Whilst acting as an outreach worker on my 50 day placement at a community project which provides advice, information and advocacy support to older Asian people (amongst other work), I did not feel, initially, that I was constantly drawing on policies and legislation in my work. However, it became clear to me that social workers are not only a product of social policy but also vehicles for its delivery. Social workers exist to help implement the social policies of the state, which given that Britain is a democracy, could be thought of as a consensus of the citizens' views and wishes.
People of any age and culture are constantly affected (albeit unknowingly) by a host of policies, initiatives, acts and guidelines every day. It would not be possible here to examine each piece of legislation which influences the lives of the people with whom I was working. I intend to concentrate chiefly on the NHS and Community Care Act 1990; the Race Relations (Amendments) Act 2000 and Manchester City Council's resulting policies; the Carers (Recognition and Services) Act 1995; a 1998 Department of Health report on the care needs of black and Asian people, and aspects of the National Service framework 2001. These are items I found relevant to the services provided by the agency with which I was placed. I will attempt to investigate the influence of those policies on the Agency and the people it serves.
As the overall standard of living rises so people expect the quality of care to increase. In addition to this, "Britain's getting older" (National Services Framework for Older People, 2001) – the baby boomers are approaching an age where the likelihood of them needing care will increase. However the number of people working has dropped (due to a decline in the birthrate). This has resulted in a smaller tax base to provide funding for care. Here there is an imbalance between the people's right to care from the state and the economic demands this places on the state – demands which are increasingly difficult to meet.. Over time the increase in tax revenue does not begin to match the increase in funding needed for health care. The response to the Conservative government to this was to launch the NHS & Community Care Act in 1990.
In 1986 the Audit Commission reported on the need for reform of the seven statutes which provided for community care. The report was followed by Sir Roy Griffiths' 1988 report "Community Care: An Agenda for Action." The NHS and Community Care Act came into force in 1993 (Hardy & Hannibal, 1997). It gave local authorities the key responsibility for identifying and assessing the need for care (section 47) and purchasing and monitoring the delivery of that care. As well as this care management role, local authorities are obliged to publish community care plans (section 46 (1)) and undertake planning and consultation with carers and service users. These reforms required new complaints procedures, contracting arrangements, inspection and regulation functions (NHS & Community Care Act, 1990)
A result of the Act is that care by institutions and professional carers within the community has been reduced. Hardy & Hannibal (1997) point out that the "…1990 Act did very little to encourage professional care, since it promoted free care." This has put the onus on relatives and friends to look after those in need, with the possibility of benefit for doing so. It can be said that care in the community has thus become care by the community, which could be viewed as a return to the time before the welfare state.
This shift has greatly reduced the government's expenditure on care. There are about 5-7 million unpaid carers in Britain (Mind, 2001). From a feminist perspective it could be said that the whole structure of Community Care depends on an almost exclusively female workforce providing voluntary or low paid care. It is acknowledged that most carers are women (all of those I encountered on placement were female). There is a reliance on the fact that family members will care for less able relatives because of bonds of obligation, affection and reciprocity.
The shift towards care by the community can have financial implications for the carers. Many carers have to give up paid employment and are then dependent on benefit. Those who continue to work are limited by their caring role and may for example damage their prospects for promotion. In the long term the number of cared for people will rise and the number of workers / carers will fall, thus the money generated by the populace could drop, as more people give up their jobs to adopt a caring role. It is not clear whether or not this drop in revenue will exceed the savings generated by the 1990 Act.
The person receiving care might find it preferable to be cared for by friends or relatives, as this care can be more personal, attentive and of a higher standard. A possible problem with informal care is that the quality control can be difficult to maintain. Some people feel that abuse at the hands of a relative is less likely to be reported. The Carers (Recognition and Services) Act 1995 addressed some of the deficiencies of the NHS & CCA. It places a duty on the local authority to carry out an assessment of the ability and needs of the carer, though the authority is not legally required to provide services based on the assessment (Mind, 2001).
The Conservative vision was of a mixed economy of welfare in which emphasis was placed on voluntary, private and the informal sectors rather than the state. New Labour also place the main responsibility for welfare with the independent sector but they maintain that their system is founded upon the principle that individual citizens must have a clear sense of responsibility for themselves and the members of their community. They call this philosophy communitarianism (Alcock, 1996). Communitarianism can be criticised as divisive, in that if people are members of an "in group" (i.e. their community) then other people will be deemed "out group", a situation which can result in tension, e.g. recent racial conflict in Oldham.