Social care is defined as a profession wherein the practitioner is closely working with individuals that are disadvantaged or marginalized or those that have special needs. Social care workers are committed to deliver and plan for creating programs geared towards providing quality care for groups or individuals that with identified needs. For example, people with physical disabilities, children, homeless people, victims of abuse and drug and alcohol dependent need specific aid in order to re-integrate themselves to the society to live a normal life. Social work is necessary to alleviate the constraint that hinders the marginalized society in achieving their goals in life. Social work is often defined as social pedagogy and the practitioners act as social pedagogues. Despite several definitions of social work, the main initiative remains constant. The values and mission of social work has been established to primarily help the less privileged as observed in its long history.
Social care is a system established by the government to identify and help the less privileged individuals within its jurisdiction. The concept of social care was rooted from the principles of funded health services that are being administered as mandated by the Poor law. The Poor Law encompasses a health privilege for the people that are completely free of charge, but in terms of social care the services administered by the local authorities can be rendered for a fee. However, in the nineteenth century voluntary and independent organizations consists of non-profit groups changed the perception of social care by influencing the health and social care provisions to provide the social services entirely free of charge. This idea was carried forward until the post-war Welfare state and by the year 1948, all of the social care services particularly health service were all administered without a fee at the point of delivery. After two years, the focus of social care delivery has shifted from institutional to community level.
Before the onset of the Second World War, the only public service care program for the disabled and older people is through the Poor Law or otherwise known as the Public Assistance as mandated by the Local Government Act of 1929. This law has been dated back centuries ago when each parish in 1601 was ordered to drop rates to provide family support and care for destitute people. Older people in the community that is no longer able to work because of age or disability are the only qualified people to received free social care. However, the level and type of care provided for older and disabled people varied over time and based on the parish’s own resources. The earliest social care program provided for the old and disabled is to pay for a pauper woman or any of the family members to house the old person or disabled person for a specific amount of time. At that time, opening an orphanage was considered as a profitable business for owners because all the children housed by the orphanage are being funded by the local government.
At best, people being distributed to private homes were given health care, clothing and food allowances to enable their stay at the host home owners. However, the Poor Law during that period has its downsides because relief distribution was stigmatized and most of the time the resources for pulling in relief aid are extremely limited. In 1834, the Poor Law was drastically amended by withdrawing relief aid from the able-bodied individuals. Meaning, the distribution of relief will no longer include people that are considerably physically fit to work. Unemployment was disregarded by the law as a ground to be qualified for social care privileges such as relief. A new program was introduced by the local government wherein destitute individuals are being recommended to work on punitive and bleak workhouses instead of being admitted to private homes for housing. In terms of pauper-mainly older people, but still physically fit to work are being placed in a more comfortable workhouse accommodation.
In 1885, the Poor law was again changed, but health care still remained free of charge for everyone that cannot afford it regardless of social status. During this year that separate hospitals dedicated to the poor and funded by the Poor Law through local authorities were established and the out-patient services have expanded. This is because of the increasing awareness that sickness among the poor eliminates their capacity to get a job and the dependency for relief and publicly funded social programs significantly increases. The local government realized that attacking sickness before it deteriorates the poor society would allow them to save money to fund several programs, so instead authorities have focused their effort in keeping the poor healthy by providing free health care. Because of the changes in the provisions of the Poor Law, there was a growing public concern about the spread of poverty among the people particularly the old and disadvantaged. The increasing public concerns led to another ratification of the Poor Law in 1900 directing the Poor Law Union to provide more comfortable and less punitive accommodation for older people (Thane 2009).
For the mentally ill, public funding were used to meet their needs by sending them to public asylums. However, there was several definition of mental retardation during that period including unmarried motherhood and homosexuality. This broad definition led to an overwhelming increase of people being sent to asylums and because of that, private institutions were also directed to admit mentally insane under public funding. However, those that were identified as mentally incapacitated, but are financially capable are being charged for the services. This directive constitutes a principle that any programs not administered through the Poor Law would still incur charges even if was publicly funded. During that period, social care and public funding is still separated by the conditions of the Poor Law. It stipulates that getting social services from publicly funded institutions will not be always free unless the Poor Law says otherwise. In 1929, the Local Government Act was ratified and the new provision of the Act stipulates that all Poor Law powers will be transferred over to public assistance committees established in local communities.
