History lessons

The community care component of the 1990 National Health Service and Community Care Act was meant to have set a clear direction for the provision of welfare services for older people (and for a wide range of other client groups) in the 1990s and beyond. Social services authorities were to be the lead agency with a responsibility to develop user-centred care management, strategic community care planning and a mixed economy of providers based upon a thriving independent sector.

However, the message of many commentators is one of Care in chaos (Hadley and Clough, 1996) as local authorities struggle to meet their expanded responsibilities within available resources. A key feature of these critiques is often a comparison of the limitations of the market ideology of the 1990 reforms (efficiency and consumer responsiveness coming from providers competing for ‘business’) with the more welfare-orientated ideology of the past with its emphasis on a right to free services. Thus, Dominelli and Hoogvelt (1996) complain of the move in social work from needs-led to budget-led provision and from the direct provision of services to the managing of services provided by others.

A rather different line of complaint has been articulated by the 1997 Labour government which has expressed enormous frustration at the continued failure of health and social services to work in partnership to the advantage of those elderly people with both health and social care needs (Means and Smith, 1998, ch 9). This is leading them to explore the potential of some kind of community care authority in which the resources of both agencies would be pooled, an approach which could be linked to the proposal in the NHS White Paper that purchasing in the health service should be driven at the locality level by general practitioners (GPs) and primary care groups (DoH, 1997).

As social scientists with a long-standing interest in the history of welfare services for older people, we remain more convinced than ever that these contemporary debates about future direction and current problems can be very helpfully illuminated by exploring the past.