Choose At Least a Twenty Year Period and Explain and Explore (Using 'Social Constructionism' and 'Power') How Ideologies of Welfare Have Changed and Developed In relation to your work in the field.
CHOOSE AT LEAST A TWENTY YEAR PERIOD AND EXPLAIN AND EXPLORE (USING 'SOCIAL CONSTRUCTIONISM' AND 'POWER') HOW IDEOLOGIES OF WELFARE HAVE CHANGED AND DEVELOPED IN RELATION TO YOUR WORK IN THE FIELD.
The move away from the post-war consensus of Welfare Services, in which the state played the central role towards the new mixed economy of welfare that we see today, began under the Labour government in the late 1970s, but was hugely influenced by the incorporation of New Right ideologies into mainstream Conservative party politics when they came to power in 1979.
This essay will attempt to examine over the twenty-year period between 1979-1999 how ideologies of welfare have changed and developed in the area of support for people with learning disabilities and mental health problems.
In order to do this, the social and economic conditions that led to new policy implementations will be looked at along with the Thatcher Governments decision to attempt to "Roll back the State" in the area of welfare provision. How successful their aims were and what outcomes this had for people with additional needs will be measured in relation to the theory of social construction.
Care in the Community initiatives and influential reports will be examined and how the dimensions of power have contributed to the changes that have taken place will be given consideration.
Finally the impact and changes New Labour have had will be assessed. Primary sources of research material used to formulate this essay were books, journals, newspapers and magazines articles.
Following the Second World War the creation of the National Health Service took place in this country and an attempt was made at improving the health of British people.
Social services evolved primarily to deal with poverty and unemployment in the nineteenth century however its real beginnings as we know it was the period after the Beveridge reforms. [Moore 1993]
By 1948 different sets of social services had developed a Children's department and the Welfare department. It was the Welfare department whose responsibilities included services for people with mental heath problems or a learning disability. [Moore 1993]
As the Welfare state evolved during post war period both the Labour and Conservative parties shared a "middle way" commitment to State welfare. [Clarke 1993]
The modern development of community care can be linked to the publication of the 1960 White Paper Health and Welfare the Development of Community Care. This proposed the use of smaller district hospitals so that care was more community located. Though it was primarily the Seebohm Committee's report in1968 that influenced and aided the development of social services as we see it today.
However in the 1970s started to see a breakdown in consensus politics the role of the state and its running costs had begun to be called into question.
The Conservatives winning Election campaign blamed the welfare state for the nations economic and moral decline. Mrs Thatcher's election win in 1979 widely represented a shift to the political right. Her Government entered office intent upon reducing the role of the state and the size of the Welfare budget. Its influence and logic for these objectives were tied to Classic Liberal convictions. The essence of the Tory message was that the British citizen should be self-reliant, take a greater responsibility, should not be crippled by taxation or sheltered by the welfare state. Reducing the welfare state they believed would increase entrepreneurial drive and increase self-reliance and self help. [King 1986 p133]
The Thatcher New Right Government attacked state intervention and anti-Welfare thinkers and talked of the, 'Nanny State', destroying independence, initiative, self-respect and fostering dependency.
In particular the Government questioned why it was that the State had to care in institutions for people who could, and the implication was should, have been looked after by family members. The Government believed it would be cheaper for people to be supported at home than maintained in State institutions. Thatcherism also criticizes the lack of choice posed by the Welfare State institutions for welfare clients.
Community care was one of the most discussed areas of social welfare at the time most people were in favour of the government's ideas for reforms but for more compassionate reasons than cost alone.
Evidence of the damage that institutionalisation has inflicted on people with learning difficulties is extensive and irrefutable, and is matched by the equally sensitive evidence that the residents themselves wanted to stay in the community. [Harker1997]
In 1980 the Barclay Report prompted a radical rethink of the social work field and strongly favoured a community approach. Barclay argued that the family friend and neighbours, rather than the state could provide the bulk of assistance. Therefore, he suggested the role of the community should be accessed and encouraged so it could care for its own. [Moore 1993.]
Most social workers also agreed it would be better for the clients to either return to or remain in their own homes where they could be monitored in a more 'normal' environment. Families also expressed that with ...