This new development gave birth to the early framework of a community level social care service. The changes however, revealed that huge numbers of disabled and older patients are receiving very limited health care and most often placed in bleak conditions. They still don’t have access to rehabilitative programs such as follow-ups on stroke patient conditions. Another prevailing problem is the lack of housing and support programs in the community that would enable the patient to have a normal living condition after leaving the hospital. Due to the problem about the health conditions of older and disabled people, the so-called bed-blockers were eliminated leading to the expansion of geriatric care. The development is also the foundation for the establishment of the NHS.
Before the Second World War, social care has already evolved from a medieval social care system into a more diversified program. It can be recalled that during the medieval times, residential care is only limited to older and disabled people distributed in almshouses and other institutions run by religious organizations. The services provided by volunteer groups vary according to the financial capability of the person receiving care. Social services are free for those are not capable to pay for it, but services provided for those that can afford incur fees even if the social services came from charitable or publicly funded organizations. The development in the social care system was derived from collaborations between the local authorities and volunteer groups. The objectives of social care have changed from a simple distribution of relief to the older and disabled people into a maximized support system for the deserving poor. The focuses of providing social care have expanded to health care and family support.
However, the change in Local Government Act is still not feasible enough to meet all the needs of the poor and disabled. The level of activities and the extent if its effective distribution remained unquantifiable and locally diverse instead of meeting social care needs on a larger perspective. One example is the quality of health care that the poor is getting from volunteer hospitals, although the health institutions are committing to provide health care services, but they are only limited to treat acute and non-chronic conditions. The situation is that the volunteer hospital would provide health care for everyone, but the free privilege is limited to the poor. In cases where in the poor patient was found to have a chronic health condition, he would either seek alternative health solutions or produce enough money to fund his hospitalization. In 1955, there were an estimated 187,000 permanently and substantially handicapped individuals that registered themselves for long-term social care benefits. However, because of the pre-war dilemma of lower birth rate higher proportion of older population, the government feared that the cost social care would significantly exhaust the national budget considering the preparation for the war.
Pension benefits were tested and were made available in 1908, but because of the rising life expectancy and low mortality rate supplementary pensions were introduced to replace the prior version. The However, it was revealed during the war that there was a so-called secret need among the older population in the majority of English communities. Because of the rising need for geriatric social care, the campaigning group called Age Concern established since 1940 championed the campaign for improved care programs for the older people. Aside from that, there was also a heightened call from the public to improve the social care benefits for the disabled because of the sudden increase of disabled people mostly consist of war casualties. Because of the increased awareness on the needs of disabled individuals, the Disabled Employment Act of 1944 was created to cater to the employment needs of the disabled. Since the government does not have enough resources to fund the needs of the disabled, the only option is to find an income generating opportunity for them in order to afford their own needs.
The new Act requires employers to have at least 3% of their workers coming from the physically disabled population or at least 20 disabled people to be hired. In 1944, the government shifted their focus on improving the social care needs of the mentally ill, the National Association for Mental Health formed several campaigns to promote better provisions specific for the mentally disabled. Because of the overwhelming response from the public regarding the improvement of social care programs provided by the government along with heightened campaigns, The National Assistance Act was enacted in 1946 as a response to the increasing campaigns for a better social care system.
The new Act took two years to be implemented and in 1948, NA has completely abolished the Poor Law and the Public Assistance Act and replaced by the National Assistance Board or NAB. The NAB took over all the responsibilities of the prior institutions created under the directives of the Poor Law. Publicly funded hospitals and other health institutions were absorbed by the National Health Service, which was also establish at the same time with NAB. In terms of caring for the older people, the newly established institutions have divided the geriatric population into two categories. The first one is the “sick,” under this category; older people will be placed in hospitals under the jurisdiction of NHS. The other category is the older people “needing care and attention,” under this category; older people will be placed in residential homes built specifically for their needs. Most of the homes for the older people are actually former workhouses. The NA Act under the authority of NAB requires local government to provide residential accommodation for the disabled and older people in need.
