ABSTRACT
Unlike social security, which is demand-led, and health care, which since the inception of the NHS has been a universal service, the provision of social care services has always been subject to implicit or explicit assessments of need. There has been a reluctance to establish legal rights to receive social care services, and access is dependent on the judgements of ‘gatekeepers’. Although health care is not an individual right, and rationing has always been implicit in decisions about resource allocation, most people can comfortably live their lives assuming that if they get cancer, or if they are injured in a road accident, they will receive treatment without an assessment of their needs or circumstances. However, accessing social care services is rather different. Those seeking support from local authority social services departments have to be seen as ‘needy’ in order to gain access to a service. Hence they are also seen as objects of pity: ‘the elderly’, ‘the disabled’, ‘the mentally ill’—people whose personal limitations mean that they are not able to look after themselves and thus need to be cared for (Hughes, 1998). They become constructed as members of ‘client groups’ with needs for support that cannot be met from within personal resources.