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In 1980 the Barclay Report prompted a radical rethink of the social work field and strongly favoured a community approach. Barclay argued that the family friend and neighbours, rather than the state could provide the bulk of assistance. Therefore, he suggested the role of the community should be accessed and encouraged so it could care for its own. [Moore 1993.]
Most social workers also agreed it would be better for the clients to either return to or remain in their own homes where they could be monitored in a more 'normal' environment. Families also expressed that with extra help they could often manage without the need for institutions and the feeling was this would be 'best' and 'natural'. [Moore 1993]
Another interpretation of the of heath and social care at this time is that they were a legitimate and advisable political reaction to many social and economic problems that had intensified during the 1980s, including some well publicized cases of neglect and cruelty in institutions, limited service user choice, and a massive social security overspend on residential and nursing homes [Kendall & Knapp 1996].
These factors around the mid-1980s saw an increased interest in developing care in the community, concepts of social construction highlighted how the social problems of providing support to people with additional needs was defined. These people had begun to be viewed as having problems rather than being a problem which saw the balance of care shifting from institutions to community care would it was hoped encouraging choice, diversity and a more normal lifestyle.
Voluntary groups became involved in planning for community care and many social services departments appointed a full time voluntary liaisons officer. [Kendall & Knapp 1996]
This fitted well with the Conservative ideology of a free marketplace from which services could be purchased and increased choice offered and supported their wish to move welfare out of the hands of state institutions by setting up the framework for care in the community and encouraging the growth of voluntary sector agencies and "enable non-state organisations to deliver services." [Moore 1993]. Voluntary organisations became a major player in mental health care and the learning disability field and the move towards "Normalization" policies identified the requirement for special needs housing for people who had been institutionalised for many years. [Wolfenberger 1980]
There were also a number of features in the political agenda that brought about substantial changes. The first was cost .The welfare state was becoming harder to fund, spending on social services was the second largest category of local authority expenditure and was subject of financial restraint so there was a lack of funding available for community care as it was at that time. [Moore 1993]
Another factor which fitted well with conservative ideology was the fact that there was six million workers of whom the majority were women who were caring for others in the community at that time and some 1.5 million were acting as unpaid carers for more than 20 hours a week. Doing just what the New Right promoted and so it was argued they had some duty to provide them with some level of support. [Moore 1993. P.152]
However not all of these factor for change can be contributed solely to the Conservative Government but have to be understood as a wider reasoning on welfare which began in the mid 1970s.
In the 1980s the Government proposed the care initiatives, which were, aimed at reshaping welfare services. In1983 the DHSS issued the 'Care in the Community' paper, which was intended to encourage the transfer of long-stay hospital patients into the community allowing the closure of long stay ward and institutions. [Johnson 1990.p177]
This intended move had been a government ambition since the 1960s, but only it when seen as a way of reducing public spending did the plan start to be put into practice.
In Wales the Welsh Office issued the All Wales Strategy document, which set out three fundamental principles, which applied to all services for people with a mental handicap or learning difficulty. They were that people with a mental handicap should have a right to normal patterns of life within the community. People with a mental handicap should have a right to be treated as individuals, and People with a mental handicap require additional help from the communities, which they live, and from professional services, if they are to develop their maximum potential as individuals. [Paragraph 2.1 All Wales Strategy document]
The Welsh Office went on to say that it wished to see all resettlement of residents of long stay mental institutions completed by 1999 so that such hospitals could close.
'Care in the Community Initiatative' encouraged a programme of pilot projects, to evaluate what would be most beneficial to the service user and to help justify the planned cost cuts the Government intended. The Audit Commissions Report in 1986 studied the cost of institutions and the insufficient provision of community care and advised a re-think. [Moore 1993 p149].
However it was the Griffiths Report in1988 set the agenda for the biggest changes, it argued for a sweeping system of transformation to both community and residential care, above all it suggested a move away from the services that had been provided by local authorities towards one in which social services departments took a more strategic role, identifying needs and purchasing care and support from other agencies. [Clarke 1993 p.78]
It was mainly due to the huge influence of this report that the 1990 Community Care Act came about this amounted to an enormous shake up in services and the way in which they were arranged. The act stated that social services departments prepare care plans for individuals on how their future needs and goals will be met these are still in use today.
