Adult Social Care

Ferguson, Iain, Lavalette, Michael

• Publisher: Policy Press
• Year: 2013
• ISBN:
  9781447315964
• Edition: 1
• Topic: Social Sciences
• Subtopic: Social Work
• Index: Social Sciences

Adult social care in Britain has been at the centre of much media and public attention in recent years. Revelations of horrific abuse in learning disability settings, the collapse of major private care home providers, abject failures of inspection and regulation, and uncertainty over how long-term care of older people should be funded have all given rise to serious public concern. In this short form book, part of the Critical and Radical Debates in Social Work series, Iain Ferguson and Michael Lavalette give an historical overview of adult social care. The roots of the current crisis are located in the under-valuing of older people and adults with disabilities and in the marketisation of social care over the past two decades. The authors critically examine recent developments in social work with adults, including the personalisation agenda, and the prospects for adult social care and social work in a context of seemingly never-ending austerity.

PART ONE

Lead essay

The crisis in adult social care

Iain Ferguson and Michael Lavalette

Introduction

Two stories dominated the British news media in the early summer of 2011. The first concerned Winterbourne View, a private hospital for adults with learning disabilities near Bristol. Undercover filming for the BBC Panorama programme in late May 2011 showed staff there involved in appalling abuse of vulnerable residents, some of it verging on torture. Residents were seen being pinned down by staff members, slapped, dragged out of bed and, in one case, doused in water and left outside in cold weather. The programme caused public outrage and some weeks later, the home, owned by the private care company Castlebeck, was closed by the Department of Health and a group of eleven carers subsequently charged with some 45 counts alleging ill-treatment against or neglect of five victims.

Hard on the heels of the Winterbourne scandal came the announcement of the closure of Southern Cross, with 37,000 residents in over 750 care homes, the biggest provider of residential care for older people in the UK. The announcement caused huge anxiety among the residents of its care homes, their relatives and Southern Cross workers, 3, 000 of whom lost their jobs. In echoes of the banking crisis of 2008, the state was forced to step in, with the Conservative–Liberal Democrat Coalition Government announcing that no resident would be turned out onto the street. In the event, many of the homes were subsequently bought out by Four Seasons, the second largest care provider (the financial stability of which was also the subject of considerable speculation in the financial press during 2011: Bowers, 2012; Scourfield, 2012).

Any suggestion that Winterbourne and Southern Cross were simply ‘bad apples’, anomalies in an otherwise high-quality social care sector, was quickly dispelled by a second Panorama investigation in October of the same year. That programme gave examples of four former Winterbourne residents being assaulted in their new homes, the homes to which they had been moved.

More systematic evidence came in a Care Quality Commission Review of Learning Disability Services in 2012 (CQC, 2012). That report was based on unannounced visits to 145 establishments: 68 NHS Trusts providing assessment and secure services; 45 independent health-care services providing assessment and treatment; and 32 adult treatment and secure services. These establishments were inspected against compliance with two outcomes:

• care and welfare of people who use services;
• safeguarding people who use services from abuse.

The Review found that overall levels of compliance were low:

• Almost half of all locations – 48% – were non-compliant with care and welfare of people who use services and safeguarding people who use services from abuse.
• NHS locations were nearly twice as likely to be compliant with both of the outcomes compared to independent health care service providers (68% and 33% respectively).
• The majority of assessment and treatment services were compliant with both outcomes (51%).
• However, there were more people (58%) in the services that were non-compliant.
• Residents tended to stay for much longer in independent/private homes than in NHS facilities.
• A lack of person-centred planning was a significant feature.

What these crises highlight is the extent to which the care of vulnerable adults, whether older people or those with a mental or physical disability, is now often in the hands of individuals and companies whose primary concern is not with the welfare of their clients and residents but rather with the generation of profit. What they also show, however, as do similar crises in the NHS, such as the events at Mid-Staffordshire Hospital exposed in the Francis Report in early 2013 (Francis, 2013), is the abject failure of the regulatory mechanisms put in place by previous New Labour governments supposedly to ensure that such things could never happen. As the Panorama programme revealed, the General Care Council, the main regulator for England and Wales, had been informed by a whistleblower on more than one occasion of the abuse that was taking place at Winterbourne and at other Castlebeck homes. But the Commission had failed to act on the allegations. As part of the fall-out from the programme, the Chief Executive of the Commission, Cynthia Bower, was forced to announce her resignation less than a year later, with a House of Commons Public Accounts Committee expressing serious concerns about the organisation’s ‘governance, culture and leadership’, including a culture of bullying against any staff members who spoke out (Public Accounts Committee, 2012).

