Background to the book

The UK government’s approach to meeting the health and welfare needs of older people continues to be highly contentious, despite the publication of a national service framework for older people (DoH, 2001b). For example, one response has been a report calling for ‘a new social compact for care in old age’ (Robinson, 2001). It would mean that we are as uncertain as ever about the health and social care divide, the appropriate role of long-term care and how best to fund services. This book contributes to these contemporary debates by reflecting critically on the long historical roots of these issues and the difficulties faced in throwing off the legacy of the past.

This book is in many ways a sequel to From Poor Law to community care: The development of welfare services for elderly people, 1939-71 (Means and Smith, 1985, 1998a). This was originally published by Croom Helm in the mid-1980s, but a much later second edition was produced by The Policy Press. The earlier book traced the roots of all those services, which were to become the responsibility of social services authorities from 1 April 1971, and had at its core an exploration of the long history of neglect of services for older people. The new book continues the story through to the implementation on 1 April 1993 of the main community care changes introduced by the 1990 National Health Service and Community Care Act.

The assumption of both books is that the study of contemporary history can illuminate the present, and that it can do this by helping us to sharpen our appreciation of the continuities and discontinuities of present policy and practice with the past. The early 21st century is a very good time to reassess the necessity for such long-term perspectives, which are not underpinned by myths of either the golden age of municipal socialism or the evils of Thatcherite privatisation. The Labour government elected in May 1997 initially appeared to have a modest programme of welfare reforms (Means and Smith, 1998b), but this has proved to be far from the case because of a modernisation agenda every bit as complex and farreaching as the privatisation and quasi-market reforms of Conservative governments during the 1980s and 1990s.