‘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.