“Social services are nothing if they are not about empowering the powerless: giving older people the chance to stay in their own home, protecting the vulnerable from abuse and neglect, promoting independence and self reliance, bringing hope to families where almost all hope has gone”
This report will assess to what extent social policy with regard to the elderly has been successful in achieving its aim. In doing this the paper will look at policy development from the late 1940s onwards. It will evaluate policy success and will look at the role of social work in particular. It will look at the impact of New Right thinking on social work policy, funding and practice. There will be an examination of the effect of social policy on vulnerable and oppressed groups and of how ageism and classism may contribute to oppression.
This is a documentary report using internet sources for Government websites and official data which is supplemented by other literature. There will be some use of figures and a diagram to illustrate certain points. After looking at policy development the findings will be used to assess the impact of policy and its effects on vulnerable adults.
The introduction of the Britain’s post-war welfare state was aimed at combating disease, poverty and ignorance. It was designed to support people in times of trouble and to protect those who were unable to protect themselves. From 1948 onwards, what were known as the personal social services, was introduced, it consisted of the health services which were responsible for public health, and welfare departments which were responsible for residential care and the care of the elderly and disabled. It also included children’s departments which were responsible for child care. A large proportion of the budget was allocated for residential care.
Since its inception the way in which the welfare state has been administered has undergone two major reforms. The first of these was in the 1960s and 70s where allocation of funding to departments was transferred from central government to the treasury. In the 1960s welfare departments and children’s departments were unified into social services departments.The second phase was in the 1980s and 90s and it led to a restructuring of the public sector and the way in which welfare was administered. This led to:
- The break up of administration into agencies, e.g. NHS Trusts and agencies responsible for Social Security.
- The introduction of the principles of management and the market which are found throughout the NHS and personal social services
- The requirement for public services to be run like markets, a separation of purchasing and provision of services and the introduction of competition.
During the setting up of the Welfare State the powers that had been held by local authorities were largely usurped by central government which still has the final say in how they conduct their affairs. Much of the work of the Social Services Departments was concerned with child services but this changed with the introduction of the NHS and Community Care Act of 1990 and there is a continuing move to operate services jointly. This also meant that care was no longer the preserve of the state, rather it should be the responsibility of the whole community. and state intervention should only occur as a final resort (Giddens, 2001). The Community Care Act of 1990 was a development not only of the 1948 Act but also of the 1970 Social Services Act which states that:
Every local authority shall establish a social services committee, and …there shall stand referred to that committee all matters relating to the discharge by the authority of- (a) their functions under the enactments specified in the first column of Schedule 1 to this Act
Under the terms of the 1990 Act everyone who wishes to access social care must first undertake an assessment of need (circular LAC (92) 12 states that any needs assessment needs to take into account the capacity of the person, their current living situation, any help or support from friends and relatives and also what the person themselves may want from care. The National Services Framework for Older People which is being continually updated has to be taken into account when such an assessment has been made. Undergoing an assessment does not necessarily mean that a person will be offered services. Different local authorities have their own sets of eligibility criteria, against which the needs of the person are assessed an assessment is also made of their ability to pay for care (Moore, 2002). The Health and Social Care Act 2001 entitled older people in residential care to free nursing care, in an attempt to integrate health and social care for older people. There has been concern that this Act might be the beginning of the end of adult social service departments.
Goodman (2005) has argued that access to care for older people may vary. The research suggested that those who were in residential care were more likely to be at a disadvantage in accessing other forms of care whereas older people who remained in their own homes were more likely to be able to access social care. The care needs of those older people in residential care tended to be met by care staff with the help of district nurses in order to provide some care to people in residential homes.
Assessment of Findings
Under the terms of the 1948 Act the state was the primary instrument of welfare and thus social care. As has been documented various later policies changed the way in which social care was distributed and accessed culminating in the Community Care Act of 1990 which shifted responsibility of care from central government to local authorities. It was claimed that this Act would lead to increased choices for service users. In contrast to this claim, some older, perhaps frail people, become socially disenfranchised and are placed in accommodation that is not up to standard nor suited to their needs. Moore (2002) points out that some commentators have argued that a mixed economy of care and the move away from public provision to one that was based on profit making:
…would actually lower the standards of care, as profit rather than public service becomes the overriding motive…(this) will lead to a narrowing of choice…clients being seen as receiving charity…(and) the extent and the quality of services will differ from place to place (Moore, 2002:259).
