Services for older people are being scrutinised by a Labour government that has resolved to bring down the 'Berlin Wall' dividing health and welfare, to drive up standards of care and to find a fairer way to finance long-term care. Anyone listening to the political rhetoric about the state of services for older people could be forgiven for thinking that shortcomings in current arrangements have arisen as a consequence of market-driven reforms introduced by the previous government. They might even be led to believe there was a golden age of public service that needs to be recaptured.
This new edition of From Poor Law to Community Care will challenge that belief. It also throws much-needed light on issues that have long bedevilled policy and practice relating to vulnerable older people. Means and Smith show how tensions and conflicts that were evident in health and welfare policies in the period 1939-71 have much in common with contemporary debates about the present and future shape of provision for older people.
They show how over a period of almost 60 years, policies have consistently reflected low priority for older people with chronic illness and disability. Furthermore, reliance has long been placed on families and voluntary organisations taking responsibility for caring for this group. And, in contrast to other care groups, there has been a tendency to opt for institutional care as the dominant service model for this particular section of the population. They also show how and why distinctions drawn between the health and welfare needs of older people have been problematic ever since the ending of the poor law, and why the division of responsibility between the NHS and local government for older people with chronic conditions has frequently been challenged.
This new edition, which re-visits a study undertaken in 1985, is aimed at students of social policy rather than managers or professionals looking for practical guidance. This may deter some NHS managers and practitioners from reading it, especially those who may wrongly think that it is only covering 'old history'. That would be a pity, for the developments discussed in this book have a direct bearing on the present-day problems that NHS staff will be tackling in partnership with social service colleagues in frontline services, primary care groups and in strategic planning forums. At the very least, NHS managers would gain a greater understanding of where their social services colleagues have come from.
The big disappointment is that developments between 1971 and the NHS and community care reforms are not included in the analysis. The authors are now engaged in a new study of that period, recognising that 'so many of the myths perpetuated about community care prior to 1990 draw upon assumptions about what did or did not happen in the period 1971-1993'.
A future edition of this book can therefore be expected to cast further light on policy developments related to older people, and should tell us much more about the influence that older people - as citizens, service users and carers - have had on the shape of welfare towards the end of the 20th century.
Janice Robinson
Director of community care, the King's Fund.
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