[Since] the 1950s a consensus had developed about the desirability of ‘community care’: the idea that where older people needed to be cared for by the state, it should where possible be in their own homes and not in large impersonal institutions. This consensus too was exploited by the New Right. By appealing to the ideas of many academics and commentators on the benefits of ‘care in the community’ the Thatcher and Major governments were able to enlist the support of many of the key stakeholders for their agenda. But the Conservative conception of ‘community care’ was in reality very different from what most people had understood by de-institutionalisation. The purpose of the Thatcher and Major reforms was both to eliminate almost entirely the role of the state in the provision of services for older people and to reduce to a minimum its responsibility for funding them. The aim was to stimulate an active market in the provision of care services (which would in turn produce the ‘efficiency savings’ that are supposed to flow from market competition), and to transfer the costs of funding care in old age to individuals and their families. [...]
The first Thatcher government began its assault on the state provision of care for the elderly almost as soon as it entered office by sharply reducing the funding of local authority social services departments. This meant that the income of the voluntary organisations on whose care homes local authorities depended began to dry up. In 1974 local authorities had paid for almost 60 per cent of voluntary sector care home residents in England; by 1983 the proportion was down to 34 per cent. [...]
These financial incentives also led many local authorities to transfer or sell their own existing care homes to the independent sector. A House of Lords ruling in 1996 found that local authorities could fulfil their duties under the 1948 National Assistance Act without providing services directly. This meant that they did not need to retain their care homes, and so, in what was probably one of the most underreported sell-offs of the Thatcher and Major years, hundreds of care homes and the land attached to them were transferred to for-profit companies or voluntary associations at rock-bottom prices. [...]
In Scotland, for example, Dumfries and Galloway Council obtained consent from the government to sell five residential care homes with a total market value of £2.03 million to a private company for £1 each. A study conducted in 1996 found that over 12 per cent of all independent residential care homes had been purchased or transferred from local authorities, and given the large number of transfers that have taken place since then, the percentage is now probably much higher. Not only was the state guaranteeing mainly for-profit providers an income stream from the public purse, it was also transferring to them, at little or even no cost, substantial assets that had been paid for out of public funds.
An edited extract from NHS plc by Allyson M. Pollock