It is appropriate to be writing this at the fag end of the
pantomime season. Social care truly is the Cinderella, ugly sisters
and general king rat of public services all rolled into one. It
includes the most devalued profession – social work. It must have
the highest proportion of minimum wage jobs of any employment
sector, except catering and refuse disposal.
The truth is, it has long been treated as the equivalent of a
refuse disposal unit for those seen as past their sell-by-date;
defective, dodgy or damaged goods. These are also those – the “poor
kiddies”, “old folk”, “lovable learning difficulties” and, of
course, the heroic “disabled” – who are meant to have the best pull
on society’s heartstrings. No wonder the sickening £8 an hour
street charity hustlers use the stereotypes mercilessly to fill
A massive task of regulation is still needed to stop organised
charity trading on a 19th century narrative based on a mixture of
“poor thingism”, impossible claims and self-aggrandisement. (All
charity appeals should include a health warning stating the
salaries of chief executives and senior managers.)
The government, meanwhile, is coming under increasing pressure over
social care, with continuing problems of staff recruitment and
retention, bed-blocking, inadequate training, unmet need and
services that aren’t good enough.
But this government has sought to treat social care with equality.
It has put in place the same kind of structures, standards and
philosophy for social care as for other health and welfare
services. Social care has not been treated as inferior to other
services. The government has appointed a succession of good
ministers – the kind who go up not down. It has made a
ground-breaking commitment to user involvement in all aspects of
the new social work degree. It has tried to break a disastrous
half-century circle of policy formation based on public scandal and
inquiry. Such a new approach could at last free social care from
its poor law past.
Of course there are old and new dilemmas to be dealt with. For
example, how to ensure there is never again a tragedy so
preventable as that of Victoria Climbi”s death, how to advance
integration without social care becoming lost in health and how to
make “welfare to work” a liberating ideal, harmonising benefits and
employment, rather than a rerun of old compulsions.
New Labour’s programmatic approach to policy has engendered some
positive initiatives in some places at some times. What is now
needed is funding and support for face-to-face workers to sustain
and make this mainstream.
The extension of direct payments schemes offers the basis for
another success story.
At a time like now, when, sadly, minds are focused more on war than
health and welfare, it is worth remembering two key military adages
here. First is the importance for success of getting as much to the
“tip of the arrow” and second of getting there “fastest with the
The message for the social care sector is clear. It’s not what’s in
the rear that counts, but what’s at the front. This means focusing
less on reorganisations, restructuring, new bodies, buildings and
capital projects, and much more on how many workers, direct
services and support arrangements there actually are at the point
of delivery; how suitable, reliable and flexible they are and how
well backed up. These are the statistics we really need.
Finally, we need to face up to some of the fundamental tensions in
the New Labour public policy approach. Although the political focus
has been on health and hospitals, it is perhaps in social care that
these are now emerging most sharply. There are the tensions between
devolution and central control, private and public provision and,
perhaps most important of all, between managerialism and user
Soon we shall have to be honest with ourselves that top-down
managerialism and bottom-up involvement and empowerment do not go
well together. The government has wedded itself to both, but it is
unlikely it can have it both ways. At some point a decision will
have to be made.
The issue for government social care will be how far it is able to
make its new social care aspirations, structures and budgetary
allocations consistent with user involvement and user-led services.
If it can, we shall begin to have a basis for enduring practical
policy and for the kind of social care support and services that
people want and will defend.
Peter Beresford is professor of social policy, Brunel
University, and is involved in the psychiatric system survivor