The ‘mixing’ of the social care economy in the UK has been one of the most notable features of the past two decades, with attention initially focusing on changes to the balance of provision and more recently turning to the sources, balance and routes of funding. Throughout the past two or three decades there has been emphasis on shifting the administrative centre of gravity – initially towards and later somewhat away from local authorities. These broad changes are discussed in this chapter as a platform for considering current quite radical efforts to shift responsibility and power to service users – for example through direct payments and individual budgets – linked to the broader choice agenda and obviously with deep roots in social work practice and personal empowerment.

Introduction

As the other chapters of this book describe, almost every area of social policy in the UK has seen shifts in the balance of provision and responsibility over recent decades. Many areas have also seen changes in financing and expenditure routes. In some cases, those organisational and economic changes promise to alter the fundamental architecture of the policy area. Social care is no exception. Of all the various changes across the social policy spectrum, in fact, some in the social care area have been particularly adventurous in both intent and implementation. Most obviously, while the UK health system has been introducing a series of quasi-market structures since the early 1990s, the social care system has been forging ahead with real markets. And while the National Health Service (NHS) has been experimenting with money that follows the patients, the social care system is now handing the money over to service users so that they can decide how best to meet their own needs. New arrangements in the NHS will very gradually broaden patient choice, but the social care sector is experimenting with ways to promote user control. It is this latter policy area that is the main focus of this chapter.

Underlying these shifts in social care are a number of fundamental principles. One has been the long-term social work commitment to empowering marginalised individuals and groups. Another has been to emphasise the roles of families, although sometimes this admirable principle has been misused to dress up a policy of benign neglect.