Introduction

Historically, the UK, Germany and Sweden have been understood as the archetypes of three contrasting welfare state models. The structural convergences of all three countries’ welfare systems have been driven by efficiency-motivated state interventions, market competition and customer choice, leading to growing disparities in access. This chapter will discuss the impact of these changes in more detail on a national policy level. The discussion will focus on the UK, setting the context for examining the individual experiences of older people and health care staff in Chapter 5. The chapter starts with a discussion of contemporary health and social care policy, including austerity policies. Following this, austerity measures will be considered in terms of the impact they had on the Health and Social Care Act 2012 and the Care Act 2014. The subsequent sections examine the privatisation of health and social care, focusing on the failure of two of the biggest privately run care conglomerates: Southern Cross and Four Seasons. Then the neoliberalisation of the home care sector will be considered, followed by a discussion of adult social and health care workers’ precarity. Finally, the chapter will discuss the ‘dementia tax’ proposed by Theresa May's Conservative government, Brexit, as well as some of the initial health and social care policies under Boris Johnson's prime ministership.

Austerity policies

The 2007–8 global economic crisis led to a financial market crash, lower income tax revenues and higher public debt (Jack, 2017 in Glasby, 2019). In the lead up to the 2010 election, the Conservative Party blamed the financial crisis on what it described as New Labour's ‘irresponsible’ economic and fiscal policies, which included investment in public services (Lee, 2011). Further, David Cameron argued that public-sector investment had eroded the ‘natural’ individual characteristics of duty and responsibility (Lee, 2011). This political rhetoric contributed to the Conservatives’ success at the polls, although they did not get an overall majority in Parliament (Bochel and Powell, 2016). The Liberal Democrats successfully pitched themselves as a viable alternative to the two main parties, gaining 24 per cent of the vote with eye-catching headline economic policies, such as the abolition of tuition fees (Bochel and Powell, 2016).