Election 2001 features

The last four years have seen the social care landscape
change drastically under a plethora of New Labour initiatives.
Here, Jonathan Pearce maps out these new initiatives, while Bill
Jordan analyses the success of the government’s social policy
programme (see below).

Kendra Inman looks at what older people want from the
new government (see below).

(It is advisable to print these three articles as they
are long)

“Community care is in tatters,” said the Labour manifesto at the
last election. So when Tony Blair came to power on that sunny
Mayday bank holiday back in 1997 bringing to an end 18 years of
Conservative rule, he promised a vision of national renewal, to
build a “country with drive, purpose and energy”.

Four years on, on the verge of another general election, it is
time to assess Labour’s record. In terms of social services
and community care, specific manifesto commitments were thin on the
ground in 1997. All Labour was prepared to give was a list: local
authorities would be free to develop a mix of public and private
care; a Royal Commission on long-term care; a long-term care
charter; an independent inspection and regulation service for
residential homes and domiciliary care; and a focus on older
people’s community care needs.

But change has come thick and fast as the government set out its
stall early on. It claimed a vision of tackling social exclusion
and poverty, and reformed public services. Over-arching strategies,
joined-up government and performance management would be key themes
in the New Labour administration. The Social Exclusion Unit was set
up in December 1997 and in less than a year had reported on
neighbourhood renewal, truancy and school exclusion, and rough
sleeping.

The report on neighbourhood renewal in particular was a classic
example of the government trying to grasp the big picture. It
became a national strategy and finally a national strategy action
plan in 2001.

Other big-picture, agenda-setting initiatives included
Supporting People – the policy and funding framework that will
bring together care, health and housing in providing support
services to people in supported and sheltered housing in 2003.

Similarly, Quality Protects in 1998 promised to transform
children’s services with a three-year strategy to define
government objectives for local authorities, including helping
children in care beyond the age of 16, improving educational
achievement and reducing the number of moves while in care. Later,
legislation on care leavers was passed.

The introduction of the Children’s Fund aimed at
preventive services for five- to 13-year-olds was part of a child
poverty strategy complemented by the creation of the Children and
Young Persons Unit.

The NHS Plan was published in summer 2000 after a hectic four
months of planning. At its launch health secretary Alan Milburn
spoke enthusiastically of joined-up services – common goals and
budgets with new care trusts delivering both health and social
care.

Based on the plan, the model of care trusts contained in this
year’s Health and Social Care Bill was an extension of the
agenda for social services which had been set in 1997 and 1998 –
the integration of health and social care and the slow steady
deletion of the term “social services” from the policy lexicon.

In 1998, plans were announced for pooled budgets for health and
social services, lead commissioners and integrated provision. These
were soon followed by the Modernising Social Services white paper,
promising independence, protection of vulnerable people and higher
standards.

It proposed the General Social Care Council in England – the
social work regulation and registration body – and parallel bodies
for Scotland Wales and Northern Ireland.

By the end of 1999 performance indicators and standards were
measuring social services departments’ performance. The Best
Value regime replaced compulsory competitive tendering in local
government, compelling social services to scrutinise all the
services they provide.

Care and carers had been mentioned in the manifesto. The
National Carer’s Strategy in 1998 gave £140 million to
local authorities to support the six million carers who supply
informal care. The Carers and Disabled Children Act 2000 allowed
them to be assessed and receive services in their own right.

In general disabled people also benefited, although many were
disappointed the government did not go further. The Disability
Rights Commission was set up, anti-discrimination measures were
extended and the Special Educational Needs and Disability Act
became law this year, allowing children with special educational
needs to attend mainstream schools.

Another manifesto commitment was long-term care. The Royal
Commission on Long Term Care for the Elderly was tasked with
solving a problem at the heart of the welfare state, namely, where
does social care end and health care begin?

Boldly, the commission recommended long-term care should be
free. But last year the government chose the minority report – that
nursing would be free, but personal care would be means-tested. As
a concession, for the first three months of admission to
residential and nursing home care, the value of a person’s
home will be disregarded from the means-testing rules.

As a result of devolution, the Scottish Parliament is taking a
different approach.

