The latest cover of Private Eye has Tony Blair peering through a magnifying glass exclaiming “Oh look – it’s my legacy”. As a crude summary of his contribution to social care, this would be just a little unfair.
Blair, or his government at any rate, has wrought enormous change on social care: it has been fundamentally restructured (in England at least) it has its own professional body social work has its own degree many – if far from all – of its service users have been lifted out of poverty and a market-driven, consumerist ethos has taken hold as never before.
If this is Blair’s legacy, social care has been transformed. Whether it is any richer for it is another question.
In contrast to his enthusiasm for health and education, Blair has displayed little interest in social care, unless as part of his determination to break up what he sees as monolithic public services and open them up to commissioner-provider markets.
In the literal sense, social care is richer – although nowhere near as much so as the NHS, where funding has increased nearly three-fold in the past 10 years. Social care has gained from a 40% real-terms rise in local government funding over the same period. But demand has often outpaced budgets.
The white paper Modernising Social Services, published early in Blair’s premiership, said that “one big trouble” was the failure to spell out what people should expect of services and to be consistent in deciding who should get them. It paved the way for performance indicators, the fair access to care guidance, and the national service frameworks for older people, mental health and children. The government’s first health secretary, old-Labour Frank Dobson, was soon replaced by the more radically reform-minded (and distinctly new Labour) Alan Milburn.
Social services found itself in a shooting gallery of targets as Blair – with his chancellor and likely successor Gordon Brown – ran one of the most centralising governments on record. As a policy, it sat uncomfortably with the growing emphasis on “localism”, the supposed devolution of power to neighbourhoods and, in the case of social care, to individual service users. But the extension of “consumer choice” to social care bears the Blair hallmark.
“The clearest expression of Blairite philosophy in adult social care is the move towards individual budgets and direct payments,” says Julian Le Grand, professor of social policy at the London School of Economics and a former adviser at Number 10. “The intention is to shift power away from professionals and bureaucracies to individuals, changing the role of the social worker who, instead of having a dominant, paternalistic relationship with the service user, becomes an adviser, facilitator and helper.”
Le Grand denies that social work will be further deprofessionalised as choice and control spread across the user community. He says the new agenda has the potential to realise the vision of social work set out in the green paper Independence, Well-Being and Choice, marking a return to “core values” of supporting individuals to take control of their own lives rather than acting as gatekeepers and rationers of services. But, says Jon Glasby, reader in health and social care at Birmingham University, the ensuing white paper Our Health, Our Care, Our Say had little to say about social work.
“The case is not being made at the moment. We don’t even know what the role of social work is supposed to be. Options for Excellence [on the future of the workforce] failed to come up with an answer, and now we’re waiting for an answer from another working party.”
James Churchill, chief executive of the Association for Real Change, is more sceptical still: “Consumerism is shorthand for turning people into their own purchasers,” he says. “But the reality may turn out to be very different, with self-directed support as a device by which an increasing amount of the true cost of delivering packages of care is switched away from social services to parents and families.
“If the predominant job in social care in future is the personal assistant, are we not going to see it becoming a ‘McJob’?”
Elsewhere the Blair/Brown double act did much to lift children and older people out of poverty, entrenched rights in at least some aspects of social policy through the Human Rights Act 1998 and the Disability Rights Commission, and gave a large measure of self-government to Scotland and Wales.
Blair’s style was a curious blend of authoritarianism and compassion, a moderately redistributive approach to welfare combined with a “Respect” agenda that targeted poor families on deprived estates.
Among his best known social policy pledges was to end child poverty in a generation. But although 700,000 were raised above the poverty line by 2005, 100,000 fell back again last year. Many pundits have argued that the billions spent on the Iraq war would have been better spent on the poor, for whom the PM’s famous indifference to income inequality has meant declining social mobility.
According to the Institute of Fiscal Studies, it will cost £4bn on top of planned expenditure to get half of all children out of poverty by 2010 and stay on course for Blair’s goal.
While welcoming the plethora of preventive initiatives like Sure Start, the Children’s Fund and the Neighbourhood Renewal Fund, Gateshead children’s services director Maggie Atkinson argues that youth crime and education policies fail the government’s own test of “joined-upness”, despite the creation of the Youth Justice Board and the decision to merge children’s social care into education departments.
“It’s an echo of how the prime minister can manifest himself in the press: a sometimes frenetic sense of ‘quick fix’ or ‘what works’ short-term thinking,” says Atkinson, who is vice president of the Association of Directors of Children’s Services. “For example, youth offending team and police targets are aiming for diametrically opposed things – preventive work on the one hand, arrests on the other – and it’s hard to make schools more inclusive if their targets are mostly about children who behave and attend.
“As a nation we continue to demonise and undervalue the young, as well as over-school, over-test and under-listen to them.”
