It would require a breathtaking combination of naivety and gullibility to deny the central point of Ferguson and Lavalette's argument: there is indeed a crisis in adult social care in the early years of the 21st century. As I am, I hope, neither naive nor gullible I would not wish to position myself as a crisis-denier – in fact I take the view that the crisis has been several decades in the making, and that successive governments have ducked or misrepresented the problem. From my analysis this is not a tale from which any political party emerges with credit.

Consequently, I don't wish to contend any of the core points of their argument: rather, I intend to expand upon four issues that typify the problems that beset adult social care. Each of these separate themes is given added force when placed in the political context outlined by Ferguson and Lavalette. The first section will examine the principles that have suffused the two major changes of the last 20 years – community care and personalisation – alongside the limited and flawed evidence that has attended their introduction. This will be placed into a financial context: indeed, I will argue that a failure to grasp the financial nettle is the single biggest failure of policy in relation to adult social care. Finally, I will address the matter of regulation – closely involved in the Winterbourne View and Southern Cross scandals, with a particular link to the previous section being that the proper financial consequences of effective regulation have never been grasped.

Principles

The first objective of the Community Care White Paper was ‘… to enable people to live in their own homes wherever feasible and sensible …’ (DH, 1989, p 5). This is important for an understanding of how the policy came to be widely accepted. For many, the avoidance of any form of institutional care was paramount, a principle that appeared to be placed at the forefront of policy. However, its implementation did not accord to this ideal as the realities of finance – expanded below – took precedence. Subsequently, much rhetoric that accompanied proposals to change the nature of care services focused on the failure of community care to live up to its high ideals (see ODI, 2008).