However, while the examples referred to above represent the most visible face of the current crisis of social care in the UK, as we shall argue in this article, this is a crisis which touches on every aspect of care – residential, home care and day care – and affects every person who requires support for daily living. It is a crisis, we shall argue, whose roots lie in the conscious decision of Conservative governments in the late 1980s to open up social care provision to market forces. The rhetoric of ‘choice’ and the creation of a ‘mixed economy of care’ has been the smokescreen for a massive transfer of social care provision to the private sector, which means, for example, that whereas in the 1980s more than 90% of social care services were in local authority hands, the bulk of social care provision is now controlled by huge companies such as Four Seasons, Serco and G4S (Gosling, 2008/2011). However, while this has been a crisis in the making for more than two decades, it has attained new and unforeseen depths since the election of a Conservative–Liberal Democrat Coalition Government in May 2010. The decision of that government to cut more than £80 billion of public sector spending in 2010, £18 billion of which will come from welfare spending, with further cuts of £2.6 billion to local authority spending in 2013, represents the biggest assault on the welfare state since its creation in 1948 and has brought the social care system to the brink of collapse (Yeates et al, 2010; Wintour and Stewart, 2013). The impact of these cuts was graphically spelled out in a letter to the Observer newspaper in 2012 by a coalition of 33 leading British charities including the British Red Cross, Mencap and the Royal National Institute for the Blind:

The care system is in crisis. To deny this is woefully wrong. Without urgent reform, the social care system will fail the hundreds of thousands of people who rely on its services. Last week, Paul Burstow, the minister of state for care services, appeared before the health committee and told its members that ‘there is no gap’ in social care funding. We disagree. Every day, people tell us they are being let down by the care system – unable to access services, finding their care reduced and relying on family and friends to provide support. The government’s figures show that this year, local authorities have spent 4.5% less in real terms on social care for older people alone than the previous year. Yet the demand for social care continues to rise. And with the number of disabled adults also increasing, in a climate of cuts more and more disabled people are unable to get the support they need to live their lives independently and be part of wider society. (Observer, 22 January 2012)

‘Austerity’ is now the universally recognised term for the draconian cuts in welfare spending imposed by governments across Europe at the behest of governing financial bodies such as the International Monetary Fund and the European Central Bank in response to the global economic crisis that erupted in 2008. It is a response whose primary concern is to shift the cost of paying for that crisis onto the shoulders of the working class and the poorest sections of society, despite the fact that, as even the former Governor of the Bank of England has acknowledged, they played no part in the creation of that crisis (Kirkup, 2011; Lapavitsas et al, 2012).

As the situation in Greece is already showing, the deepest cuts ever inflicted on welfare spending will create levels of misery not experienced since the Second World War (Garganas, 2012). Later in this article, we shall explore some of the ways in which the Coalition’s cuts are now impacting on services in Britain. It would be wrong, however, to see the government’s current programme of welfare retrenchment as simply being about cuts. In her book The shock doctrine, the writer and activist Naomi Klein explored the ways in which governments exploit the public’s disorientation following massive collective shocks – wars, terrorist attacks, or natural disasters – to achieve control by imposing what she calls ‘economic shock therapy’ (Klein, 2008). In a much-cited example of Klein’s thesis, soon after the financial crisis broke out in 2008, Rahm Emmanuel, an adviser to Barak Obama, argued in an interview that:

You never want a serious crisis to go to waste. And what I mean by that is an opportunity to do things you think you could not do before. (Emmanuel, 2009)

Similarly, the sheer scale of the Coalition Government’s assault on welfare indicates that what is involved here is something much more fundamental than simply ‘deficit reduction’ (Ferguson, 2011). Rather, it suggests that the Coalition Government in the UK is precisely seeking to use the current crisis to make structural and strategic advances that would be more difficult to push through in ‘normal’ times and which will change the whole basis of the post-war welfare settlement: in Kimber’s words,

To force the market even deeper into society, increase privatisation, weaken workers’ collective strength, and make the welfare state serve capital rather than fulfill any of the needs of the majority. (Kimber, 2011)

The extent to which they can succeed in this aim, and how those of us who wish to defend decent social care services should respond, are questions to which we shall return in the final part of this article.

