Social care is a prisoner of its history

Social care is in many ways a prisoner of its history. Serial failure by governments of the past 25 years to put it on a sustainable footing is ascribed usually to political expediency, the avoidance of cost, the inability of opposition parties to resist a cheap shot, but it stems also from social care’s back story.

As we await the unveiling of the Johnson government’s reform plans, promised by the end of the year, it is well worth tracing where we have come from. And it does not make happy reading. Left out of the core welfare state institutions created in or around 1948, the persistence of both a needs test and a means test for social care means it has never really shrugged off its association with the Victorian poor law.

Fast forward to 1988 and the observation that year by Sir Roy Griffiths that what he called community care was ‘a poor relation; everybody’s distant relative but nobody’s baby’. That still has an awful ring of truth. Griffiths, a Sainsbury’s boss, had been asked by Margaret Thatcher to find a way of capping runaway spending on social security which then funded people living in care homes. His solution – to pass responsibility to local government and give it a cash limit to design, organise and purchase care services – formed the basis of the system we have today.

Many old hands see the introduction of a regulated market as having dismantled the grand vision for social services for adults and children that had been set out in the Seebohm report in 1968 and given concrete form in the creation of social services departments in local authorities in the early 1970s. Bob Hudson is one such veteran and in a new book, he recalls being elected a councillor in Sunderland in 1972 and being appointed to the area’s new social services committee. ‘At the time,’ he writes, ‘it was assumed what was termed ‘the personal social services’ would follow the path to ‘welfare state’ status that had already been taken for health, education, housing and social security.’

Hudson, who went on to have a distinguished academic career and remains a visiting professor in public policy at the University of Kent, chronicles what he sees as the ‘long-running marginal policy status’ of adult social care. His concise and eminently readable book, Clients, Consumers or Citizens?, is sub-titled The Privatisation of Social Care in England and he sees the marketisation that began with Griffiths as now difficult to reconcile with both the hierarchical approach of the state and emerging models of community networks that can underpin care and support.

He adds one more complication thrown up by history. While the 1999 royal commission on long-term care (the first use of the term ‘social care’ does not appear in official documents until 2003) ended up on the shelf, the then Labour government unimpressed by its call for free personal care, Hudson points out that it did have the lasting effect of narrowing the focus to what it defined as personal care, excluding costs attributable to such things as cleaning, laundry, shopping, transport and sitting services for companionship. It reduced our understanding of social care, he argues, to ‘a residual, means-tested service for those needing assistance with bodily functions’.

With the reform debate seemingly about to start, can we defy the drag of history and find a way back from here to an enabling vision of comprehensive social care based on human rights and citizenship and shaped by an ethical framework which, Hudson acknowledges, was one positive to come out of the Covid-19 pandemic? From this starting point, the odds look long.

Like Hudson, Nicholas Timmins is a shrewd observer of the policy landscape. His magisterial biography of the welfare state, The Five Giants, is widely acknowledged as the seminal work on the topic. Social care reform, he has written more recently, is ‘one of the great public policy failures of the past generation’ – and there are few politicians, left or right, who would seek to gainsay that.

But why is it so hard? Timmins suggests it is in fact not one problem, but at least three: ‘Who pays for it? What do people get for it? And how and by whom should it be provided?’ And he goes on: ‘Worse, there is no perfect answer to any of these questions. All solutions will require compromise at a time when there is not a lot of compromise in the air.’

Clients, Consumers or Citizens? is published by Policy Press

David Brindle is a care sector commentator and former public services editor of the Guardian. He is chair of Ambient Support.   

Photo Credit – Danie Franco