The governance of social care for the elderly in England
Introduction In their early work, Bevir and Rhodes (2003) emphasised the importance of governance narratives, provided both by policy actors and academic analysts, for understanding the reform of British governance from the 1970s. Each of these narratives was rooted in a tradition of thinking about British politics: Tory, Whig, Liberal and Socialist. Of these, they suggested that two were particularly influential in informing our understanding of approaches to reforming governance after 1979. The first, the liberal tradition, contained a reform narrative of restoring markets and combating state overload, and a governance narrative of seeking to build networks of communities. This was closely associated with the reforms conducted by the Thatcher-Major governments 1979-1997, highlighting the influence of New Right critiques of state bureaucracy and novel market governance approaches to public service provision. The second was the socialist tradition, which contained a reform narrative of seeking to redefine the bureaucratic state and join up government. This was closely associated with the BlairBrown Governments, 1997-2010, highlighting the influence of Third Way ideas and network governance approaches to try and deal with seemingly insurmountable social problems (Bevir and Rhodes 2003: 196). More recently, Bevir and Rhodes have sought to address governance as the outcomes of reform. Governance is of course a potentially elusive concept: ‘governance can refer to a new process of governing, a changed condition of ordered rule, or the new method by which society is governed’ (ibid.: 4). In focusing on what has resulted from reform they are keen to avoid a monolithic portrayal of a new order of governance. Rather they conceptualise contemporary governance as a constellation of policies, meaningful actions and contingent, shifting, and contestable cultural practices that bear the imprint both of bureaucracy and recent governance reform projects. They seek a decentred analysis that reveals narratives of policies, actions, or practices and the forms of knowledge that variously inform them. In still privileging the role of ideas they seek to consider how ideas of modernist social science provide sources for these forms of knowledge. This means a focus in the present era on considering how governance practice is rooted, on the one hand, in ideas of neoclassical economics, rational choice, and
social conservatism that informed the New Right; and, on the other, the ideas of revisionist social democracy, development planning, and networks that informed New Labour, as well as legacies of ideas of welfare state bureaucracy (see Bevir 2010, 2013; Bevir and Rhodes 2010). The current chapter seeks to contribute to this agenda for understanding contemporary British governance by addressing the policy area of social care for the elderly. This is a significant case through which to develop the research approach, as policy needs have escalated in recent decades and both Conservative and Labour governments have prioritised reform. In turn, the governance approach has the potential to contribute to the study of a policy area that has been analysed by a rich yet fragmented, research literature because relatively few such accounts are over time or relate to policy development to governmental change (see Gray and Birrell 2013). The following sections will address the analyses that have shaped our understanding of reform across the whole period since 1979: the policy prescriptions offered, the ideas that have informed them, and the governance legacies they have left. Section two addresses the historical context to elderly social care policy and how reform was developed between 1979 and 1997. Section three addresses further reforms and reform debates between 1997 and 2010. Finally, section four addresses reform debates and policies under the Conservative-Liberal Democrat Coalition between 2010 and 2014. The chapter draws on policy documentation, memoir and secondary works. The analysis has a UK government focus, and therefore has a consistent reference only to policy for England. Much of this implicitly is relevant for Wales before devolution in 1999 and some reference will be made to approaches taken in Scotland and Wales after devolution in 1999. Nonetheless, the policy trajectory for both Scotland and Northern Ireland was distinct even before devolution, and has continued to be so for both of these and Wales since. These lie outside the concerns of the present chapter. Even so, simply as a study of England, the chapter reveals how the work of policymakers and the analyses of academics help us to relate the grand narratives of reform to policy practice and outcomes, suggesting that governance outcomes and the forms of knowledge that inform them are indeed complex, and that perceptions of elderly social care reform are characterised predominantly by preoccupations with their inadequacy, unworkability and unfairness.