NAB was also empowered to do inspections of the pre-existing homes run by volunteer and charitable institutions to evaluate if the facilities are adequate enough to cater to the needs of the older and disabled people. The criteria include providing recreation facilities and meal for their older residents, day centers and clubs. The local authorities on the other hand were ordered to establish their own health responsibilities such as health visitation in residential areas, home help and child welfare clinics. All the NHS services will be provided and distributed to residential communities for free at the point of delivery. However, local authorities were allowed to provide similar services for a fee, but not in home visits social services. These dramatic changes led to William Beveridge’s idea of the Welfare State (Thane 2009). The principle behind the Welfare State suggests that personal payment (donation), comprehensive basic services alternatives and voluntary action should be implemented to provide protection for the poorest. However, the Welfare State principle was not widely endorsed by the government because of the existing designation of public social services that are free at the point of delivery program.
Despite the significant changes in the social care system, the boundaries separating health care and social services still exist and the government cannot be contented with providing care for the older and disabled people alone. Because of that, NAB was replaced by the Supplementary Benefits Commission in 1966 and two years later, the institution was absorbed by the Department of Health and Social Security in 1968. The new department also replaced the Ministries of Health and National Insurance, but the institution remained operational until 1988 or until the Department of Health was separated from social security. However, these changes further complicate the relationship between social and health care. Furthermore, the healthcare responsibility was also moved from the Ministry of Health to the local government.
Between 1950’s to 1960’s, another set of changes took place in caring for the mentally ill. The out-patient replaced the in-patient treatment for the insane. This was influenced largely by learning that keeping the mentally disabled in a long-term institutional program actually has harmful effects to patient. In 1959, The Mental Health Act stated that mentally disabled people should be allowed to live outside of the mental institution, but people are very concern about the provisions of the Mental Health Act because of the lack of home service support intended for the mentally ill. The National Assistance Act originally enacted in 1948 was also ratified in 1962 adding another provision. Home facilities for older and disabled people are required to create a ten-year health and social services plan designed to allow the older and the disabled to live longer in Home facilities. Several changes happened ten years following the enactment of the said Acts including community and home assistance to older people that preferred to stay in their homes.
Further development was introduced during 1980’s to 2000 regarding social and health care improvement for older people and disabled people. Several programs integrated to the pre-existing ones adapting diversified approach in providing social care not only limited to the sick and for those that are in need. Child welfare, support programs for domestic violence victims and other sector of the population showing immediate support from the social care sector was included in the modern approach. The initiatives of social care have further expanded from a community based support into a major national concern. These changes from the seventeenth century up to today have had significant impact to the social care practitioners in terms of values and responsibilities. The way of interaction and level of commitment provided by the practitioners from medieval to the modern day social care have changed dramatically because of the constant evolution of social care objectives, mission and priorities (Miller 2010).
The history of social care has shown a positive outcome in defining the scope of responsibilities of its practitioners. Apart from adopting professional standards, Social care workers today are more engaged in championing the advocacies of social welfare by constantly innovating their planning and evaluation methods. Social practitioners today are more focused in identifying the needs of the people starting from the time of consultation up to the day-to-day delivery of services and shared life experiences. Practitioners of social care were able to separate themselves from the definition of the social worker because social care workers are basically engaged in a person-to-person work capacity. To compare the modern social care practitioner from the older times, social care workers today seeks to provide a more stable environment where the client can benefit from education, social and relationship interventions. The social care practitioners in the older times on the other hand are less reliable in finding the suitable environment for the people due to the limited provisions and resources provided by the primitive policies on social care.
Because of the continuous evolution and changes in the scope of social care commitment to the public, practitioners are now able to perform the role of managing the needs of their clients. For example, a disabled child is in need of a residential placement, the responsibility of the social care practitioner is not only limited to finding a residential placement for the child, but also to coordinate case view meetings, negotiations and termination of placement in response to the child’s need for protection (dit.ie). In a nutshell, the history of social care has helped its practitioners in shaping their roles in helping the people in need while embodying the core principles of social justice, empowerment of the people, respect for dignity and encouragement. Social care professionals strive to provide as much shared life-space opportunities for the people to meet their emotional, physical and social needs.
References
Dit.ie (2002) DIT School of Social Sciences and Law - What is Social Care?. [online] Available at: http://www.dit.ie/socialscienceslaw/socialsciences/whatissocialcare/ [Accessed: 5 Nov 2012].
Miller, E. (2010) Can the shift from need-led to outcomes-focused assessment in health and social care deliver on policy priorities? . Research, Policy and Planning, 28 (2), p.115-127.
Thane, P. (2009) Memorandum Submitted to the House of Commons' Health Committee Inquiry: Social Care. History and Policy, 1 (0), p.1-15.
