Introduction

Social work with older people in the UK has only relatively recently emerged as a separate and distinct area of expert practice and provision, mostly in response to government reforms, which, in the 1990s, laid the foundations of contemporary policy and practice following the implementation of the National Health and Community Care Act (DH, 1990). This led to the creation of specialist systems of assessment and care management, prior to which older people accessed a wide range of generic social care services. While this gave rise to new optimism and belief that social work could make a positive contribution to the lives of vulnerable people within a community-based framework, significant debates have since drawn attention to the increasing complexity and uncertainty about the direction of travel being taken in social work with older people. This has been influenced by wholesale structural change, the unquestioning acceptance of the free market, neo-liberalism, as well as the universal adoption of economic rationalism, managerialism and fiscal restraint. Not least, a notable change in the retreat of government from its traditional role of provider and funder of care has led to greater promotion of individualisation within care provision while, at the same time, reducing eligibility for services (Ferguson, 2007). These developments pose enormous challenges, tensions and ambiguities for the orientation of social work with older people, where evidence is beginning to emerge of ever-widening inequalities and social exclusion (Grenier and Guberman, 2009). Both Ian Rees Jones and Paul Higgs (see Chapter Seven, this volume) and Christina Victor (see Chapter Eight, this volume) have already provided analyses that document the importance of socio-demographic factors in the experience of health and illness, the relationship between class health inequalities in later life, and the use of social work services. Those from less privileged backgrounds are more likely to be subject to the assessment and instrumental measurement of tasks and activities considered essential to their independence and the inequities and hierarchies of resource allocation involved. Victor further documented the strong association between the prevalence of disabilities and socio-economic position, as measured by a range of variables such as education, income and housing tenure.