Wednesday, 21 July 2010

Will History repeat Itself? (Big Soceity & Care in the Community)

On paper David Cameron’s "Big Society" looks a quite attractive policy for a decentralist  like myself, but in reality it is a policy to transfer power to voluntary groups which will be run by the sort of people that the Con-Lib coalition approve of. You can bet your life no group that advocates any form pf democratic participation bases on socialist principals will be allowed.

I am  reminded of another Tory Policy "Care in the community" which was introduced in the late 1980.s with the claim that it would end institutionalised care.

The basis behind "Care in the Community"  was intended,

To cap public expenditure on independent sector residential and nursing home care. This was achieved in that local authorities became responsible for operating a needs-based yet cash-limited system.

The Plan was to having a mixed economy of care, i.e. a variety of providers. The mixed economy provision in residential and nursing home care would be maintained despite the social security budget being capped. And there would many independent organisations providing domiciliary care services.

The main aim was to redefine the boundaries between health and social care. Much of the continuing care of elderly and disabled people was provided by the NHS. Now much of tha this would  re-defined as social care and is the responsibility of local authorities.

An important point to note however was that NHS services a was free, whereas social services have to be contributed . so some people could be charged under Care in the Community where they had previously received it free under the NHS or the local authority could pick up the bill by means testing

Means and Smith ( Bristol University (1989) claimed that the reforms:

Introduced a system that is no better than the previous more bureaucratic systems of resource allocation

Were an excellent idea, but received little understanding or commitment from social services as the lead agency in community care

the enthusiasm of local authorities was undermined by vested professional interests, or the service legacy of the last forty years

health services and social services workers have not worked well together and there have been few 'multidisciplinary' assessments carried out

in reality little collaboration took place except at senior management level

the reforms have been undermined by chronic underfunding by central government .

the voluntarily sector was the main beneficiary of this attempt to develop a "mixed economy of care"

What we saw under the Care in the Community agenda was sick people being made homeless wandering the streets as social services fought with limited budgets to deal with a crisis which should have been dealt with by the NHS and supported by central government.

It is clear in my mind that the major driving force behind this disastrous policy was to cut costs and so it will be with Cameron's Big Society.

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