initiatives remained scarce in these low-income neighbourhoods. Nonetheless, the analysis surfaces the work still carried out by the neighbourhood network providing different forms of collective care.

The faltering of maintenance and repair

Maintenance and repair require intimate knowledge of neighbourhood needs, and the neighbourhood network embodies this knowledge. The small group of citizens that makes up the network covers a broad range of attachments to the neighbourhood. Members are for example active as a board member of a local football club, resuscitation volunteer, or member of a mothers club. Famous for being a ‘neighbourhood connoisseur’, one of the network members explains how he developed all his neighbourhood knowledge. ‘Well, yes [laughs] (…) at a certain moment it [the neighbourhood] takes hold of you, you know a lot of people (…)’ (interview). Together with family and friends, the respondent collects food and clothes from those that can spare it, redistributes it among those who need it and hosts an active Facebook site where neighbourhood news is exchanged. Neighbourhood network members maintain relations over the years, with neighbours, school, church and sports activities. That this results in the development of collective care, is recognised by the network itself: ‘Network or platform, it does not matter what you call it, as long as inhabitants know “there lives Rose, there lives Fred, and here lives Gaston” (members of the network including himself)’ (Field notes). While the neighbourhood platforms with their historical ties to the neighbourhood were criticised for not involving new inhabitants, the neighbourhood network still holds a central epistemic position within the neighbourhood.

Because of their local knowledge, the network knows when and where repair work is needed. For example, when inhabitants complained about the lack of information and news from their neighbourhood, network members re-instated an important infrastructure that was lacking, issuing a neighbourhood newspaper. Repair work also takes place during monthly network meetings. During the meetings, that are supported by a social worker, members aim to align new initiatives with inhabitants needs. When a humanitarian foundation introduces a new project addressing loneliness, network members share their own experiences on the subject. Based on their local knowledge, they foresee that some plans of the foundation do not match neighbourhood life and try to steer it in the right direction. They question the loneliness label and point to the poverty in the neighbourhood.

‘Nobody will walk around with a sign “lonely”; I would also belong to the target group if I would not be doing so much volunteer work’. And: [Responding to the organization’s example of visiting the theatre together with a buddy:] ‘meeting places are important, but also a barrier, financially spoken’ (field notes)

Through this kind of work, the neighbourhood network tries to make sure collective needs are well understood and adequately addressed.

However, many of its members observe a decline in the collective care capacities of the network. They feel that the individualising policies of the municipality hampered the network’s effectiveness.

In the past [when we were a platform] we could take up complaints ourselves and pass those on [to the municipality], now, people have to do all of that themselves. (Network member, field notes)

While the municipality no longer recognises the networks collectively formed knowledge about the neighbourhood and its problems, its expectations of help and other initiatives by individual citizens are high. However, as network members state, the welfare reforms have reduced motivation of many inhabitants to invest in this.

Because we did not get help, not from the municipality, not from political parties, from nobody (…) should I now all of a sudden offer help for everything and everybody, what I didn’t get myself? I refuse to do so. (Network member, interview)

While I am trying to attract young people, here in the neighbourhood it is like me myself and I, they turn their back on everybody else. (network member, field notes)

Due to the neoliberal reform of neighbourhood representatives into facilitators, the network is less equipped to actively form collectives and thereby enhance participation. As network members feel little support from both inhabitants and the municipality, collaboration between network members itself becomes a precarious process. In the past, the neighbourhood platform organised protests and thereby shaped new collectives. In the current situation, the network does not feel legitimised to address issues like a municipal plan to place solar panels in a site bordering the neighbourhood that according to some is agricultural heritage. While a dedicated social worker prevents many disagreements between network members from turning into conflicts, she does not understand her role as supporting an activist stance by the network. Without recognition of the work done by citizen groups such as the neighbourhood-network to ‘collect the collective’, collective care infrastructures fall apart.

Collecting neglected things: the lost ambulance

While struggling with her ‘facilitating’ role, the epistemic position of the network allows it to identify neighbourhood needs that are not observed by institutional actors that lack intimate knowledge of the neighbourhood. The example of emergency services can illustrate how the network’s epistemic position allowed it to signal a breakdown in neighbourhood care.

