Why we should celebrate the birth of social care (but not too much)

The 1948 National Assistance Act was the foundation of modern social care but also created issues that last to this day, says Simon Bottery, in the first of a series of blogs marking the event.

1948 saw the birth of the NHS, British Rail, the Land Rover, the Polo mint, King Charles, Lulu... and modern social care.

75 years ago, the National Assistance Act received Royal Assent on 13 May 1948 and came into force across England, Wales and Scotland on 5 July that year, bringing to an end more than 300 years of the Poor Laws. The Act introduced the duty on local authorities to provide accommodation for older and ‘infirm’ people and a power to promote the welfare of disabled people (though, a product of its age, the Act talks refers to people who are ‘blind, deaf, dumb and crippled’). It also required residential care homes to be regulated and allowed local authorities to financially support voluntary organisations to, for example, provide meals to the elderly.

So, should we be getting out the bunting and balloons for the Act? Or is it something of an anachronism now? Did it even, perhaps, send us in the wrong direction? Inevitably, the answer is: a bit of all three.

The Act makes it clear that there is a public responsibility to provides services to people who, because of age, illness or disability, need support. The focus was on decent accommodation for older people and for the time it was a radical concept.

Encouragingly, older age is seen in the Act as a time of possibility rather than inevitable decline. At one point in the debate in the Commons, Aneurin Bevan says he is trying to think of a collective name for the homes. An MP suggests ‘eventide homes’, but no, snaps back Bevan, ‘old people think they are facing the dawn, not eventide’. There is also a welcome emphasis on supporting independence. Indeed, Bevan told the Houses of Commons older people ‘do not want to be interfered with; they want to lead their own lives’.

There is even a hint of the personalisation agenda in the Act’s recognition that accommodation should not be standardised but rather should cater for the differing needs and tastes of different types of people. For example, the aim to have no more than 25–30 people living in a home is still close to the average for residential care homes for older people, although they have recently been getting larger.

'But it is also clear reading the Act today that it created problems that are still a challenge'

But it is also clear reading the Act today that it created problems that are still a challenge today. The most obvious example is the fault line the Act creates between what we now call social care and the National Health Service – which also came into being on 5 July 1948. Crucially, while the NHS is free at the point of use, local authorities are allowed to charge for the accommodation and support they provide. The means test had arrived, driving a cultural and administrative wedge between health and social care services which persists to this day.

Even more fundamentally, the Act provides little by way of a clear vision on which to build a modern social care system. The problem goes even deeper than simply the focus on older people’s housing, the jarring language or a failure, perhaps understandable for the time, to have a sense of older and disabled people’s rights or a concept of the social model of disability.

The bigger problem is that there is no real cohesion to the Act: it is a series of measures to resolve problems that had not already been tackled, requiring local authorities to provide services that ‘fill in the gaps’ between the support already provided by existing legislation. As a guide to the Act, published in 1949, explains, the purpose of the legislation is to cover ‘residual cases’ not already covered under legislation.

This narrow sense of social care as being defined by what it is not, and as a range of services for specific groups of people and conditions, rather than as enabling wider wellbeing, has probably contributed to the sense, still felt today, of social care as a second class citizen. Indeed the social care provisions of the Act are not even its main focus - ‘the National Assistance’ of the title is, essentially, the means-tested social security system, which the Act also establishes.

'Despite recent decline, around one million people now benefit from publicly funded social care year, local authorities spend around £27 billion on it a year and the social care sector employs around 1.5m people.'

Finally, the Act surely sets social care off on the wrong foot by focusing so much on residential care. The direction is understandable – Britain had a terrible post-war housing shortage so accommodation was a priority – but imagine how different care would look if the Act had required local authorities to provide care and support in people’s own homes rather than provide institutional care.

Still, despite these drawbacks, the Act has proved to be a landmark piece of legislation that has been developed and built upon, most notably by the 2014 Care Act. Despite recent decline, around one million people now benefit from publicly funded social care year, local authorities spend around £27 billion on it a year and the social care sector employs around 1.5m people.

So when people, thinking of the more-famous establishment of the National Health Service, say that social care is in need of a ‘1948 moment’ they forget that we have already had one, even if it does not quite stir the blood in the same way.