Care homes also came under the spotlight. Work began on
standards in 1999, published this year and due to come into force
in April 2002. They cover choice of accommodation, health and
personal care, social activities, complaints, staffing and
management. The standards will be implemented by the National Care
Standards Commission. From 2002, local authority inspection and
regulation units will transfer to the NCSC, which will also
regulate care homes, children’s homes, domiciliary care
agencies, adoption and fostering agencies, as well as private and
voluntary hospitals.

Usually, wherever standards were published, a strategy could be
found close by.

The National Learning Disability Strategy launched in 1999
resulted in a white paper this year, while the Mental Health
Strategy of 1998 led to a green paper, white paper and proposed
reform of the Mental Health Act at the end of last year. The
government wants to see 24-hour services, assertive outreach teams,
better treatment and more staff.

The underpinning of the strategy by the modernisation of the
care programme approach in 1999 contains much of Labour’s
health and social care philosophy – integration of health
authorities and social services, two levels of CPA service and
crisis planning.

Mental health was also subject to another government creation –
the national service framework, comprising aims, standards,
milestones and timetables. Older people’s services also
received an NSF this year.

Another innovation was the creation of the role of tsar to lead
change or reform. Older people got Professor Ian Philp, mental
health got Professor Louis Appleby. Keith Hellawell and Louise
Casey represent drugs and homelessness respectively.

There was no national service framework for asylum seekers, and
they didn’t get a tsar either. The Immigration and Asylum Act
1999 created the National Asylum Support Service and the
universally condemned voucher scheme. The accommodation and support
of asylum-seekers transferred from local authorities to Nass in
April 2000, but by the Labour Party conference in September,
campaigners had won a government concession to review the voucher
scheme. The Home Office promised to act quickly, but recently
announced the review would be delayed until after the election.

Social work itself was not forgotten. The Social Care Institute
for Excellence will be established this year, and aims to develop a
knowledge bank of research-based good practice.

Adoption is also set for change – the first major review in 25
years. The government wants an increase in adoption from local
authority care, more national standards and a national adoption
register.

There was other progress on adoption with the enactment of the
Adoption (Intercountry Aspects) Act 1999 which promised new
safeguards for children adopted from abroad. Key sections of the
act were only brought into force this year following the
Kilshaws’ internet twins fiasco.

As with many areas of social care, strategies are in place.
Indeed, local government is drowning in plans, consultations,
reviews and targets which it must address. But the full impact
remains to be seen. As the government might say, much has been
rolled out, but not everything is online. An early election helps
to avoid potentially trickier questions that arise through
implementation. Ask the asylum seekers about that.

——————————————————————————————————

Bill Jordan evaluates New Labour’s social policy
programme and finds social inclusion for all is still a very long
way off.

How successful has New Labour’s social policy programme
been? The problem of assessing it is that Tony Blair’s
government combined grandiose claims of a new dawn: “Rediscovering
a true national purpose” and becoming “a model of a 21st century
developed nation” with very modest specific targets. In short, the
rhetorical victories have outnumbered the material
achievements.

New Labour aimed to change the moral and political culture
around welfare issues; to reform the tax-benefit system; and to
improve the performance of public services. The flagship programme
was directed at unemployment and the most striking successes have
been in reductions of young claimants (around 70 per cent), and
increased labour-market participation by lone parents (about 30 per
cent). This reflects the resources ploughed into the New Deals and
into improving incentives through the Working Families Tax Credit
scheme.

But has the government, as ministers boast, simultaneously
delivered a blow against the twin evils left by 18 years of
Conservative rule – poverty and social exclusion? New Labour was
keen to redefine social justice in such a way that this claim could
be upheld. The objective was to move from a welfare state “that
primarily provides passive support to one that provides active
support to help people become more independent”.

This justified holding down benefit rates, putting pressure on
claimants to take short-term, low-paid jobs, and emphasising their
“responsibilities” because “work is the only reliable route out of
poverty”.There is no question that this strategy has been
politically successful. Labour’s pre-election research had
shown that taxpayers were willing to pay more to support
“deserving” groups – pensioners, disabled people and their carers,
“hardworking families with children” – but not lone parents and
those claiming unemployment benefits.

