A new vision for adult social care? Continuities and change in the care of older people

The reform of adult social care is a major preoccupation within England. It is presented as the inevitable consequence of the changed expectations of people who use services; in addition, the detail of policy is portrayed as being in accordance with what those people specify they want from social care. However, there appears to be little recognition of the complexities and contradictions that characterize much of the policy. Of these, the inadequacy of the resource base of adult social care is most significant; consequently, rationing of scarce resources will continue to be a priority. The paper also highlights problems in other areas, including the rhetoric that accompanies policy change and the evidence base for that change, the lack of connection between issues of independence and protection, the partial understandings of partnership that appear to characterize it and the inadequate conceptualizations both of the nature of those people who require social care support and of the character of that support. In discussing these issues, the paper emphasizes that there remain continuities in the context of policy, while noting the continual focus on discontinuity within government documents.