From community care to market care? : the development of welfare services for older people, 1971-1993

This study reflects a growing recognition of the contribution that studies of the post-war "welfare state" can make to contemporary debates about the restructuring of welfare. Drawing on the community care debates from 1971 to 1993, it illuminates contemporary concerns about such key issues as rationing care, the health and social care divide, the changing role of residential care and the growing emphasis on provider competition. "From community care to market care?" focuses on the interpretation and development of national policy at local authority level in four contrasting local authorities. The authors outline the development of welfare services for older people from 1971 to 1993, and explore whether service developments in this period were as inadequate as claimed by the proponents of radical change. The continuities and changes in the pre- and post-1990 NHS and Community Care Act systems of community care are also examined. The results of the study should make a significant contribution to the community care provision for older people. The book will be of interest to academic, policy and practitioner audiences. FROM COMMUNITY CARE TO MARKET CARE?......Page 2 Contents......Page 6 List of tables and figures......Page 7 Advisory Group members......Page 9 Acknowledgements......Page 10 Background to the book......Page 12 The Griffiths Report and the reform of community care......Page 13 Research objectives and methodology......Page 17 Introducing the rest of the book......Page 20 Establishing social services in the early 1970s......Page 21 Introduction......Page 24 Meeting manifesto commitments......Page 25 Modernising local authorities and social services......Page 27 Modernising the health services......Page 31 Understanding the Third Way in public policy......Page 33 Modernising community care for older people: key issues with long histories......Page 35 Introduction......Page 38 Home care prior to 1971......Page 39 Towards a right for free home care?......Page 42 From boom to bust......Page 45 Towards the targeting of home care services?......Page 49 Conclusion......Page 56 Introduction......Page 60 Large-scale production of new homes in a land of plenty?......Page 61 The challenge of increasing dependency......Page 65 Responding to the challenge of the independent sector......Page 69 Conclusion......Page 80 The policy and organisational context......Page 84 Defining in need of care and attention, 1948-71......Page 88 Reducing continuing care beds......Page 90 What is health care? What is social care?......Page 93 Joint finance and joint planning......Page 99 Dementia struggles......Page 101 Working relationships: an overview......Page 103 Conclusion......Page 106 Introduction......Page 110 The voluntary sector and older people in the 1960s......Page 111 The traditional voluntary sector and older people......Page 112 The growth of independent residential and nursing homes......Page 120 Time limited grants, new service provision in the community and the voluntary sector......Page 125 Towards a contract culture?......Page 127 Voluntary organisations as the voice of older people......Page 132 Conclusion......Page 136 What are quasi-markets?......Page 140 Implementing quasi-markets in community care: an overview......Page 141 Towards a purchaser–provider split?......Page 146 Contracting with the independent residential and nursing home sector......Page 156 Assessment, care management and eligibility for services......Page 161 Conclusion......Page 168 A lack of policy direction? A lack of priority?......Page 174 Paying for long-term care? The role of long-term care?......Page 176 What is the boundary between health and social care? What is the future of social services?......Page 178 Planning versus markets? Mixed economy or privatisation?......Page 182 Economic imperatives......Page 185 Nothing changes? Everything changes?......Page 186 References......Page 190 Index......Page 204

This study reflects a growing recognition of the contribution that studies of the post-war 'welfare state' can make to contemporary debates about the restructuring of welfare. Drawing on the community care debates from 1971 to 1993, it illuminates contemporary concerns about such key issues as rationing care, the health and social care divide, the changing role of residential care and the growing emphasis on provider competition. From community care to market care focuses on the interpretation and development of national policy at local authority level in four contrasting local authorities. The results of the study will make a significant contribution to our understanding of the community care provision of older people.

This study focuses on the contribution that studies of the post-war 'welfare state' can make to debates about welfare. Drawing on community care debates from 1971 to 1993, it illuminates contemporary concerns about such key issues as rationing care, the health and social care divide, the changing role of residential care and the growing emphasis on provider competition. This study reflects a recognition of contributions studies of the post-war 'welfare state' make to contemporary debates about the restructuring of welfare. It illuminates concerns about key issues such as rationing care and health and social care divide.