Over the years, inhabitants have experienced cases of emergency services arriving (too) late at their destination in the neighbourhood.

Police and the fire brigade are often in my street, they don’t know where they should be. Sometimes, coincidentally, I am outside and (…) they ask me (…), [I say] you need to take a detour (…) these are precious minutes. (interview network members)

Network members point out that they try to prevent more harm by giving precise instructions about how to drive when they call the ER: ‘at the apothecary and snack counter’ (Field notes). To the network, the accumulated stories of the emergency services troubles indicate a serious breakdown of care infrastructures.

Addressing the need of the neighbourhood to receive timely emergency care, the network investigated what parts of the local infrastructure might be broken. They consider different causes for the problem. First, they recognise that following restructuring works some years ago, the neighbourhood’s street plan was changed and that street signage has not changed accordingly. However, when the problem is discussed in a working group to address the signage at the housing corporation, a different explanation presents itself. Not street signs but digital street maps appear to be the problem.

You can indicate addresses with giant letters, but if it’s not on Google or the Emergency Services GPS, then you don’t get there. (interview network)

To the network, the identification of the problem as a matter of failing Geo Positioning Systems is a sign that institutions do not care for the neighbourhood.

‘Updating [GPS] costs money’ (…) [however] life is much more precious than those couple of thousands for updating. (interview network)

The network considers the failing GPS a case of institutional neglect.

To solve the problem, the network tries to find the responsible institutional actors. First, the network contacts the local police, who uses the GPS system, but the police refers to the municipality. The municipality however does not consider itself owner of the problem either. When a city alderwoman visits a network meeting, the network stresses the gravity of the problem: ‘someone died here [in the neighbourhood centre] four years ago because of a late ambulance’. In response, the alderwoman refers to municipal web forms to file a complaint. However, at the network’s subsequent attempts to enter their concerns in the web system, it appears that the digital form demands data like the exact times of arrival and ambulance number plates, to identify the late ambulances and personnel in question. This information was not written down during emergencies.

‘They wanted to know very specific details’ [but] if I have to research all of that, then they do not need to take the patient with them anymore, if you know what I mean. (Interview)

Despite a collection of testimonies of ambulances who did not show up in time, the network’s concerns did not get through to other parties. A much needed ‘caring with’ did not take place.

It was at this point that the research itself became an actor in the process. As we followed these processes in the neighbourhood, we mobilised our network to arrange a meeting with a director of the regional emergency services. To the director, the experiences of the neighbourhood did not directly resonate, but he was willing to visit the neighbourhood network. The network organised a tour for three EMS representatives, visiting the locations where ambulances were known to arrive in a wrong street or at a wrong entrance. The visit not only was an acknowledgment of neighbourhood needs, it provided a unique opportunity to learn from the network members’ stories. Soon after the meeting, the emergency room coordinator announced a few adjustments to the system, and some weeks later, there was a first indication that the emergency services had indeed found its way back to the right locations.

The adjustments of some coordinates may have been simple; addressing the need for good emergency care certainly was not. Lack of institutionalised forms of cooperation within the city prevented a quick repair of essential care infrastructures. The methodology of the research enabled a mediating role for the university, but it was the network’s knowledge that formed the crucial step towards repair.

Neighbourhood care by a professional neighbourhood team

Many welfare-reform advocates have described care professionals and institutions as one of the welfare state’s major problems (Diers, 2004). Professional care had made people too dependent, (Kretzmann & McKnight, 1993) while professional care had become bureaucratic and distant from the ‘lifeworld’ of neighbourhoods and communities. The new neoliberal citizen participation-ideology tried to break with this ‘old professionalism’ and ‘system-thinking’ and stimulate professionals to help less and ‘facilitate’ more: professionals had to enable people to help themselves by receiving and providing support for others in the neighbourhood. To support and provide local care, in the Netherlands much was expected from so-called ‘neighbourhood teams’. In order to be in ‘the veins of the neighbourhood’, nurses, social workers, municipal employees, youth workers, mental health workers and community workers formed a team outside the setting of their ‘mother institutions’. The teams have regular meetings, consults and home-visits in the neighbourhood to activate citizens’ ability for self-management (Van Arum & Lub, 2014). We analyse the strategies and struggles of a professional neighbourhood team performing collective care.

