Long-term care: from public responsibility to private good

Abstract

The neo-liberal assault on the welfare state has not always been direct. The acknowledged popularity of the UK NHS has resulted in governments using covert means to undermine its core principles, namely universality and equity. Long-term care with its vulnerable client base is an important example of how care has become a private responsibility with little or no debate or discussion. Using the social security regulations, the Conservative government of the early 1980s pumpprimed with public funds the massive expansion of private nursing and residential care, to the extent that the past 20 years has witnessed the evolution of a significant new economic market sector. This article charts the trajectory and structure of the market in long-term care provision, from its ‘cottage industry’ beginnings to increasing dominance by generic, often publicly-quoted multinational corporations. It shows how the privatization of funding was accompanied by transferring responsibility for payment of care from central government to local authorities in 1993, and how the introduction of eligibility criteria and the shrinking of public provision has made care a private and personal responsibility. Government is now encouraging companies to diversify into higher-cost specialist areas such as diagnostics, acute psychiatric care and acute hospital and intermediate care, with long-term care increasingly seen as a lower profit ‘core’ industrial package predicated on basic services and casualized, low wage labour. The commodification of the care process is now being extended to other parts of the NHS and has serious implications for the health and well-being of the whole population and not just for the most frail and vulnerable.