Introduction

The previous chapter outlined the modernisation agenda of the present government for the welfare state and its broad implications for services for older people. This chapter begins the process of exploring the roots of some of the issues that need to be tackled by examining the growth of home care services from 1971 to 1993 in the four case study areas (a London Borough, two English Counties and a Metropolitan Authority).

The community care reform elements of the 1990 NHS and Community Care Act were justified by the Conservative government on the grounds that existing provision was service driven, rather than user centred, and that much needed to be done to support people to live in their own homes, rather than allowing them to drift into institutional care (DoH, 1989a, 1990).

Chapter One indicated how this view of the rationale for the community care reforms was completely rejected by some commentators. Sceptical observers saw the changes as a mechanism to cap the public expenditure costs of residential and nursing home care (Hudson, 1990; Lewis and Glennerster, 1996) and to put much greater emphasis on charging and self-provisioning than hitherto. Dominelli and Hoogvelt (1996, p 52) claimed that the 1990 Act brought the market and the contract culture into social work and commented how “social workers are increasingly drawn into becoming managers and accountants, with their time spent pushing paper and pen, or should we say exercising their fingers on the keyboards of their computers, rather than in direct work with users”. The community care reforms were seen by many as having undermined a rights-based and free system of care, which was being replaced by an approach driven by the need to ration and to charge, and controlled by managers whose central concern was to stay within budget rather than to meet need. The resultant growth of charging and means testing for domiciliary services since the early 1990s was indeed a major source of anger and frustration for many service users and disability groups (Baldwin and Lunt, 1996; Chetwynd et al, 1996).

This chapter takes a detailed look at home care policy and practice in the period that preceded the 1990 reforms.