As the numbers of young people on Asbos or in jail have remorselessly risen, the numbers of older people receiving social services have gradually declined over the decade. More home care hours are provided, but to fewer, needier people, a byproduct of demographic trends and the NHS focus on getting “bed-blockers” out of hospital.
All of this has made it much harder for adult social services to embrace the white paper’s aspiration of more low-level, preventive work with clients.
While the first Blair government ignored the recommendation of its own Royal Commission on Long-Term Care for free personal care, the next generation of older people will hope it pays more attention to last year’s Wanless report, commissioned by the King’s Fund. But so far the Treasury has given no indication that it is willing to embark on a multi-billion pound investment that would need to see spending on social care for older people rise from 1.1% to 2.1% of GDP over the next 20 years.
Le Grand still reckons that Wanless is the way forward: “The current means-tested system encourages people to duck and weave by concealing their private resources, whereas the Wanless proposal actually encourages people to use their own resources. But it might have to wait until there’s a new prime minister.”
So is he pinning his hopes on Gordon Brown? “I’m not sure I’d go as far as that,” he says.
“That a 2007 review is exploring the role of social work tells its own tale of policy neglect”
Jon Glasby, University of Birmingham
“Issues relating to the education and care of children and young people with special needs have failed to be resolved, with the same conflicts in policy and practice as 10 years ago”
Bob Lewis, director, Priory Education Services
“Social care under Blair’s leadership has continued to be a ‘Cinderella’ service”
Andrea Rowe, chief executive, Skills for Care
“Although it is now customary to officially refer to ‘health and social care’, the reality is that only the former matters politically”
Bob Hudson, professor of partnership studies, University of Durham
“Since 1997, social care has been talked about in a wholly new way it’s on the agenda.”
Lynne Berry, chief executive, General Social Care Council
“He started full of promise, but progress was slow. Valuing People is good but we want more”
Shaun Webster, service user
“There has been a shift of emphasis politically from a focus on securing economic growth towards the importance of quality of life issues”
Matt Townsend, public affairs officer, The Disabilities Trust
“We’ve seen phenomenal shifts in the way social care is planned for people with learning disabilities and their families”
Jo Williams, chief executive, Mencap
“Our optimism about ending child poverty when Tony Blair came to power is ebbing away”
Clare Tickell, chief executive, NCH
“Blair’s policies have served to push the needs of children damaged by their families and the state even further to the margins”
Mary Walsh, chief executive, SACCS
“I believe that Tony Blair will come to be recognised as a great prime minister”
Martin Narey, chief executive, Barnardo’s
“It’s harder to get services now. I’ve been diagnosed with cancer and treatment has been slow because of ageism in the NHS”
Joan Scott, service user
“The assault on child poverty, and the raft of policies to tackle it, has been hugely signficant – Sure Start is a real success”
Helen Dent, chief executive, Family Welfare Association
“This government has done more for children in care than any I have known, through progressive policies backed by resources”
Sir William Utting, author, People Like Us, published in 1997
“My real worry is that we will look back on these as the halcyon days”
John Coughlan, president, Association of Directors of Children’s Services
“Good intentions brought new resources, but sadly the centrism and complexity of Blairite policy has often stifled local progress”
Andrew McCulloch, chief executive, Mental Health Foundation
“The personalisation agenda has been most important – putting people at the centre of what we do in health and social care”
Anne Williams, adult social service director, Salford, and president, Association of Directors of Adult Social Services
“It may be fashionable to damn the decade, but many older people have benefited from the new care standards and inspections regime”
Paul Cann, director of policy and research, Help the Aged
Social care under Gordon Brown
Will Gordon Brown’s social policy be different from Tony Blair’s? Brown’s welfarist instincts are probably somewhat stronger than Blair’s, and he is unlikely to warm to the PM’s authoritarian alter ego, “Respect tsar” Louise Casey. But, given that the Treasury has set the tone for a large tranche of social policy over the past decade, it is unlikely that Brown’s accession will produce a marked change of tack.
Brown will find it no easier than Blair to relinquish control of priorities, although the demand for efficiency savings and the trend towards fewer, more strategic targets focused on outcomes looks like continuing.
The chancellor is reckoned to be a good deal more lukewarm than Blair about public service reform and the growth of markets, as the rumpus over foundation hospitals a few years ago showed. However, he is a keen advocate of the voluntary sector and is unlikely to find the market reforms in local authorities alarming.
Sir Derek Wanless’s report on the NHS may have been the trigger for Brown to pour billions into the health service, but he has so far shown rather less interest in Wanless’s equivalent for older people’s social care.
The truth is that little is known about how distinctive Brown’s social policy programme would be. His leadership campaign will, it is hoped, reveal all.
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This article appeared in the 10 May issue under the headline “He transformed social care…”
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