In 2000 the Government introduced the Care Standards Act as a response to poor standards in care homes. This has not been seen to be effective however, as stories of the abuse of older people in care have proliferated in recent years(Observer, 18th February, 2001). In the last hundred years people’s life expectancy in the western world has increased dramatically and there are now almost 5 million people over the age of 75 in the UK. Conversely the birth rate is now at an all time low. These changes in British demographics have generated an increased demand on the health service and on caring services generally. Although many older people remain in their own homes and may receive some kind of care to help them, there are presently about 200,000 people in registered residential homes in England. 35,000 of these homes are run by the local authority and 165,000 live in homes run by the independent sector. These figures do not include the 150,000 old people who are in nursing homes (Moore, 2002). Older people are a marginalised group viewed by society as no longer useful, they are, of necessity, greater consumers of health and other services (Moore, 2002). When they feel they can no longer cope alone, or when relatives can no longer care for them, they go into residential or nursing homes, many of which are privately owned and run for a profit. Even when they are in council run homes older people are expected to at least make a contribution to the cost of their care. What is principally needed is a change in the way older people access services. In order for older people to have their needs met in ways which contribute to their quality of life and give them some choice over what happens to them Dunning (2005) suggests a greater need for advocates. He argues that in certain areas advocates should be a requirement for older people at certain times in their lives such as:
- retirement, which can bring about a reduction of income and social networks
- a decline in physical and mental health, sensory impairment and the need for health and social services
- a change in housing and living arrangements
- ageism. ( Dunning, 2005:10).
Dunning’s advice is wise if people want to access adequate care particularly as under the terms of the 1990 Act the care is no longer provided by the state alone. If a service user has been assessed as eligible for care then what is called a care package has to drawn up by the social worker. This package is organized primarily by the local authority and voluntary and charitable organizations also play a part in this. Increasingly this has meant that the autonomy of the social worker in this process is rapidly being eroded they are not always able to do what they see fit with regard to a service user’s need due to the need to collaborate with other agencies.
Wanless (2006) found that access to care often depends on financial concerns and keeping people in care costs a lot of money. This has to be a consideration when the number of people entering residential care is increasing rapidly and estimated to increase by 50% over the next twenty years. The diagram below shows the cost of social care for older people in 2003/4.
Social worker’s decisions are subject to review by the care manager who is the person who holds the budget, this person’s primary job is to keep costs down. The social worker may do their utmost to obtain the best possible care for the older person they are dealing with but the final decision is often taken with regard to financial concerns. This is probably more of a problem with older people accessing care than with anyone else because they place a greater demand on the health and caring services.
When the welfare state was formed the total cost of residential care, or care that enabled a person to remain in their own home was met by the state. Those who went into private care did so as a matter of choice rather than a concern for the Government’s coffers. The New Right policies of Margaret Thatcher’s government was to roll back the welfare state and although the present government call their policies the third way they are very close to those of the New Right. Wanless (2006) maintains that there has been fragmentation in the responsibility for social care at both local and central government levels. After the 1990 Act local authorities were no longer the direct providers of care, rather they were care managers. As a result of this a large part of government funded residential care and 69% of domiciliary services are provided by the independent sector. Social care is managed like other businesses whereby those with the most acceptable tender will get the work. Is this an empowering experience for older people, or do they become more oppressed and discriminated against than might previously have been the case? The Government has tried to address some of these issues by its promotion of participation and service user involvement. This is not always helpful as Dunning (2005) has pointed out. This is because of the power imbalance that exists between service users and professionals. Professionals may also use language that is not always accessible to service users. Arguably, in the current climate, it helps older people to have an advocate who is there to offer support and to help promote their interests.
The Government pledged, in 201, that an older people’s champion would be appointed in each local authority. The champions would be there to represent older people’s interests. It was anticipated that as the champions should be doctors, nurses, other health professionals or social work practitioners, this might help to drive up standards of care. Quinn et al (2003) have argued that knowing what is on offer, and that if necessary there is someone who will put forward their views can be empowering for older people:
Information, advice and advocacy are services in their own right. They are also fundamental in enabling older people to receive the services they require. (Quinn et al., 2003, p. 3)
While the promotion of advocacy and service user participation may make accessing care easier for older people, and could involve greater levels of empowerment overall policy development appears to have placed financial concerns before the needs of vulnerable people. New Right policies have, to a large extent, been continued under New Labour. Most of the developments since 1970 have hedged social work practice so that professionals are limited in the types and amount of care that they can offer service users. They have introduced market principles into a profession that was built on a concern for justice irrespective of a person’s ability to pay. As a result I would say that policy does not fulfil its aims to bring hope to the hopeless and protect the vulnerable.
Dunning, A. 2005 Information, Advice and Advocacy for Older People York, Joseph Rowntree Foundation
Giddens, A. 2001 Sociology Cambridge, Polity Press
Moore, S 2002 Social Welfare Alive Cheltenham, Nelson Thorne
Quinn, A., Snowling, A. and Denicolo, P. (2003) Older People’s Perspectives: Devising Information, Advice and Advocacy Services. York: Joseph
Wanless 2006 Securing Good Care for Older People: Taking a long term view London, Kings Fund Publications
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