State and private provision of elderly care setting the framework after Beveridge

brought about reform of public assistance institutions by replacing them with local authority residential homes, but the Act did not empower development of general welfare support of older people who remained in their own homes. This absence is a recurring feature of the British system where the social security system often did not address the main providers of elderly care namely families and their friends. However, the 1948 Local Government Act393 empowered394 grants by them to

393

(11&12 Geo.6, c.26).

394

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voluntary organisations to develop general welfare services, such as ‘meals on wheels’ for the elderly.

The 1948 legislation did not really progress until the National Assistance (Amendment) Act 1962 prescribed that local authorities could directly provide meals services because demonstrably the voluntary sector had not been able to develop national coverage to meet obvious growing need. Even so it took the Health Services and Public Health Act 1968395 to make discretionary home help services

mandatory.

Implementation of policy change by central government over the last quarter of the 20th century shows increasing local authority engagement, increasing private

and diminishing public care delivery. Provider competition, rationing, targeting and the economic necessity of less local authority direct care home provision become the watchwords. By the last decade of that century, national policy has also driven a visible change in the increasing number of elderly being maintained for longer in their own homes or with families396.

One clear message from the above implementation level of local government officials involvement is from the 1970’s central government gradually engages with elderly care issues along with substantial regulatory change with the Registered Homes Act 1984 and eventual policy realisation that modern equipment has greatly improved to facilitate the delay or prevention of care home use for the elderly. This

395

Even implementation of the 1968 Act on this fell foul of concurrent local government social services re- organisation implemented on 1 April 1971 because of the merger of local authority welfare departments with the functions of others. Radical local government upheaval on 1 April 1974 (pursuant to the Local Government Act 1972 {1972, c.70} implementing a previous Royal Commission), soon added to the administrative confusion. In each of the changes interim preparation and transitional arrangements confused officials and the public.

396

Robin Means, Hazel Morbey and Randall Smith, From Community Care to Market Care? – The development of welfare services for older people (Bristol: The Policy Press, 2002).

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modernisation includes better mobility machinery and local authority funding of the elderly person’s home adaptation.

In its continuing empirical analyses detail the same 2002 Study397 shows

progression by the late 1980s for home care staff to extend their skills set by being encouraged to take on a growing amount of personal care tasks, a momentum which continues thereafter clearly aiding reduction of care home use.

Nevertheless, with local authority homes, “...the late 1970’s and early 1980’s was also a period of neglect for such homes in terms of physical standards and often in terms of quality of care. These deficiencies were exposed by the rapid development of independent sector residential and nursing home care in the 1980’s and the associated passing of the 1984 Registered Homes Act.”398

The 1984 Act recognised the need to structure a growing private sector of accommodation which paralleled an existing nursing home system,399 where the

boundaries between the two were not always clear and required regulatory oversight.400 Private home expansion was itself stimulated by local authority home

closures rather than such authorities trying to financially resource facility upgrades in times of great budgetary constraint as well as demographic influences.

Specifically the Law Commission in 1983 had been requested to examine and report back to the Lord Chancellor the Government’s stated purpose to continue to assimilate legislation relating to residential care homes and the then legislation relating to nursing homes, respectively then the Health and Social Services and

397

Means and Others, Ibid.

398 _{(1984, c.23) – Means and OthersIbid. p.69.} 399

Repealed by the Blair Labour government’s Care Standards Act 2000 (2000, c.14) which replaced the 1984 Act standards with more stringent levels of regulation again (38 standards were enumerated) overseen by the new Commission for Social Care Inspection.

400

Implementing in this respect Law Commission Report LC 128 (December 1983)- specifically reporting to Parliament on the Registered Homes Bill 1983(Cmnd.9115).

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Social Security Adjudications Act 1983401 and the Nursing Homes Act 1975,402 in

respect of which the proposed consolidating statute under consideration had raised technical inconsistencies in respect of secondary legislation and criminal offences in the intended combined regulatory oversight.403

The new statute provided for compulsory registration, standards and inspection of residential care homes as a new category404 a similar structure for

nursing homes,405 and a registered homes tribunal system with its structure and

jurisdiction.406 The effect appears to have been to increasingly drive up the cost of

compliance by care providers as well as standards but, in respect of the latter, the consumers were increasingly expectant of rising standards.

Also in focus in the study407 of the local government officers are issues

affecting elderly care delivery identifying the then continuing tensions between local authorities and their NHS local counterparts, particularly cultural issues, when common funding arrangements are redirected by Government as political experiments, or provided on a finite basis, and also in particular in respect of older people with dementia. Although defined as an organic illness “there is often little medical intervention available or appropriate and so their greatest need is for social support. A consequence of this in the study period was growing numbers of older people in local authority residential care.”408

The more notable conclusions of the study are that a comprehensive policy direction appears to have been achieved, but “there is no consolidated legal

401

(1983, c.41).

402

(1975, c.37).

403 _{Resolved in the Appendix to the Law Commission Report – (December 1983) – ibid.} 404

Ibid. Part One, ss1-14, with appeals under s.15.

405

Ibid. Part Two, ss21-33, with appeals under s.34.

406_{Ibid. S.39.} 407

Means and Others (April 2002), Ibid.

408

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framework relating to services for older people equivalent to the 1989 Children Act.”409And even “if one argues that the financial investment in intermediate care is

impressive, it would seem that the…dominant political concern is not the quality of life of older people but rather bed blockage.”410

A further valuable insight into the shift by local authorities in the late 1980s and early 1990s from running their own residential care facilities is the development of residential care schemes with the ‘not for profit’ voluntary organisation sector, especially housing associations. This appeared to be more politically acceptable than a council closing down homes as such, but some such schemes “...foundered on the problem of the size of the capital investment required to bring them up to registration standard.”411

Thus the foregoing analysis forms a picture of reactive progression from the post-war Beveridge welfare state into the 1980’s and 1990’s world of public and private mixes of care delivery but continuing the flawed lack of integration.

Parallel developments on the regulatory side of events track the course of legislation from nursing home specific regulation, notably the Nursing Homes Act 1975,412 dealing with specialised delivery of professional nursing care organisations

and local NHS oversight of these, to the joining together in one regulatory statute of that system and the residential care home system with the Registered Homes Act 1984,413 representing significant regulatory progression.

409 _{(1989, c.41).}

410

Means and Others, Ibid, p.163-165. ‘Bed blockage’ referring to a problem still much in the news of older people overstaying in NHS hospitals thus preventing availability of beds to other patients.

411_{Means and Others, Ibid, p.111.}

412

(1975, C.37).

413

136