NEW RIGHT
The 1980s saw the development of New Right approaches. These prioritised reducing and controlling public expenditure by moving services from the state to the private sector. Community care policy highlighted that severe measures taken in achieving equality hindered personal freedom, showing inequality in a diverse and imbalanced society was impossible. Community Care policy stressed on free market encouraging marketization led by local authorities (Johns, 2011). Making a Reality of Community Care, 1986 by the Audit Commission condemned the slow implementation of community care resulting in the Griffith’s report which made a proposal for a care economy were care managers purchased care from private or voluntary sectors. This was seen as increasing workload, defeating the purpose of reducing expenditure; they accepted to convert local authority social services departments into buyers of services from being providers (Department of Health (2000). Lymbery and Holloway (2007) identified that the report failed to make any proposals for the practical support for carers. The report also conflicted with the political drive towards reducing local authorities’ role. The government responded to this by publishing Caring for People (Department of Health, 1989 as cited in Adams, 2002 p.96), identifying the promotion of the independent sector and introduction of clearly defined responsibilities. These were legislated by the National Health Service and Community Care Act 1990 (Johns, 2011). Community care influence from outside the UK can be discerned with the expansion of case management under the Older Americans Act 1965 being used in developing a community care model for Britain.
THIRD WAY
The National Health Services and Community Care Act 1990 clarified the provision of welfare services for older people. There was a “responsibility to develop person-centred care management, strategic community care planning and a mixed economy of providers”, (Means and Smith, 1998). There was also a lack of co-ordinated care methods. The lack of public investment discouraged local authorities from developing community care services and the resource constraints on local authorities meant they struggled to meet these increased responsibilities. (Johns, 2011, p55; Adams, 2002, p95)
Labour government promoted a Third Way philosophy, which looked at what worked best. It utilised all the ideologies as they best suited a situation, to meet the needs of “modern citizens”, Harris 2008, as cited in Johns (2011). Older people more generously had contributed to the Second World War and had survived in the decade of the Great Depression. The assumptions were that they were to be rewarded for this contribution as loyal citizens. However, they could not freely choose their care regardless of cost, since they had to first convince the local authority that they were truly in need. Care would be provided in accordance with local authority policies, inevitably making reference to their budgets. This made service provision discretionary rather than citizenship entitled.
Supporting People provided opportunities to improve the quality of life of older people and to increase their independence by enabling provision of house-related support. There were health and housing inequalities which the government set out to reduce by integrating housing into the community agenda. This would be through joint working by the department of Health and the Department of Environment, producing the Housing and Community Care Framework (Means et al, 2008). This was designed to coordinate the housing, health and social services especially for the black and ethnic minority older people facing difficulty in accessing services and benefits especially those with dementia/ Alzheimer’s as it was often misdiagnosed, but there were also language barriers. Most were seen as not having the mental capacity to make choices but in areas of literate ethnic minorities, this problem was not as prevalent. (Mirza, nd).
Modernising Social Services 1998, focused on the quality and provision of services for older people rather than on the supplier. The National Service Framework for Older People 2001 was introduced to measure the consistency in the delivery of services by providers. It was a medium for ensuring their needs were at the core of health and social services reforms. The policy initiative made clear the framework expectations and the role of the individual and the state, (Crawford and Walker 2008, p65-67). The weakness was the practicality of this guidance, due to disparities in how local authorities provided services as a result of the location of the local authority and how much their budget allowed. Some of the allocated funds might not allow the local authority to offer all the services required by the older people at the specified time to meet their needs. (Anon, 1999)
In 2006 the government acknowledged an increasing number of older people with complex conditions such as dementia. The demographic challenges presented by ageing were characterised Our Health, Our Care, Our Say white paper which focused on how personalisation improved care. The Way to Go Home (Audit Commission, 2000) as cited in Williams (2002) highlighted challenges facing older people in accessing health and social care, identifying the increasing unsustainable demand on service and a cycle of disempowerment and suppression of choice and individuality. Engaging older people in the process of putting their real needs at the centre of policy development was a challenge (Williams, 2002).
