In England, social care is defined as the provision of social work, personal care, protection or social support services to children or adults in need or at risk, or adults with needs arising from illness, disability, old age or poverty. The main legal definitions flow from the National Health Service and Community Care Act 1990, with other provisions covering disability and responsibilities to informal carers. That provision may have one or more of the following aims: to protect people who use care services from abuse or neglect, to prevent deterioration of or promote physical or mental health, to promote independence and social inclusion, to improve opportunities and life chances, to strengthen families and to protect human rights in relation to people's social needs.Social Care Institute for Excellence http://www.scie.org.uk
Since the 1990s, local commissioners (mainly based in councils) oversee a market with many different types of social care provision available, either purchased by public bodies after assessments or accessed on a self funded basis by the public. These include community support and activities, advisory services and advocacy, provision of equipment to manage disabilities, alarm systems, e.g., to manage the outcome of falls, home/domiciliary care or daycare, housing options with levels of care support attached, residential nursing home care, as well as support for informal carers.
Social care is frequently used as a synonymous term with social welfare, and as an alternative to social work.Dearing, A. (1993) The social welfare word book, Harlow: Longman The term often implies informal networks of support and assistance as well as services funded following assessments by social work and other professions.
Social care in the modern context encompasses many areas of need, each with a level of specialist services. These can be broadly categorised as follows:
Adults – this includes support for older people, people with mental health problems, learning or physical disabilities, those with alcohol and substance misuse problems, prevention of abuse or neglect, needs related to homelessness, domestic abuse and associated support for families and carers. Due to a range of legislation, benefit entitlement, history and supply of services, adults over the age of 65 are routinely assessed as requiring a lower "personal budget" and less favourable care than younger people with similar needs and/or disabilities. This is considered ageism.[UK is 'completely and institutionally ageist'] The Guardian Children, young people and families – this includes preventative family support and child protection services, child placement, fostering, adoption, working with young offenders, children and young people who have learning or physical disabilities, or who are homeless, as well as support for families and carers. Workforce – this includes the provision of resources, training and support for those working in social care. Social care is in the jurisdiction of the Minister of State for Social Care in the Department of Health and Social Care.
History
Social care has long existed as an informal concept, through family and community support and charitable works. In medieval times, social care had been provided by monastic foundations, but at the Reformation, that support ended when the monasteries were dissolved. The loss of monastic social support (and education) was one of the declared grievances behind the Pilgrimage of Grace.
After briefly experimenting with harsher approaches to the destitute, the Tudor establishment passed the Poor Relief Act 1601, which made civil parishes (a local government unit) responsible for providing basic health, domestic care, housing, and employment support, to those in need; this was one of the earliest acts of Parliament to offer statutory support. The "care" to be provided could include payments, food, apprenticeships, boarding or referral to a workhouse.
Originally the workhouse was simply a labour exchange for small pieces of low value work, which were usually carried out in-situ. In the late 18th century, a generous system of income support – the Speenhamland system – was established on an ad-hoc basis in parts of the country, and promoted by the Tory Prime Minister William Pitt the Younger. Others thought it was too generous, and were worried that it would lead to people not bothering to work. As a result, the Whigs passed the Poor Law Reform Act, which turned workhouses into harsh, almost prison-like, environments; it is these reformed workhouses which lead to the notoriety of the workhouse concept.
Under the Poor Law Reform Act, civil parishes were encouraged to form Poor Law Unions with other nearby civil parishes, and establish a joint workhouse, which were to require to operate in a manner that was so harsh and basic that people would only resort to workhouses if they were absolutely destitute and had no other option. The workhouse would provide shelter, meals, and basic social care, in return for unpleasant, harsh, and menial work; only those who were so frail that work was impossible were to be excused. All support outside the workhouse was to be abolished.
Meanwhile, the rise of industrialisation, lead to a rapidly more urbanized population, causing great social deprivation. It also bought a decline in the support provided by family and close-knit communities as people became more mobile and moved to different areas for work.Blackwell Reference Online http://www.blackwellreference.com However, the increasingly wealthy middle classes, now having enough time and money to engage in leisurely pursuits, established voluntary organisations which sought to alleviate these difficulties, providing rudimentary social work, and medical services. Mutually owned societies also developed, providing medical support to their members, when needed, in return for insurance-like subscriptions;BBC History http://www.bbc.co.uk/history some of these Industrial and Provident Societies later merged to become national not-for-profit health organisations, such as BUPA, which survives into the 21st century.
