Policy proposals published in England during 2005 emphasise the importance of ensuring that older people and adults needing care achieve ‘independence’ and are given ‘choices’ consistent with their own well-being. Indeed, the Green Paper on social care is entitled Independence, well-being and choice: Our vision for the future of social care for adults in England (DH, 2005). This chapter will first explore how far the interpretation of the complex and fluid concepts of ‘independence’ and ‘choice’ reflected in current policies is adequate ‘to secure the dignity and quality of life of older citizens, and to ensure that they receive the support they need in the place, and manner they prefer’ (Baldwin, 1995, p 138). This exploration will be placed within the contexts of the growing emphasis on individuals as consumers rather than as citizens; the increasing identification of ‘active citizenship’ with being in paid employment; and the increasing commodification and marketisation of care services. In particular, current policy developments in domiciliary and residential care services will be examined to illustrate some of the contradictions and dilemmas that arise in these contexts, which are very different from those of the post-war British welfare state.

The ‘active’ and ‘independent’ citizen

As Lewis argues in Chapter Two, by the end of the 20th century the solutions to poverty, welfare dependency and the rising costs of pensions being advocated in many advanced industrialised societies were for more adults to become and remain active in the labour market. In 1999, the Organisation for Economic Co-operation and Development (OECD) published a report A caring world: The new social policy agenda. As well as advocating the combination of employment-oriented social policies with family-friendly policies so that parents could more easily combine care and employment, the authors of the report argued that countries should develop ‘an active ageing policy’. This would include: