By Catherine Needham, Professor of Public Policy and Public Management
Health Services Management Centre, University of Birmingham
As the weight of expectations builds on the forthcoming social care green paper, it is timely that this week is the 70th anniversary of the National Assistance Act 1948 which created social services in their current form.
The Act created a safety net for people who through circumstances such as old age or disability could not pay into national insurance. Local authorities were given a legal duty to provide suitable accommodation for those for whom support was not available elsewhere, and it was this legislation that underpinned care for older people, people with disabilities and people in need of mental health services until the Care Act 2014.
Let’s hope that the forthcoming green paper puts dignity and shared citizenship at the heart of a social care settlement for the next 70 years.
As the green paper team finalise their work, here are four things that a look back at the National Assistance Act can teach us:
1. Don’t forget integration: The National Assistance Act received Royal Assent on 13 May 1948, just weeks before the launch of the National Health Service. Much attention will be focused this summer on the 70th anniversary of the NHS, with perhaps a passing aside about 1948 as the year when the gulf between health and social care was formalised. Bridging that gulf between the local authority-delivered social care system and the nationally managed NHS, set down in law so many decades ago, remains one of the key policy ambitions of our time.
2. Don’t forget dignity: ‘An Act to terminate the existing poor law…’ – that was the beginning of the lengthy subtitle of the National Assistance Act. We are still struggling with the issue that animated the social reformers of the 1940s: how to provide support for people in ways that recognise citizenship and inclusion rather than stigma and blame. It is heartening to see Scotland making dignity explicit in its new Social Security (Scotland) Act, which includes among its principles that social security is a human right and that “respect for the dignity of individuals is to be at the heart of the Scottish social security system”.
3. Don’t forget the frontline: as the National Assistance Act was implemented by the local state, the stigma of destitution was recreated through intrusive means-testing, inadequate financial support and forced institutionalisation. Local offices of the National Assistance Board were inconsistent in their application of the rules, and distinguished between the deserving and undeserving in much the same way as the Poor Law Boards had done. The stigma of state support has been magnified further in recent years. If the future is to be different, the local state needs to have the resources and commitment to recruit, train and develop frontline staff who can work in ways that put dignity over rationing and targets.
4. Make it last: for all its flaws the National Assistance Act shaped social care for over half a century. We are only four years since the Care Act 2014 which replaced it, and yet it is clear that the recent Act ducked many of the key issues that we need to make appropriate provision for older people, people with disabilities and people using mental health services.
Let’s hope that the forthcoming green paper puts dignity and shared citizenship at the heart of a social care settlement for the next 70 years.