COALITION
The Coalition (neo liberalists) continued with cuts in welfare spending, impacting upon the economic and social well-being of older people and constraining the options and resources available to social workers. The coalition, through the Big Society and the Responsibility Agenda put cost ceilings on care for older people giving the assumption they did not deserve similar levels of provision as others, highlighting age discrimination in health and social care provision a contradiction of Putting People First, which received criticism for the motives of the personalisation agenda and its practical impact on quality of services received (Cunningham and Cunningham 2012). There was an argument on how it masked regression. The personal capacity of some old people was inadequate in challenging the adaptation of their own care in accordance with the Mental Capacity Act 2005. Personal budgets lower levels of well-being and increase levels of anxiety and stress for older people, representing a hindrance rather than a benefit, (Ashkam 2008 as cited in Cunningham and Cunningham, 2012). Another key criticism was the assertion that difficulties faced by older adults were a result of the failure in service delivery rather a lack of funding for care. Change will not succeed unless providers and commissioners work together with older people throughout. This current system of care, in relation to older people was confusing, imbalanced, under-resourced and unsustainable. Eligibility criterion was determined by where an individual lives and there is no portability if you move between local authorities meaning that in many cases older people do not have good experiences. There is unacceptable variation in eligibility for services across the country creating a ‘postcode lottery’ effect. Additionally, there is risk of older people failing to protect themselves against very high care costs. The current availability and choice of financial products to support them in meeting care costs is limited. (Malley et al, 2006)
SOCIAL WORK
Policy changes came coupled with social work changes. Dominelli (nd) correctly states, “social work is currently caught in a moment of fluidity and ambiguity as its professional commitment to enhancing the well-being of those in hardship clashes with cold winds of economic necessity”. The Poor Law, in the form of its voluntary equivalent, Charity Organisation Society (COS) was influential in developing social work. COS was there to prevent abuse of charity and encourage people to take responsibility for their action be self-reliant. Establishing COS was an attempt to control and co-ordinate activities ensuring that only the desperately needy older people would be assisted. COS helped shape policy agenda and developed the “casework” method of investigation which social workers are using today. COS caseworkers made detailed inquiries before giving support. These caseworkers were unpopular because of the manner of inquisition and the stigmatising methods of investigation which deterred many from seeking assistance. The formalisation of social work training at the School of Sociology was birthed from COS. (Cunningham and Cunningham, 2012)
Parish administrators represented caseworkers by assessing families’, present-day community care and needs assessment. Parishes varied across the country and some parishes adopted a harsher approach than others representing beginning of “postcode lottery”. (Cunningham and Cunningham, 2012)
There was a change in social work in the 1970s which was aided by a commitment to a mixed economy. Social work began to shift from a position of commanding widespread support to one where it was indicative of all that was wrong with the economy and the welfare state. (Cunningham and Cunningham, 2012)
Thatcherism’s cost-cutting, led to a shift for social workers from needs-led to budget-led provision of services in the care of older adults. In addition to tis there was also a move from direct provision of services to the managing of services by others. Social work intervention became more of assessing clients’ needs than helping them solve their problems, resulting in frustration from the bureaucratisation of social work. (Means and Smith, 1998, p1)
Social work practice was directed by the NHSCCA 1990. There was a purchaser-provider quasi-market. Social work with older people involved local authorities being managers of the process and individuals promoting their own welfare. This resulted in a decline of social worker roles and influence. To reduce conflict about roles, the Barclay report promoted the idea of community social work. It adapted social work to New Right policies since it promoted the notion that people’s needs were met best through minimal state provision. (Johns, 2011 p70-71)
The Seebohm report (1968) showed fragmentation in services, resulting in families having more than one social worker causing inconsistency and a lack of continuity causing an absence of personalised service. The report revealed demarcation arguments on responsibilities of support service provision. It encouraged a unified, general department combining all departments in the form of local authority social services departments. It was received enthusiastically as it encompassed aspirations of social workers for organisational unification. (Johns, 2011, p56)
Social workers became more involved in the planning and decision making for the service user. Personalisation allowed social workers to return to roots of the profession, using their skills and values to empower older people. Social workers could assist in the decisions regarding personal budgets, assessment of needs and appealing for additional funding. Social workers had a brokerage role offering information or sourcing services to device a support plan, due to older people’s reluctance to sustain responsibilities of managing a direct payment. Social workers will potentially continue to play an important part in helping older people engage in using new arrangements to achieve well-being (Adams, 2002)
CONCLUSION
A compressed essay on the complex history of services and policies tends to oversimplify their developments, but it can be concluded that the organisation and delivery of social work has seen significant changes. Social work is an “unstable entity, prone to change and influence from the political sphere, from the socio-political context in which it is rooted” (Thompson et al, nd). Regardless of the policy, the dominant tenet through time has been cost-cutting measures at the detriment of the care of older people. Funding social care in the future will need more resources from the state, individuals and carers to tackle existing and future pressures and in implementation of reforms.
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