The “Modernising Social Services” report (Secretary of State for Health 1998) concerns New Labour’s policy for improving social services that emphasises the important role this plays in helping people deal with personal crisis and life-changing events. In this report, social services were criticised for not previously meeting public expectations in key areas including:
Inconsistencies in provision across the country.
Inefficiencies in effective use of financial budgets.
A lack of public awareness of what services should be available by whom.
Insufficient safeguards to protect vulnerable children.
Failures in co-ordination where, for example, local authorities disagreed on which body should be responsible for care.
Inflexibility as regards individual needs and circumstances.
To rectify these deficiencies, the report recommended improvements in all the areas listed. For example, with the elderly, this was to involve awarding payments directly to those aged 65 and over, thus promoting greater personal control as well as reshaping services to initiate greater independence and reduce inactivity. A long-term care charter was also to be introduced to further individual needs with assessments to gauge customer satisfaction. Children’s services were to be improved by introducing robust new inspection regimes for care with a national register to prevent undesirable individuals from working and coming into contact with children. Similar safeguards were to be introduced for the mentally ill. To achieve the required standards, new qualifications and training of staff were to be introduced and legislation enacted to improve liaison between various relevant bodies such as health and social services. An annual government report was to be established monitoring service delivery by both local authorities and social services with action taken where standards failed to meet requirements. To finance these changes, annual funding was to be raised by 3.1 per cent per annum over three years and a Social Services Modernisation Fund inaugurated where funds were to be focussed on key areas. The report hoped that these initiatives would lead to real improvements in services covering all the sectors specified leading to a restoration of the public’s confidence but concluded that this modernisation would be a long term process of which the report represented just one step towards attaining significant improvements during the early part of the 21st century (section 8.1 and 8.2).
Previous policy towards social care
Although the health service had been comparatively successful in improving health up until the beginning of the 1980’s, it became a victim of its own success as those cured of present illnesses became ill at an older, more vulnerable, age (Glasby, 2007 p. 33) leading to greater pressure on social services in general. To offset the spiralling costs, the Thatcher government, which came to power in 1979, thus moved away from care provided by government bodies to a system based more on self reliance predicated on the notion that the demands of welfare was affecting the UK economy (Alcock 1996). This led to various market-based reforms in response two reports (Griffiths 1983, 1988) where integrated management structures were recommended at all levels of both the NHS and social services where the emphasis was to be on efficiency. In addition, the amount of funding available for the NHS reduced and ways were implemented to improve efficiency and service provision that culminated in a government White Paper (Dept. of Health 1989a) that saw the introduction of the internal market and the purchaser/provider divide. Similarly, in social care, social service departments were to both plan and organize community care with local authorities acting as purchases of the different care facilities available – a scheme that has been criticised for transferring the increasing government budget onto local authorities despite the apparent aim of the Caring for People reforms (Dept. of Health 1989b) that sort to empower individuals by providing greater choice. The extent of the government’s limited response to these and other recommendations can be gauged by Griffiths (1992) – the author of the two Griffiths’ reports – criticism of the lack of positive action. The government’s policy was also criticised because, with a shift of responsibility to families, voluntary organizations and individuals themselves, a means was provided whereby privatisation could be promoted and free care reduced (Baggot 2004, p.276). The result of these policies was that by 1989 the share of private and voluntary organizations had expanded to cover half the long term provision for care of the elderly. Moreover, those reforms introduces as a result of the Griffiths Report led to defensive management and reduced morale among professionals working in social care during the 1990’s (Baggot 2004 p. 279).