Struggling to address neighbourhood needs

To carry out her task, the neighbourhood team met weekly to discuss neighbourhood concerns that they learned about. For example, the team discusses a client with a drug addiction history and mental health problems, looking for volunteer work in the green. After one of the professionals has introduced the case, a social worker responds by suggesting a local volunteering initiative in which citizens do maintenance work in parks. Taking the vulnerability of this client into account, she recommends a specific location where the volunteers are easy-going. For not only the client’s interest is at stake here, the precarious character of the initiative and the other volunteers need to be protected. Hence, the team tries to navigate the needs of this individual with the needs of the larger neighbourhood.

This balancing act is however quite complex and the team often has to discuss whether they, as facilitators of care work by others, need to act when a problem is brought to their attention. When a club of elderly reports a woman who disrupts the peace in their meeting place with strange and racist remarks, the majority of the team is of the opinion that there is no role for them in this matter. The woman herself did not ask for help and intervening is considered paternalistic: ‘we don’t approach someone without there being a question for support’. However, a social worker calls upon the team’s responsibility to care for the elderly club as they, as providers of informal care, need support too.

Please go to meet them [the elderly club] when you have office hours (in the same building) and get to know them, talk to them. (field notes)

However, most team members lack time and organisational support to invest in longer term relationships with the neighbourhood. A district nurse formed an exception. Being familiar to many local inhabitants, she can identify collective needs. When she for example learned that many local elderly wanted to organise a new coffee club, but felt uncomfortable with the finances of such an initiative, she offered to handle the finances herself. While visiting a neighbourhood event on a weekend, the district nurse explained that this form of care felt natural to her: it is simply about ‘showing your face’. However, as the circulation of professionals in the team is high, few professionals develop these kind of ties with the neighbourhood.

Another difficulty for the neighbourhood team in carrying out collective care was formed by the local policy context that celebrates citizen participation. The municipality expects professionals to activate citizens for voluntary care. In a new municipal document, it was for instance suggested that patients dismissed by the hospital can be ‘passed on’ to the neighbourhood team for informal care. However, low-income neighbourhoods do not present untapped reservoirs of volunteers. The team cannot simply ‘make’ citizens available to provide care and their response to the document is telling.

Do they think they can dump that here, that there’s immediately someone at the doorstep [of the patient who has returned home]? (…) We are not the solution to everything. (field notes)

The discrepancy between the municipal policy reality, informed by statistics of high percentages of citizens ‘available’ for volunteer work because they are retired or unemployed, and the team’s experience, is big.

A final difficulty for the neighbourhood team in providing collective care consisted of navigating public and professional ideas about fairness in addressing collective needs. Whereas the support for individual care like assigning a cleaning help is supported by strict guidelines, the basis for judgements about collective care was far from clear. An example may illustrate the dilemmas of the professionals in spending their small neighbourhood budget. A team in another neighbourhood supported an indebted inhabitant with the purchase of a car he relied on for keeping his job. Although the decision prevented the man’s dependence on social benefits and helped the neighbourhood keep an active volunteer who gives rides to neighbours, other inhabitants criticised the decision. As one of the professionals points out, ‘where we see a tailor made solution, citizens see arbitrariness’. Thus, when the team under study received a request for a scooter by a local couple that started a so-called ‘giveaway shop’, the team discussed whether this would be mainly for personal benefit or strengthen the neighbourhoods social infrastructure. Considering the fact that the couple’s health situation did not allow them to bicycle, but needed to be mobile in order to do their volunteer work, they decided to provide the scooter. Later they learned that the woman had an ambiguous reputation: she supported inhabitants but she also made ‘the people who work with her run away screaming eventually’. Decisions on collective care in other words involve risks, which can only be addressed when professionals are familiar with neighbourhood relations and histories.