Local authorities had to honour the choices of the service users and their families, as they became the purchaser of services offered. 75% of the 1993-4 budgets for community care had to be spent on care in the independent sector, and only the remaining 25% could be spent on local authority care. [More 1993 p.153] This was a decision, which was not approved of by everyone Bob Abbereley spokesman for the Confederation of Health Service Employees said:
"We are horrified that the Secretary of state appears to have effectively instructed local authorities to spend 75% of the provision on private facilities.... Simple decanting thousands of people into poorly regulated private homes is not care in the community, it is straightforward privatisation" [More 1993 p.153]
The Labour government also criticized the plan by saying the Governments figures did not add up, it reported that their plan was £200 million short of funds needed to make it work and that this would lead to 12,000 elderly and disabled people at risk of not getting the care services they required. [The Guardian 3oct 1992]
990 also saw the end of the Thatcher Government with John Major succeeding her. This appeared to have little impact on Welfare as the Major Government seemed in agreement of many of the Thatcher ideologies and was more concerned with uniting the party. [Jones 1997]
In 1993, The new system of community care came fully into operation and whilst the idea of people purchasing the services they require while living in their own home is a socially constructed ideal most would agree with the reality is not always as straight forward.
The disabled and the mentally ill are often the least powerful group in society and have few means of negotiating with local councils for an increase of resources. They instead rely on groups such as Mind and Scope to advocate for them and raise questions about how both government policy and social and cultural opinion is formed.
Two words that were used with much frequency in the Governments language when talking about community care were 'enabling' and 'promote' an expression of distancing of responsibilities or of promoting service user rights?
Benefits paid to those with disabilities grew during the 1980s from £100 million to over £1.5billion a year [Clarke 1993 p147] and the Conservative ideology that the consumer should be given choice and competition of services was activated by the benefit recipient receiving money rather than services.
However research has shown that few people spend this income on care. Disability still remains highly correlated with poverty and many recipients spend the money on food and clothing also families do not respond to needs in a market manner as the Government had forecast also there is not always a clearly established care service for hire in return for payments. [Clarke 1993 P147]
Although the idea of direct payments were aimed at empowering the individuals who were in receipt of them an imbalance of power still remains for the service user people with mental health problems or learning disabilities may still have to do what others think is in their best interest.
The three dimensions of power that exist within society can be identified here. The first dimension of power is the lies with the Governments as they made the decision to change benefit rules to allow direct payments to take place. The second dimension would be the groups or individuals who have set the agenda or applied pressure to enable these changes to come about like advocate groups The third dimension of power then raises the questions of how preferences needs and desires are composed often in the case of people with special needs these could be family, staff teams, or social workers and of course the people themselves. [Classnotes]
The right to social services from the local authority dose not mean the right to receive what you need, but what the social worker recommends as long as the cost can be met. The question of rights becomes clouded by professional judgement, a duty of care and financial management. [Clarke 1993]
Community resistance is another factor, which needed consideration when setting up residential facilities for people with learning difficulties or mental health problems. Social construction refers to the different way the an individual or groups behaviour is judged and interpreted within their culture and society this process then will determine whether the behaviour is a problem and if it is whether it's a private or public one. In the case of people with additional needs this would be weather they are considered as having a problem or as being one and depending on which conclusion the local community arrive at will determine weather the reaction they receive will be helpful or hostile.
Media portrayal is highly influential and has recently led to an assumption that many schizophrenics are a problem as they are violent murders, which is certainly unhelpful. The years of institutionalisation that people with learning disabilities have suffered have also been detrimental. The lack of contact between the community and people with special needs, and has tended to create confusion and apprehension, when these people displayed the institutional behaviour they have learnt they are seen as being a problem rather than having one and so they are seen as deserving segregation or objects to be feared. [Wolfenberger 1980]
"Community care is in tatters," stated the Labour manifesto in 1997 So when Tony Blair came to power in May that year bringing an end to 18 years of Conservative rule, he promised a vision of renewal. [Jordan 2001]
Labour's per-election research had shown that taxpayers were willing to support 'deserving' groups like disabled people and their carers. The Conservatives never fully convinced the country's public through the use of social constructionism that cuts in Welfare were necessary. New Labour aimed to change the moral and political culture around welfare issues. [Jordan 2001] However specific manifesto commitments were few in number and many people believed there was little to choose between the two main political parties as Labour and the Conservatives had come as close as they had ever been on there social welfare ideologies. [Cervi 1997]
But agenda setting initiatives and changes did come 'Modernising Social Services' white paper was announced in1998 and promised the independence, protection of vulnerable people and higher standards. Other key legislation included the 1998 National Carers Strategy, which gave £140 million to local authorities to support the six million carers who were providing informal care.
