Review

Disgruntled dabbling in social care

Social Care in a Mixed Economy
G Wistow, N Knapp, B Hardy and C Allen
Open University Press, 1994, £14.99

If there are any beginners left on the community care scene this book is not for them. Just about everyone else will find something that helps them make sense of what is happening at present and what is likely to happen in the future. The book is based on a research project in which senior officers and chairs of social services in 25 English local authorities were interviewed between 1990 and 1992. These interviews were supplemented by others with representatives from district health authorities and the voluntary and private sectors.

But the real strength of the book comes from the long involvement of the authors in analysing community care policies. Understandably, given the research data, the approach is top-down but the book is a lot more than an uncritical round up of the directorate view. Each section sets out policy goals, past and present, and offers useful boxes summarising key developments. Market ideology as it applies in government policy making, and specifically to social care, is clearly explained. A chapter entitled Social care is different deals with the uncritical application of marketisation across a range of services. As the authors say of their findings: ‘There are fewer born-again free marketeers to be found among social service officers and members than disgruntled dabblers in service specifications and contracts.’ This applied in both Tory and other authorities.

There are very useful chapters analysing the run up to the 1990 NHS and Community Care Act and the transfer of residential homes. The book argues that virtually everyone interviewed was in favour of broad concepts such as enabling, choice, independence and needs-led planning, but that this consensus was only possible because clear definitions were lacking. The authors divide enabling into three different models: enabling as personal development; enabling as community development; and enabling as market development. Clearly it is not possible to implement all three at once and this explains why local authorities are using the same words but getting remarkably different results.

The book ends with a range of scenarios for the future. It is a strength that none looks ridiculous, but we are waiting hopefully for the new ‘bottom-up pressures’ that are going to shift the balance away from top-down changes.