Collecting neglected things: front porch talks

Like the neighbourhood citizens network, the neighbourhood team of professionals needed to have intimate knowledge about the neighbourhood in order to identify collective needs and to arrange collective care. While most citizens developed this by living in the neighbourhoods, most professionals lived elsewhere. Since office hours, although held in the neighbourhood to bridge the distance between professionals and inhabitants, attracted few people, the professionals decided to take a more out-reaching approach. The team for example started to use a small bus to ‘collect’ inhabitants’ stories, concerns and insights on different locations. This way, they learned that the expectation of inhabitant’s self-management and participation was often not realistic as many inhabitants in the neighbourhood were ‘in the survival mode’. Rather than motivating inhabitants to attend social meetings in the neighbourhood themselves, the professionals learned that ‘what works best is when you take them there yourself’. Finally, the neighbourhood team initiated a media project to shed light on the lives of neighbourhood inhabitants. Called ‘front porch talks’: the team published online interviews with inhabitants about their passions and activities in the neighbourhood. One story was about an inhabitant hosting his own radio station looking for local listeners, another addressed the organisation of creative workshops for inhabitants. The interview series not only brought the professionals more in touch with the neighbourhood, it showed the predominantly invisible (volunteer-) work done by neighbourhood inhabitants to a wider audience.

Collecting neglected things as a new approach to the neighbourhood enabled professionals to connect better to collective needs. Addressing these needs together with inhabitants however remained difficult. Caring with, as understood by Tronto, requires the active construction of a shared understanding of collective needs. When a neighbourhood network asked the professionals for help in organising a neighbourhood care-market to inform inhabitants about different care-services, the professionals remained ambivalent towards their own role in this.

‘They [the network] have nice ideas, like a demonstration of a resuscitation practice’ (…) but actually, they need to do this themselves.

However, the professionals considered this idea of a care market also problematic, because some of the care services had reached their maximum capacity, and PR would be rather misleading ‘as people cannot get help’.

Not surprisingly, the care market did not take place. However, the lack of exchange between professionals and inhabitants implied that different understandings of collective needs – a need to be informed about care services and a need to be informed about the currently limited provision of care, were not actively discussed. In other words, a structural caring with between the team and the neighbourhood network could not take place.

Discussion

Inspired by feminist and STS scholarship of care we studied practices of collective care within low-income neighbourhoods in the context of welfare reforms and citizen participation policies. Our analysis showed that citizen’s networks and professional teams including social workers struggled heavily to (re)produce a landscape of collective neighbourhood care. Resources were scarce and policy aims forced them to engage in distant, short-term relationships instead of developing intimate, long term and stable relationships. New ways of working did not acknowledge the relational dimension of knowledge and care. Both citizens and professionals experienced that these new policies fragmented already fragile neighbourhood ties and that ‘facilitating’ inhabitants to take care for themselves did not generate more participation. Against all odds, both citizens and professionals employed specific strategies to work around the hurdles, to mobilise and develop neighbourhood knowledge, to identify neighbourhood needs and to perform maintenance and repair of collective care infrastructures. While social work traditionally recognises the significance of invisible care work (Pithouse, 2019), welfare reforms and the socialisation of new professionals in a self-management policy discourse contributes to the erosion of collective care practices. Our study adds to the (re-)valuation of collective neighbourhood care as an important context and practice of social work in three ways.

First, neighbourhood care is an epistemic practice. Several authors (Graham & Thrift, 2007; Jackson, 2014) have argued that care as maintenance is an inherently creative practice that relies on expertise and experience. The collective care by the neighbourhood citizen network stems from its historical, intimate epistemic position in the neighbourhood, which also forms the basis for generating new relations and knowledge. In line with studies that emphasise the importance of service users and patients’ knowledge for social work (Beresford, 2000; Lee et al., 2019), our analysis emphasises the importance of inhabitants’ knowledge for the practice of social work, especially within low-income neighbourhoods. Tronto and de la Bellacasa have argued that caring with is essential for addressing collective needs (Puig de La Bellacasa, 2017; Tronto, 2013). Rather than starting from a citizen’s self-management ideology that ‘they need to do this themselves’, both neighbourhood professionals and policy makers should recognise citizens as epistemic partners, as has also been argued by Callon an Wynne (Callon, 2009; Wynne, 1992). Recognising the knowledge and strengths that each brings, rather than following strict role descriptions, fosters cooperation. Our findings moreover highlight how the development of this local knowledge and its mobilisation for collective care require forms of institutionalisation. The lack of funding and legitimacy assigned to neighbourhood networks, as well as the rapid turnover of professionals within the neighbourhood team, all form structural challenges for the continuity of collective care in an already disadvantaged and fragmented neighbourhood.