The doubt is whether this strategy has delivered social
inclusion for those now in employment or “security” for those still
outside. Statistics on continuing inequalities, and the evidence
from disadvantaged districts, suggest that it has not.

This is hardly surprising. On the one hand, the kinds of jobs
created – primarily in service work, not least in social care – do
not provide “ladders of opportunity”. More often, they trap workers
in exploited, insecure positions, on poverty wages. Furthermore,
they arise in more affluent areas, away from pockets of
deprivation. There is no question of them becoming members of the
communities in which they work, because housing costs there are too
high. In other words, their employment still leaves them excluded
on several dimensions.

On the other hand, new programmes for the regeneration of poor
areas favour private sector initiatives and create little new local
employment. Schemes that are focused on the resident population,
such as the New Deal for Communities and the work of the Social
Exclusion Unit, target problems like crime, drugs, and homelessness
– issues of control and enforcement.

In the public services, New Labour’s determination to
stick to Conservative spending plans meant that the necessary
long-term investment has only just begun. Instead, the government
has relied on detailed top-down prescriptions, quality standards,
targets, and a whole range of measures aimed at “joined-up”
approaches.

Nearly all New Labour’s claimed achievements in this part
of its programme are contested and involve redefinitions of goals
or manipulations of statistics. The overall picture, as in
transport, the environment and the public infrastructure generally,
is of continued neglect and dilapidation, with staff struggling to
keep faith, and to cling to future promises of Treasury
benevolence.

Because of tight constraints on public sector pay, recruitment
crises have hit all these services, especially in cities such as
London, where house prices have risen sharply. It is ironic that
New Labour, so obsessed with tight immigration controls, should
last year have been forced to reverse its line on “economic
migration”, partly to allow the overseas recruitment of desperately
needed teachers, nurses, and social workers.

Finally, New Labour’s attempt to appear tough on crime and
asylum has been costly, not least because it has stirred up
populist movements and opened the door for political opportunism by
its opponents. If social justice includes a rational and tolerant
climate for debate on these issues, the government has failed in
this also.

On balance, New Labour’s record may be seen more
positively if it is judged in the light of the social legacy of the
Thatcher/Major years, rather than that of its own grandiose claims
of radicalism. As an interim, transitional programme, it has been
modestly successful. But it will need to reassess its goals and
even the direction of many of the changes it has initiated during
its second term in office.

Above all, the emphasis on opportunity as the basis for social
justice cannot be sustained if employment is taken as the only
relevant yardstick. A more embracing notion of inclusion, a broader
concept of engagement and participation, and a more generous
approach to redistribution, are all needed.

Bill Jordan is professor of social policy at
Exeter and Huddersfield Universities, and reader in social policy
at North London University. He is the author (with Charlie Jordan)
of Social Work and the Third Way: Tough Love as Social Policy
(Sage, 2000).

———————————————————————————————————–

Kendra Inman looks at what older people want from the
next government.

Older people’s opinions vary as much as those of any other
age group. But when it comes to election campaigns, they are united
on a handful of key issues.

If the calls to Age Concern’s advice line are anything to
go by, older people worry about “health service provision, pension
levels, and transport,” says the charity’s head of policy
Helena Herklots. “They want to know whether there will be enough
support to help them remain independent and to take part in society
and whether or not that help will be hard to get.”

In addition, a recent Mori poll carried out for Help the Aged
revealed that older people on very low incomes are most worried
about crime. It was cited by 31 per cent of those asked as the key
priority for improvement in their local area. Despite the fact that
statistics show they are less likely to be victims of crime than
younger people, more than half of respondents felt crime had
increased in their neighbourhood. Older people also identified
money and pensions – 17 per cent – followed by public transport –
13 per cent – and health – 9 per cent – as topics that caused them
concern.

In the run-up to the election, two high profile older
people’s charities have outlined their demands. Age Concern
has called for all the political parties to act on five priorities
to secure the votes of older people. The charity’s wish-list
includes an end to pensioner poverty, new laws to outlaw age
discrimination, an end to ageism in the NHS and other public
services, an end to charges for long-term care and cheap and
reliable public transport. Help the Aged adds warm homes and a
greater say in local services to the list.