Policy under New Labour
With the election of New Labour in 1997 a “third way” was offered as a means of bridging the divide between right-wing reliance on market forces and the more socially driven attitudes of the left. This culminated in the 1998 report on social care that came out of the Labour parties wish for “joined up government” that endeavoured to link the various agencies together, especially services to do with health and social welfare – two departments that had previously operated as relatively separate entities (Glasby 2007, p. 7). Thus, interagency working became one of the main areas of concern after 1998. The reality, however, seems to indicate that there were important changes as well as continuities with previous policies (ibid p. 36). Thus, there was an undertaking to stay within previous spending limits but the internal market was abolished. Later, however, spending limits were broken with large increases in expenditure and the internal market was replaced with a similarly functioning primary care commissioning system. In this respect, the government expressed the wish to build only on that which had previously proved effective (Dept. of Health 1997). One policy that continued accordingly involved the closing of large institutions that helped to deinstitutionalise the attitudes of inmates and staff (Baggot 2004). The policy of community care was hence strengthened whereby individuals from groups such as the mentally ill, the elderly, those with learning difficulties, etc., were given more say in decisions about care and the various options for living in the community or at home. Glasby (ibid), however, has criticised the concept of community care because, although facilities became more human in scale and community oriented, they still tended to be institutional in outlook with the previous ethos in relation to providers and users continuing to prevail well into the 21st century. In addition, up to 2001, there were still obvious disparities in delivery of policies across local authorities. Despite this negativity, government publications such as “Valuing People” (Dept. of Health 2001) had, at least, shifted emphasis by highlighting the main issues.
The trend whereby the independent sector took charge of residential and nursing homes continued, however, to the extent that nearly all commercial and voluntary organizations now came under independent control – a trend also reflected in home care where independent involvement had increased to about fifty per cent by 2002 (Baggot 2004, p.282). The tendency towards more central government control in monitoring social care and the integration of services also continued but there were strong criticisms as regards the regulation of care homes (Fahey et al 2003). A series of regulatory acts during from 2000 onwards, however, attempted to remedy this situation (Baggot 2004, p. 292) and a performance framework was introduced with a “Best Value” system to gauge efficiency that was later censured for emphasising cost over quality.
Although there have been many recommendations for change to social services since the 1980’s, the application of these to the real world has been piecemeal and often influenced by political expediency. The move towards independent provision during the Conservative period, although well intentioned, led to a cutback in funding with problems concerning standards and monitoring with the move towards care in the community leading to difficulties of integration of services across providers and communication between professional groups. With the arrival of New Labour, the policy of care in the community continued with attempts at greater integration, improvement of standards, and increased monitoring leading to different levels of success. Regional variations in provision continued and the rhetoric was not always met with real change that may be a consequence of the fact that long-standing attitudes continued to influence actual policy. Moreover, the move towards care in the community has still not been matched by corresponding high quality services or adequate liaison between professional groups and providers to the extent that the aims of the “Modernising Social Services” report still remain to be achieved. Ultimately, it seems a paradox continues to exist between an approach where people are regarded as citizens having equal rights to service that is opposed to the alternative whereby individuals are viewed as customers with the right to choose a “product”. Continuing tensions relating to this dichotomy may be the source of ongoing shortfalls in provision that have led to ongoing problems with regard to local health and social service integration. Nevertheless, as the report on “Modernising Social Services” has emphasised, improvements to the system were expected to be a gradual stepwise process which seems to be confirmed by the various measured enhancements in services to date.
Alcock, P. Social Policy: Themes and issues. Basingstoke: Macmillan.
Baggot, R. 2004. Health and Health Care in Britain. Palgrave: Houndmills.
Dept. of Health. 1989a Working for patients. HMSO: London.
Dept. of Health. 1989b Caring for people. HMSO: London.
Dept. of Health. 1997. The new NHS: Modern, dependable. The Stationary Office: London.
Dept. of Health. 2001. Valuing People: A new strategy for learning disability for the 21st century. The Stationary Office: London.
Fahey, T., Montgomery, A., Barnes, J. and Protheroe, J. 2003. Quality of Care for Elderly Residents. in Nursing Homes and Elderly People Living at Home: Controlled Observational Study. British Medical Journal. 326. pp. 580-583,
Glasby, J. 2007. Understanding Health and Social Care. The Policy Press: Bristol.
Griffiths R. 1983. NHS management inquiry (The Griffiths Report). DHSS: London.
Griffiths, R. 1988. Community care: Agenda for action (The Griffiths Report). HMSO: London.
Griffiths, R. 1993 Seven years of progress – general management in the NHS. Health Economics. 1 (1): pp. 67-70.
Secretary of State. 1998 Modernising Social Services – Promoting independence. Improving protection. Raising standards. The Stationary Office: London.