‘What matters is what works’? How discourses of modernization have both silenced and limited debate on domiciliary care for older people

Abstract

Policy statements about the care of vulnerable older people repeatedly emphasize the desirability of keeping people at home. An enduring problem in implementing this strategy is the ongoing crisis within the quasi-market in domiciliary care. The government announced in 2004 that it wanted a new vision for adult social care. In such circumstances, it could be argued that, in order to achieve home care services that are stable, flexible and better placed to integrate more effectively with health agencies, local authorities should significantly expand in-house provision. Despite exhortations from ministers to think the unthinkable, such a proposal is actually ‘unsayable’. This article discusses how discourses of modernization exclude ideas that imply an expansion of directly provided social care. Such discourses have so much invested in the shedding of what it regards as outmoded ‘welfarist’ baggage, they are blind to proposals that could improve the lives of older, vulnerable citizens.

Provider and Care Workforce Influences on Quality of Home-Care Services in England

“…In England, the trend for replacing in-house provision with independent home care shows no sign of abating. While one recommendation might be to reverse the trend and encourage more in-house provision, it has been argued that such a proposal in the current policy climate is not just unlikely to be well received, it is "actually 'unsayable' " (Scourfield, 2006). More realistically, we need to consider the implications for future commissioning.…”

A Model in the Desert: Modernization, Advanced Liberalism, and Child Protection Reform in Postcommunist Romania

“…30 Moreover, despite initial expectations that neoliberal policies would produce less overbearing government, the necessity to administer and audit independent providers created large new bureaucracies. 31 Governing through arm's-length procedures has also proven tricky as the use of indicators often motivated service providers to prioritize governmentimposed standards over the welfare of their users. 32 And finally, the work of frontline social workers has been negatively affected.…”

‘Trying to do a jigsaw without the picture on the box’: understanding the challenges of care integration in the context of single assessment for older people in England

“…Recent initiatives mandated by central government to ensure that health and social care organisations overcome difficulties of service co-ordination must be understood in the context of an uneasy history of institutions that have been separate for more than half a century [14,15,17]. …”