The concept of community care is not a modern phenomenon, its origins stretch as far back as the 1834 Poor law amendment act. To define community care is not an easy task; it has euphoric connotations, romantic notions of warmth and feeling, welcoming individuals that may need welfare and medical support back into communities. In reality community care does not display such a rosy picture, many individuals are placed back into communities from whence they came that they no longer recognise, communities that are apprehensive about accepting such individuals back.
Bulmer (1987) argues that there is two clear definitions of community from a social care arena, firstly the focus is upon local social relations within a geographical area, the second is the sense of belonging which is also alluded to in the concept of community care, Bulmer goes on to explain that although an individual can be part of a geographical neighbourhood, it does not mean they are part of a community. Community care is at present a government policy, expressed in a white paper which was finally implemented through the 1990 NHS and Community Care Act, it requires services for certain client groups of health and social services, those with mental illness, the physically disabled and the Elderly (Payne, pg7, 1995).
When the 1990 act was implemented it appointed Social Services as being the lead agency, this meant restructuring the department of Personal Social Services to allow for its new role of purchaser and provider of services within community care. Personal Social Services has a long history of providing ‘state’ provided services to those in need of support, previously most care was within ‘state’ supported institutions. Did the restructuring aid the delivery of community care? To answer that question it is important to look at the evolution of community care and the developing role of Personal Social Services as its mediator.
The Industrial Revolution saw the break down of the rural family network, the able bodied moved out to work in the developing cities of the 1800’s, leaving behind the elderly, disabled and those that suffered from mental illness; without the support network of their family, friends and neighbours, their plight became a social problem.
The New Poor law of 1834 tried to address the problem, institutions were designed to deal with growing social problems, the able bodied were put in Workhouses, soon enough the Workhouses became a dumping ground for the elderly, the long term sick and the mentally ill. In 1845 The Lunacy Act was implemented and county asylums were established for those that were classified as ‘lunatics’ these asylums were seen as form of social control for a dangerous group of individuals, as throughout the history of social care funding became a problem, the treatment for the mentally ill deteriorated.
Political ideology in the 20th century changed from laissez-faire principles to a collective ideology, which stressed upon community responsibilities as opposed to individual liberties. During the Second World War children were fostered out to safer communities and psychiatric Social Workers sought community based alternatives to asylums (Samways, 2002). In 1961 Errving Goffman theoretical study into psychiatric ‘total’ institutions found them to be dehumanizing, this study highlighted a real problem, public concern was growing for changes to be made to the current system of care. The 1968 Seebolm Committee investigated and recommend that there should be local community based family services, community participation and that through social planning local needs would be met (Samways, 2002).
By the 1980’s there was an alleged serious funding crisis, a Conservative government was in power after the 1979 election and Margaret Thatcher was the leader of the party. Under Thatcher’s influence New Right philosophy was the ideology of the party, it moved away from the Collective ideology of the past and dispelled the ideas of universal care for all by the state. Although it did believe in the principles of Community Care, its future implementation would be ‘market’ based with the major contributors of its Community Care services to be provided by the independent sector.
The Conservatives policy ‘Priorities for the Elderly’ emphasised not care ‘in’ the community but care ‘by’ the community (Lewis ; Glennerster, pg 2, 1996). It also placed emphasis on support by family, friends and neighbours, reminiscent of feudalism period when the family was the support network, not realistic in a capitalist industrial society such as Britain. Feminist have argued that it also makes assumptions about who will be the main carers, it is assumed that women are ‘natural’ carers as women in a patriarchal society are seen as pivotal in caring, Finch (1994) rejects community care in favour of expanding institutional care on the basis that ‘family’ support in community care is basically care by women (Cowen, pg173, 1999).
During the 1980’s Social Service spending on residential care was escalating out of control, by the mid 1980’s the sum spent had risen from £10million to £500 million (Lewis ; Glennerster, pg5, 1996). In 1988 Sir Roy Griffith Thatcher’s advisor reported on the way in which public funds are used to support community care and how this could be improved. Griffiths recommended that the Social security payments to individuals for care should cease and the sums be transferred to Local Authorities. The primary function of the public services would be to design and arrange the provision of care, this provision of care should come from a variety of sources, and a ‘mixed’ economy should be implemented with Social Services as the lead agency.
The Griffiths report was followed by a White paper, called ‘Caring for People’, this subsequently led to the 1990 NHS and Community Care Act, and it implemented Griffith’s recommendations except ‘ring fence’ funding and Community Care Ministers (Samways, 2002).