No-one would deny the charities’ aims are laudable but
will they be fulfilled? If the pollsters are right and the election
is little more than a shoe-in for Labour, will older people feature
in the manifesto? Or, as many suspect, has the government already
set out its stall?

In recent months, the Labour good news machine has gone into
overdrive. Announcements about tackling pensioner poverty with the
minimum income guarantee (MIG), and above-inflation rise in the
state pension, and an end to discrimination in the health service
with the National Service Framework for Older People, have come
thick and fast.

The campaign to restore the link between earnings and the state
pension led by the formidable former MP Barbara Castle has failed
to convince the government. Instead, ministers have responded to
pensioner poverty by targeting means-tested benefits at the least
well-off.

Campaigners have welcomed the moves and agree that the worst-off
pensioners will have more money in their purses and wallets.
However, there are major drawbacks, says Help the Aged. People shy
away from claiming means-tested benefits so the extra cash is
failing to reach many who need it. More than 500,000 pensioners who
are entitled to MIG fail to claim it – a total of one in five of
all those eligible. The pension credit, designed to reward savers
on moderate incomes, is due to be introduced in 2003 and will
further complicate the claiming process, say critics.

“If you are an elderly person getting by at the bottom of the
welfare state you will be better off,” says Mervyn Kohler, head of
public affairs for the charity Help the Aged. However,
“there’s a catch. It is difficult enough to get people to
take up the current benefits. If the current take-up rates are
replicated with the new credit the results will be dreadful. People
will lose out.”

Fellow campaigners at Age Concern agree that the new moves are
unnecessarily bureaucratic.

“We believe the basic state pension is still the best way to end
pensioner poverty,” according to a spokesperson. The charity is
calling for the non-means tested basic state pension to be
increased to at least £90 a week for a single person and
£135 a week for a couple, plus housing costs. The state
pension should also be maintained at levels that mean older
people’s standard of living keeps pace with that of the rest
of the population. For 2001/2, the state pension for a single
person has been set at £72.50 per week – almost £20 below
the charity’s target.

Also in campaigners’ sights is long-term care,
specifically free personal care, as recommended by the Royal
Commission on the subject. Throughout the passage of the health and
social care bill through parliament the government in London has
stubbornly refused to give in to calls to implement the
commission’s recommendation that nursing and personal care
should be paid for by the state.

In Wales, Plaid Cymru added its voice to campaign for free care.
The Scottish Parliament’s decision to fund personal care
turned up the heat, but still ministers at Westminster stand firm.
The health and social care bill will mean free nursing care for
those in care homes, but personal care will remain
means-tested.

Campaigners do not expect to see a sudden u-turn. “It’s
very disappointing that there’s been no movement on free
personal care in the bill. Not even on widening the definition of
nursing care which is far too narrow,” says Pauline Thompson,
policy officer with Age Concern.

“Labour would like the health and social care bill to be the
last word on the subject,” says one campaigner. “They’ve
rammed it through the commons and made a lot of MPs in their own
party very unhappy. But no one’s prepared to rock the boat
before an election.”

On the health front, Labour hopes the National Service Framework
for Older People, announced in March, will address complaints about
age discrimination in the NHS. The reappearance of matrons on wards
is another move designed to woo older voters. Whether or not it is
successful remains to be seen.

Labour must also combat the perceived exclusion of older people
in one of its central policies – tackling social inclusion. Critics
complain that while the social exclusion unit has beavered away on
teenage pregnancies and homelessness, older people as a group have
been overlooked.

The SEU acknowledges that some older people are at
disproportionate risk of falling into poverty and are subjected to
discrimination when it comes to jobs. But the next two pieces of
work the SEU will undertake are on the education of children in
care and transport – it can only be hoped that the latter study
will bring about the improvements the grey lobby wants.

Whatever the parties finally commit themselves to in their
manifestos, politicians ignore the concerns of older people at
their peril – even in a slack year, they are twice as likely to
vote as young adults. As all the political parties battle with an
apathetic electorate, they would do well not to forget that
statistic.