Monday, 30 January 2012

The evolution of social care

When capitalism developed, apart from the rich only those who were able to work had any real means of providing for their needs. Workhouses, orphanages, asylums and long-stay hospitals were built to 'warehouse' anybody who could not play a productive role in the factories and farms.

Ironically, the early pioneers of this kind of segregated 'care' believed they were doing 'good', looking after the needy and vulnerable cast-offs of society. Many institutions were run by religious orders or philanthropic business people but the large institutions became synonymous with abuse and neglect.
In the 1970s and 1980s, disabled people started to speak up and argued for radical change. They wanted the same social, political and civil rights as the rest of society. Many called for the closure of the large institutions and for disabled people (also people with mental health problems, learning difficulties and elderly people) to have more independence.
They argued against the medical model of dependence and institutionalisation and for a social model of inclusion and equality. Slogans, such as "Free Our People" and "Piss on Pity", appeared on the T-shirts of disabled people at demonstrations across the country.
At the same time, a number of investigations were taking place into allegations of abuse and neglect in many long-stay institutions - one of the most notorious being Normansfield mental hospital in London.
The workers at Normansfield, the nurses and care assistants through their trade unions, blew the whistle on neglect and abuse. They went on strike in 1976 against the hospital management, demanding increased resources and the sacking of the top consultant. The investigation report commended them for their action. This is an excellent example of health and social care workers taking strike action in support of the people they care for.
The call for the closure of the large institutions coincided with the election of Thatcher's Tory government and the beginning of a determined attack on our public services which has continued under New Labour. The Tories saw this as a great opportunity to make massive savings in public expenditure.
Closing the institutions was to save the public purse millions of pounds. Although there has always been a range of care providers, including businesses and informal (unpaid) care provided by families, this was the start of the major involvement of the third sector (charities and 'not-for-profit' organisations) in what has become known as the 'mixed economy of care'.
The NHS and Community Care Act 1990, under the cloak of 'promoting independence, freedom and choice', sounded the death knell for publicly-run social care.
Social workers became care managers, whose job was to assess people's needs and then to source appropriate services from the 'market'. Care managers had to prioritise charities and businesses when looking for providers of care services and to find the cheapest bidders - compulsory competitive tendering of human services.
Now we have a system of open economic warfare between competing providers, constantly cutting costs, quality of care and staff wages to bid for lucrative social care contracts. Social workers (care managers) have become gatekeepers for scarce resources, forced into commissioning roles they were never trained for and drowning in mountains of financial accounts and paperwork they never imagined when doing their social work training.