Secondly, our study of collective care points at the importance of less visible forms of both citizen participation and professional work. Whereas the importance of ‘presence’ is widely recognised in social work (Baart, 2007), similar observations could be made for citizens and neighbourhood care. As neighbourhood dwellers, citizens may engage in maintenance work of local infrastructures simply by being attentive witnesses of what is going on in their environment. The importance of proximity and nearness applies to individuals as well as buildings, streets, and meeting places. Continuous observations of the emergency services’ enabled the neighbourhood network to collect neglected things and finally restore the local emergency care infrastructure. Recognition of this ‘under the radar’ type of citizen participation, next to very visible heroic (Murphy, 2003) ‘citizen initiatives’, or citizen participation as informal care for family (Van Groenou & De Boer, 2016), is crucial for collective neighbourhood care. The recognition of maintenance as an alternative ‘mode of being a citizen’ (Tully, 1999) by professionals and policymakers could also contribute to destigmatising low-income groups, as ‘citizen participation’ is notoriously represented as an activity of the middle class.

Thirdly, our study adds to the broad literature on health inequities (Marmot, 2020; Ruckert & Labonté, 2017) by addressing the potential loss of local caring infrastructures. In addition to studies that have demonstrated the rise of anxiety and insecurity of individuals within already deprived areas and communities as a result of welfare reforms (Chase & Walker, 2013; Edmiston, 2017), our analysis points to the ‘collective losses’ neighbourhoods suffer. Whereas the deinstitutionalisation of healthcare requires the institutionalisation of neighbourhood care, neoliberal policies predicated on the revival of civil society established the opposite, contributing to the loss of shared patterns of cooperation in which collective needs can be addressed. The destruction of the social landscape of the neighbourhoods in our study fostered disillusion and cynicism in both professionals and citizens regarding their expectations of authorities as well as (fellow) citizens. To allow collective care practices to be sustained and developed, we need a notion of caring neighbourhoods that recognises the work by citizens, social workers and other neighbourhood professional, as practices of ‘continual maintenance and repair’ (Amin, 2006).

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This research was funded by ZonMW project-number 531001309; Netherlands Organisation for Health Research and Development.

Notes on contributors

Sanne Raap

Sanne Raap is a PhD candidate at the department of Health, Ethics & Society at the Faculty of Health, Medicine and Life Sciences of the University of Maastricht, the Netherlands. She studied Philosophy and International Relations in Groningen and her research interest are in the Philosophy and Sociology of Public Health, and Science and Technology Studies. She is currently engaged in a participatory ethnographic research project on Healthy Neighbourhoods and is one of the initiators of a collaborative platform with disadvantaged neighbourhoods in Maastricht, the University-with-the-Neighbourhood.

Mare Knibbe

Mare Knibbe is assistant professor at the school for Public Health and Primary Care (Caphri), Faculty of Health medicine and Lifesciences at Maastricht University. She studied religious studies in Groningen and conducted her PhD-research about moral perspectives in practices of living liver donation. Currently Knibbe does ethnographic research on health and resilience in challenging socio-economic circumstances in neighbourhoods and city. She studied innovative forms of mental health promotion, community care, experiences of homelessness and relations between health and places in the city. Her research interests are at the intersections of urban sociology and philosophy of public health.

Klasien Horstman

Klasien Horstman was trained in historical and philosophical sociology and in science and technology studies. Since 2009, she is professor in Philosophy in Public Health at Maastricht University, The Netherlands. Her research focuses on the interactions of science, politics and society in diverse public health practices, such as urban health, health promotion, work place health promotion, vaccination, AMR prevention. Her interest in the question how scientific research may contribute to social inequality, marginalisation and stigmatisation, led her to initiate a collaborative platform for engagement with disadvantaged neighbourhoods in Maastricht, the University-with-the-neighbourhood.