Philip Haynes - Complex Policy Planning: The Government Strategic Management of the Social Care Market

Complex Policy Planning

The Government strategic management of the social care market

PHILIP HAYNES

Health and Social Policy Research Centre, University of Brighton

First published 1999 by Ashgate Publishing

Reissued 2018 by Routledge

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Copyright Philip Haynes 1999

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A Library of Congress record exists under LC control number: 99072606

ISBN 13: 978-1-138-61756-8 (hbk)
ISBN 13: 978-0-429-46161-3 (ebk)

This book seeks to investigate the development of planning in community care policy, that is, the provision of social care to adults in the community, and community based institutions, who suffer a long term illness.

Community care was never clearly and consistently defined and the political will, in the fonn of policy-making and planning machinery and especially resource allocation and reallocation were never mobilised to achieve it. (Walken 1989, p. 205).

The movement of health and social care services from institutions into the community has lead to attempt to differentiate between health and social care where health care is the domain of the NHS (National Health Service) and social care the jurisdiction of local authority social services. Bebbington (1996, p. 10) has proposed that:

health care interventions have the objective of ameliorating disability: for example, drugs or physiotherapy to improve mobility; while social care interventions are concerned with compensation or assistance to cope with the effect of the disability on daily life: for example, assistance with the problems caused by mobility difficulties such as shopping.

But in practice the rigid separation of health and social care is difficult to achieve and arguably a total professional separation is unhelpful to service users. Those placed in the community still have important health needs that can be provided for by the universal domiciliary nursing care of the NHS. The onset of long term illness often has disabling affects, with the result that social care is required. Social care includes a broad range of services that must be offered if a necessary quality of living is be maintained following the diagnosis of a long term illness. Social care can include such items as housing adaptations, maintenance and up-keep of the home, assistance with meals and personal hygiene, and assistance with social activities such as shopping and interacting with peers in the community. Social care is not only about prescribing for such material and psychological needs, it also requires a subjective definition of quality of life from the recipient (Clark, 1996, p. 162). What is defined by the individual as necessary to maintain a quality of social existence may be rather different to what another person requires. It is in part a recognition of the individuality of those suffering from long term illness that social care services have increasingly had to grabble with concepts like diversity and choice. The emphasise on these aspects of individuality is also the result of the pervading social ethos of the last two decades with the growth of individual expression, privatism, consumerism and market forms of social organisation.

When social care is provided in an institutional or residential setting it is easier for the material elements of health and social care to be fully integrated and for the inter-relationship of the two aspects to be monitored. The move towards community care and the policy aim to support people living independently as long as is possible (House of Commons, 1990) creates some important challenges for the planning and management of social and health care if a fully integrated and a user defined quality of social care is to be provided. Professionals are concerned that a limited provision of social care that does not embrace health care needs will lead to increased occurrences of health care emergencies and missed opportunities to prevent the escalation and increased severity of disabling illness (House of Commons Health Committee 1995, Vol II).

With the attempt to remove social care responsibilities from the long stay NHS institutions, as increased demands and expectations were placed on health care expenditure, the state has tried to reinforce the universal perception that social care services are not free at the point of delivery. Since the 1948 National Assistance Act the involvement of local authority personal social services in assisting adults suffering long term ill health was based on a selective model of welfarism, where applicants were subject to assessment and means testing. The process of deinstitutionalisation and community care evident in the 1980s with its associated drift of social care provision from the NHS to local social services departments has increased the prominence of selective means tested social care rather than the universalist tradition of the NHS. Given the parallel growth in the older population and a higher incidence of disability this switch from universal provision to means tested provision has not gone unnoticed by the public and has been perceived as unpopular (Parker and Clarke, 1997). Policy options to include social care in a universal taxation based welfare system have not been seriously considered recently by either of the two major political parties in Britain. Before losing the General Election of 1997 the Conservative Party was moving towards encouraging private long term illness insurance by tax subsidy (Secretary of State for Health, 1996), this despite commentaries that argued such a scheme would leave many people unprotected (House of Commons Health Committee, 1996; Wistow, 1997). Other policy proposals that attempt to keep the organisation of funding outside of the state domain and look to release capital and property value late in life, such as equity release schemes, have similar problems of social exclusion (Oldman, 1991). More imaginative recommendations have come from the Joseph Rowntree Foundation (1996) who argue for a partnership approach where the state is willing to take substantial responsibilities. Such an increased element of planned state involvement is seen as inevitable if policy is to offer a diversity of care to all social groups and minorities.

Planning in social policy has been traditional linked with corporate ideas of monolithic provision, with essentially large bureaucratic processes delivering welfare to the public (Walker, 1984, p. 1). The accountability of such planning in western democracies was intended to be political and sustained via central and local government representative elections. But in the 1970s the weaknesses of such simple political lines of accountability became apparent with the process of monopolistic state bureaucracy and professionalism itself dominating much of the decision making over service delivery (Niskanen, 1973; Tullock, 1976; Dunleavy, 1991). This led to policy scientists and politicians seeking alternative models of service delivery that gave more resources to private and voluntary organisations.