Before then, however, it is necessary to set the current crisis of care in its wider historical and political context. To do that we shall look first at the history of what is today termed ‘adult social care’ in the UK and where this has sat within changes to welfare policy within the development of capitalism in the UK. While there has never been a ‘golden age’ of welfare, it is nevertheless true that struggles from below (as well as reforms from above) have resulted in gains for working people (the NHS being the most obvious example) that need to be defended.

Secondly, we shall locate the roots of the current crisis in the market fundamentalist (or neoliberal) policies initiated by the Conservative governments of the 1980s, which for the most part were continued by New Labour governments from 1997 onwards.

If many of the problems that the social care system is currently experiencing stem from the neoliberal welfare policies of the past two decades, it is also true that the cuts to welfare spending currently being imposed by the Coalition Government have qualitatively deepened the crisis and, in the next part of this article, we shall look at some examples of how these cuts are destroying people’s lives and services.

In the period immediately following the 2010 election, the idea of the Big Society provided the overarching ideological framework for the welfare policies of the Coalition. In response, some social work commentators saw this idea as offering opportunities for the progressive development of both social care and professional social work. While the idea’s emphasis on ‘community’ can indeed appear attractive after two decades in which professional social work has been reduced to care management, we shall suggest that within a wider context of austerity, the progressive aspects of personalisation and community social work approaches have been subsumed by an agenda which preaches self-reliance and self-help to vulnerable individuals and resource-starved communities.

Finally, we shall look at alternatives. Much of the argument around social care has been framed in terms of what on what ‘we as a country’ can afford. The Dilnot Commission, for example, set up by the government in 2010 to make recommendations for ‘a fair and sustainable funding system’ for adult social care in England specifically ruled out funding social care out of general taxation on the grounds that it would be too expensive, offering instead a model of ‘shared responsibility’ (Dilnot Commission, 2011). Yet in its 2012 budget, the government felt able to reduce tax for the richest people in the country while its own figures showed that almost a thousand UK taxpayers earning more than £1m a year have a tax rate of less than 30% of their income, with the very richest often paying less than 10% and, according to HMRC, the 20 biggest ‘legal’ tax avoiders managing to reduce their income tax bills by a total of £145m in a year (BBC, 2012). In contrast to Dilnot, therefore, we shall argue that there is no shortage of money to fund a social care system ‘fit for purpose’ in the 21st century; the question, rather, is one of political priorities.

So far, we have referred to social care ‘in the UK’. Yet even within the UK, devolved governments in Scotland and in Wales have been able to develop policies which are less stridently market-oriented (albeit within an approach which remains broadly neoliberal). In Scotland, for example, personal care is available without charge for everyone aged 65 and over who has been assessed by the local authority as needing it. In addition, several of the key ‘reforms’ being implemented by the Westminster government such as the Health and Social Care Act 2012 and the Public Services (Social Value) Act 2012 will not apply north of the border (Mooney and Scott, 2012). To say this is not to paint what is in practice a mildly social-democratic Scottish National Party government as more radical than it is: the reason that that government wishes greater fiscal powers, for example, is to allow it to make Scottish capitalism more ‘competitive’ by reducing taxes for large multinational companies! Rather, it is to argue that governments can make political choices about how to respond to a global crisis. What choices they do make, of course, in the area of social care as elsewhere, will depend in large part on the influence that a range of social forces bring to bear on them. In the final part of the article, we shall consider the kind of alliances that will be necessary not only to defend existing services from further cuts and austerity but also to construct a more democratic and inclusive s...