The Disability Rights Commission was set up and care homes came under the spotlight in 1999 where work began on standards to cover choice of accommodation, health and personal care, social activities, complaints, staffing and management. The National learning Disability Strategy launched in 1999 resulted in a white paper this year, while the Mental Health Strategy of 1998 led to a proposed reform of the mental health act at the end of the year. [Jordan 2001]. However by the next Election Labour support had dropped dramatically among social care workers. [Downey 2001] Although the vast majority did not believe that Labour policies had been harmful to social care, they had not been convinced that they had shown enough commitment to it. [Downey 2001]
Jordan [2001] goes on to argue that nearly all of New Labours claimed achievements can be contested as they involve redefinitions of goals or manipulation of statistics. A report by the National Schizophrenic Fellowship in 1991 would seem to support this opinion, according to their findings during 1978 -1990, mental health beds were reduced by 33,000, yet fewer than 11,000 community places have been provided, even worse there is know knowledge of what happened to these people [Moore 1993,p303] Research for the home office, suggests that one-fifth of the sentenced prison population have mental health problems and also that the number of mentally disordered homeless have risen [The Independent 1991]
In conclusion the impact of 'Thatcherism' and the application of Classical Liberal ideologies had an enormous impact on social welfare. In her years in office Mrs Thatcher doubtlessly effected a deeper change in social values than any other democratic politician in the post-war period. The Welfare State received the blame for the nations economic decline, and once in office the Conservative Government introduced reforms aimed at dismantling what they believed was a "Nanny State", which had been brought about by extensive welfare investment during the 1960s and 70s.
Each successive Conservative Government has also placed public spending cuts high on their agenda, arguing that they are not only necessary, but also derisible.
The extent to which the state was "Rolled back" is the subject of much debate, what as cut back from the Welfare state became greatly increased expenditure on law and order, as inner city riots took place and the crime rate soared [Tivey & Wright 1989]
In specific areas of community care the Tories belief was that it would be cheaper for people to be supported in their own homes rather than being maintained in state run institutions, however this was not the case by 1986 the government was spending approximately 6 million, and rising and today the amount is in excess of £2 billion [Moore 1993]
Another issue is the concept of care in the community inevitably increases the demand for housing and yet no new funds were made available to allow for this and the consequence was that homelessness has risen greatly, latest figures suggest there are 75,000 officially homeless [Big Issue 2001]. Crisis add to this an estimated 400,000 hidden homeless, missing from government statistics [Big Issue 2001]. The Tomlinson Report 1993 estimate that around half of these people have significant psychiatric problems [Cohen 1993]
In many public services, New Labour's determination to stick to Conservative spending plans meant that the necessary long-term investment has only just begun. On balance New Labour's attempt at restructuring the welfare state may be seen as positive if it is judged in the light of the social legacy of the Thatcher/Major years, but few in the social care field would argue that many more resources need to be provided.
The impact of the changes in welfare are not easily assessed, complex political, economical and social forces as well as internal and international pressers have shaped the British welfare regime in the last twenty years.
The move towards Community Care and Normalisation programmes for people with learning disabilities and mental health problems have challenged the deeply constructed views by some and have been welcomed the majority as a positive step into a more decent and caring society. With the help of social constructionism consideration was given to the social problems that existed within community care. The Victorian notion of locking people up because they had special needs in institutions was then questioned because of cost but also because it was no longer deemed socially or culturally acceptable.
The three dimensions of power then come in to play and their influence has developed and re-shaped the social policy, on the whole in favour of people with special needs.
Let us hope that the good work that has been done and positive intent to do more will continue and welfare promises by what ever Government are in power are transferred into practice and the funding needed to enable a wider range of support with special needs to take more control over their lives in the wider community.