The 1990 Act was one the most influential in the history of community care, it meant a major restructuring of Personal Social Services, community care would now consist of a managed market, and Social Workers were now recast as Care Managers. These new roles adopted two slices of much broader Social Work roles, firstly the individualistic counselling Social Work role and the Community Social Work social care planning role, they would have a selection of individual cases which would benefit from intensive assessment, resulting in the best possible pattern of service to the individual (Payne, pg81, 1995). Responsibility lay with them to present a ‘seamless’ service to the client by a purchaser provider split, negotiating with a variety of agencies to provide the most appropriate service to the individual, collaboration of all three of the ‘welfare giants’ (Social Services, NHS, Accommodation) was paramount in providing an efficient service to the end user.
The were many changes to Personal Social Services after the implementation of the 1990 Community Care Act, most of these changes happened to quickly, departments were reorganised practically overnight, mass confusion was experienced by many departments affected by the act. However there were those that felt some of the vital changes aided the community care service, the public sector it was felt emphasised conformity, and administered rather than managed services. It was also felt that the public sector has a wider stakeholder interest than the private sector, moreover it was thought that the private sector works with a clearer conception of its customers, in the public sector, it is difficult to define exactly who the customer is, due to the existence of customers, clients and consumers (Dopson ; Steward, 1990, cited in Hudson, 1994). Quasi-markets were used to encourage competitive behaviour and choice rather than profit; services were arranged on a contractual basis, determining all aspects of the relationship, this stimulated greater choice for service users and increased consumer rights (Cowen, pg89, 1999).
Unfortunately it was the contractual agreement that was to be an Achilles heel for voluntary services, their existence uncertain with the change from grants to contracts and service agreements. The Governments move to the markets and contract culture had political reverberation regarding the voluntary sector, Reading (1994) argued ‘the political teeth of voluntary organisations have been extracted’ the direct responsiveness to the service user was endangered as they become totally reliant on the local authorities for finance (Reading, 1994; Wistow, 1994, cited in Cowen, 1999).
Voluntary organisations are not consistently the same in all geographical areas, there are definite spatial variations throughout the country, and this would hinder them in providing a universal service for all, also it is important to note that not all voluntary services attract the same public sentiment, hence donations may vary depending on how the service appeals to the public and also those in charge of statutory funding (Reading, 1994).
The private sector is also affected by spatial variations; again they cannot provide a universal comprehensive service. There is also the concern that the private sector’s first motivation is self interest and not the provision of community service. Individuals in need of care that were deemed to be to expensive would be off loaded, the private sector does not want to take on users that are to costly, and that may require expensive medication or drain labour resources. ‘Consumer empowerment’ never fully developed as it was subject to class position and geographical location, Marxist argue that conflict and class divisions is caused by the existence of differing relationships to the means of production (Samways, 2002).
Collaboration was another thorn in the side of community care, in rhetoric it was appeasing but in reality it was a lot more complex to achieve. Collaboration was intended to produce ‘seamless care’ unfortunately due to the different nature of the organisations of health and social services in terms of priorities, accountabilities and structures ‘seams well stitched together’ might have been a more appropriate goal according to Lewis & Glennerster (1996).
What has changed since the dawn of the New Labour government, led by Tony Blair in 1997? Thatcher’s legacy is still with us and will remain so for some time. New Labour’s ideology is centre left, they believe there is a place for welfare pluralism but with the state in a stronger position then Thatcher’s ‘filling in the gaps’. At the time of writing there are no specific changes to community care policy by the New Labour government, however there was a Royal Commission report in 1999 Long Term Care, originally set up to answer critics and there disquiet about the decline of hospitals and the impact of the 1990 Act had on community care. The report was released in 1999 and set forth the following view point on the current system;
“The commission is clear about the strong lack of trust in the current system, there are pronounced feelings that Government was meant to underwrite the system in some universal sense through taxation, and it has not done so. Delivery by Local government, with its less centrally controllable system of finance, which produces variations in the implementation of the funding system, contributes to unease. The current system is failing; more needs to be done to spread good practice nationally’ (Royal Commission, 1999)
The Royal commission independent report highlights the main problems, the lack of a universal system, less controllable system of finance and the need to comprehensively and universally have good practice in all geographical areas. Unfortunately the restructuring that Personal Social Services underwent through the implementation of the Community Care Act of 1990 did nothing substantial to ensure that this would happen. It was a haphazard process which put too much pressure on the independent sector to manage and successfully control a welfare system which had been evolving for at least two hundred years.
To conclude the negative consequences far out way any aids that might have been experienced during the turbulent years in which the Community Care Act of 1990 was enforced, Personal Social Service’s came under enormous pressure to perform in its new role as both purchaser and provider of services with no real support network, their new role as aforementioned was not eased through collaboration with other agencies, it resulted in a system which was fraught with difficulties, Personal Social Service was hindered by the Community Care Act of 1990, not aided.