This is an empirical study which a/ describes and evaluates the role of day centres with regard to young people with physical impairments aged between 16 and 30, b/ describes and evaluates the interactions between users and staff within the day centre environment, c/ outlines and assesses the level of user participation in the centres with reference to activities, the decision making process and control, and d/ suggests a set of policy recommendations which are applicable to both the service studied and day services generally for this user group. Four ideal types of day centre for the younger physically impaired are identified. All are criticised on the basis that they are inherently segregative, emphasize difference and perpetuate stigma. Within this context day centres are perceived as the 'dumping ground' for those people who are excluded, because of physical impairment, from the normal social and economic life of society. Empirical evidence to support this view is provided firstly by the overtly negative features of the general organization and admission policies of the system studied, secondly by the degree of social and economic disadvantage experienced by the users interviewed prior to day centre use, and thirdly by the manner in which they were similarly labelled and 'directed' toward the centres. I argue that day centre use reinforces disadvantage because a/ although helper/helped relations within the system are viewed positively by both users and staff, user participation and control of services is low and, b/ while the system provides a range of facilities which give many users a level of self determination unavailable in the community at large, its capacity to extend those experiences beyond the day centre boundary is limited to only a few. Consequently attendance for the majority will be long term. I list a number of recommendations, including the formulation of a national policy clarifying the role of day services for this user group, which might help to alleviate this problem. I conclude that present policies which successfully disable young people with impairments are no longer simply socially unacceptable. They are economically inept.

AIM - To explore the perspectives of service users and professional staff towards service user involvement within the context of a changing cultural environment at a UK hospice. METHOD - Case study and thematic analysis including interviews with 16 staff including the CEO and 6 service users at a UK hospice. FINDINGS - Three overarching themes were identified: involvement and disempowerment in decision-making; belonging and alienation in a period of organisational change; struggle to maintain wellbeing and identity in a changing culture. A key finding is that service users receiving care from the hospice wanted their voices to be heard, valued and respected for their personal care and issues affecting the hospice. Service users did not consider it a burden to be asked for their views. They felt disempowered by a consultation process about organisational changes that appeared not to take their views on board. There is a need to consider whether a reliance on surveys for involving service users is sufficient or can become tokenistic. External social-political-economic pressures plus increasing privatisation of public services could influence the way that hospices operate in future. This could involve moving from a sanctuary to a business culture and potentially towards managerialism by adopting a regulatory rather than rights-based approach with an emphasis on increasing reach, measuring numbers and hitting targets. Service users being viewed as consumers with a focus on reablement/rehabilitation activities and less on psychosocial support could also serve to push hospices to start behaving more like hospitals. CONCLUSION - More qualitative research is needed to ensure the voices of service users living with a life-limiting illness are heard. The contributions they make towards co-production of services and research should also be heard and influence practice and policy. Service users should also be more involved in education and training of staff.

Den akuta hemlösheten har ökat i såväl Sverige som internationellt under de senastedecennierna, där den ideella sektorn har fått en allt större roll i att erbjuda välfärdstjänster föratt stävja samhällsproblemet. Tidigare forskning har visat på både problematiska ochgynnsamma aspekter med organiseringen av det ideella arbetet mot akut hemlöshet. Ideelladagliga verksamheter riskerar att bidra till att situationen i hemlöshet snarare upprätthålls änförändras samtidigt som individer i hemlöshet får basala och sociala behov tillgodoseddagenom insatserna. I tidigare forskning har dock lite utrymme getts åt att undersöka dagligafrivilligorganisationers arbete mot akut hemlöshet i Sverige i förhållande till sociala rättigheteroch sociala skyldigheter. Den här kvalitativa studien har därför genom sex semistruktureradeintervjuer med personal samt deltagande observationer undersökt en dagligfrivilligorganisations insatser, funktion och syfte med utgångspunkt i socialt medborgarskapoch erkännandeteori. Studiens resultat visar att relationskapande mellan personal och gäster iakut hemlöshet är centralt för att skapa tillit men leder också till en dold disciplinering, vilketär en förutsättning för att skapa en social miljö som präglas av alla människors lika värde.Resultaten visar även att den ideella verksamhetens insatser kan bidra till att individer i akuthemlöshet kan tillvarata sociala rättigheter inom verksamhetens kontext samtidigt somverksamheten kan innebära dels en förutsättning, dels en barriär för gäster att kunna uppfyllasociala skyldigheter gentemot samhället. Relationen mellan gäster och personal kan emellertidleda till känslor av erkännande hos gäster och därmed främja självförverkligande. Socialarättigheter behöver ges lättare åtkomst till på strukturell och lokal nivå för att individer i akuthemlöshet ska ges förutsättningar att kunna delta i samhällsgemenskap och samhällsutveckling.Studiens resultat är av relevans för socialt arbete såväl på nationell och kommunal nivå som förden ideella sektorn och bidrar till en fördjupad orientering över dagliga frivilligorganisationersansvarsroll och insats i arbetet mot akut hemlöshet. / Acute homelessness has increased in both Sweden and internationally during the past decades,where the non-profit sector has gained an increasingly larger role in providing welfare servicesto prevent the social problem. Previous research has shown both problematic and beneficialaspects of day centres work towards acute homelessness. Day centres can help maintain ratherthan change the situation of homelessness, while individuals who experience homelessness alsoget basic and social needs met. However, little attention has been given to the work of daycentres in Sweden in relation to social rights and social obligations. This qualitative study has,through six semi-structured interviews with staff and participant observations, examinedinterventions, function and purpose of a day centre with social citizenship and recognition astheoretical framework. The study's findings show that relationship building between staff andguests in acute homelessness is central to creating trust but do also provide a form of discipline,which is a prerequisite for creating a social environment characterized by equality.Furthermore, the results show that the interventions offered by day centres can help individualsin acute homelessness to take account of their social rights within the context of the day centre,while serving as an obstacle as well as a possibility for individuals to fulfil social obligationstowards the society. The results also show that the relationship between guests and staff canlead to recognition among guests and promote self-realization. Social rights need to be moreeasily attainable at a structural and local level in order for individuals who experience acutehomelessness to be given the opportunity to participate in the community and socialdevelopment. The study’s results are of relevance for social work at national and local level aswell for the non-profit sector and give an orientation of the role, responsibility and interventionsof non-profit work towards acute homelessness.