Many workhouses established infirmary sections to house frail inmates. Under the Tory government of the late 1860s, the Metropolitan Poor Act transferred responsibility for the frail poor from Poor Law Unions, in the Metropolis (the urban area around London), to a new Metropolitan Asylums Board. The Act also combined the funding of the Poor Law Unions into a shared Common Poor Fund. The Metropolitan Asylums Board established new asylums to house and treat the frail poor, and was empowered by the Metropolitan Poor Act to charge the cost of medical treatment to the Common Poor Fund. Outside the Metropolis, many Poor Law Unions moved support for the frail to new locations, away from provision for the able-bodied poor.
In the early 20th century, responsibility for social protection was gradually transferred away from workhouses, and a distinct separation grew between policies to support income maintenance and those to support frailty. In 1906, the descendants of the Whigs, the Liberal party, came to power, and reversed their earlier opposition to Speenhamland-like systems, by bringing into force the first means-tested pension for people aged 70 and over; the able-bodied elderly no longer required the workhouse. In 1929, as one of his last acts in office, the Tory prime minister Stanley Baldwin passed the Local Government Act, enabling – but not compelling – local councils to take over responsibility for frail people who lived within their area. In the early 1930s, the Unemployment Assistance Board was established to provide income support to the unemployed, removing the able-bodied from workhouses.
Local councils had been introduced in the later 19th century as a governmental unit large enough to take over from the boards which ran the many public services which had been introduced during that century. Most of them were not keen on taking over responsibility for medical services for the poor, but many were willing to take over from infirmaries and asylums that focused on simply providing social care, and often re-labelled them as care homes. The development of social sciences such as psychology and sociology bought social structures under further scrutiny, and opened the way for social work to become an area of academic study, creating a professional role.
Since wounded military staff were treated by medical officers within the military, the use of mass-conscription in World War II had meant that a much larger portion of the population had state organised medical services available to them. With an eye on future expectations of the public, Churchill commissioned the Beveridge Report into the future of welfare and health services. Once the war had ended, all the main parties promised to act on the Report's recommendations and made manifesto promises to establish a national health service; in the later 1940s the NHS was directly created as a result, absorbing the medically focused asylums and infirmaries (many of which had been renamed hospitals by this point). The workhouse concept was formally abolished.
In December 1965, the Labour government created the Committee on Local Authority Personal Social Services, chaired by Frederic Seebohm, Baron Seebohm. Amongst other things, the Seebohm Report (published 1968) recommended the establishment of a unified social service within each major local authority.
Care Act 2014 In an effort to reform the 60-year-old legislation regarding social care in England, the Care Act 2014 received royal assent after being introduced on 9 May 2013. The act details the local authorities' duties in relation to assessing the needs and eligibility of people for publicly funded care.
Under the act, local authorities are required to:
Assess people's needs for care and support, using a new national minimum threshold to judge eligibility Involve the person in the assessment, and a carer or nominee where appropriate Consider services besides public care that reach the same outcomes, e.g., preventative services or community support Provide assessment, care and support for the needs of carers, even if the person they care for does not receive local authority services.
Eligibility for adult social care, under the Care Act 2014, depends upon an individual's finances. If the financial resources of someone who is a permanent resident exceeds £23,250, the local authority is not permitted to pay towards the cost of provision of accommodation in a care home. For adults whose need for care and support other than permanent residence exceeds £23,250, the local authority may (but is not required to) pay towards the cost of care.
The Care Act 2014 also saw the implementation of a funding cost cap, the maximum contribution that an individual may need to make towards their care costs over their lifetime. Once the cap had been reached, any further social care would be provided free of charge. This was due to be in effect from April 2016 but was delayed to April 2020.
In September 2021, under the Conservative government, Boris Johnson announced plans for reform in adult social care, starting with the funding cost cap increasing to £86,000 from October 2023. Under the new cap, the upper capital limit (the point at which people are eligible to receive financial support from their local authority) rose to £100,000, from the previous £23,250. The lower capital limit (the threshold below which an individual will not have to pay anything for their care) rose to £20,000, from the previous £14,250. The new cap does not cover daily living costs for people in care homes.