Community Care and the Restructuring of Welfare

Abstract

The focus of the last chapter was upon the neglect of service provision for elderly people and for people with physical disabilities, mental health problems and learning difficulties. However, it was pointed out that this neglect has never been absolute. At various times, concern about demographic change or the abuse of inmates in institutions has raised the political profile of these services and led to expressions of a commitment to improve or change the overall situation. This chapter begins by describing how the pressure for reform began to build up in the 1980s and ultimately led to the Griffiths Report (1988), Community Care: An Agenda for Action, which in turn fed into the White Paper on community care (Department of Health, 1989a) and the National Health Service and Community Care Act 1990. The second half of the chapter argues that it is a mistake to see these changes either as peculiar to community care or as the product of a temporary phenomenon known as Thatcherism. The community care reforms reflect broader debates about how best to manage private and public sector organisations in increasingly diverse western societies. More specifically they provide an illustration of a growing trend to introduce markets into public services.