The institutional legacy

The adult social care services that are available today have evolved from the residual institutional provision that was made available to paupers of all ages under the Victorian Poor Law (Thane, 1996). Although the Poor Law was revoked to widespread acclaim by the National Assistance Act 1948, unlike other sectors (notably, health, housing and education), no comprehensive policy was introduced to replace it. The 1948 Act (Section 21) stated that it should be the duty of every local authority to set up a ‘welfare department’ to provide ‘residential accommodation for persons who by reason of age, infirmity or any other circumstances are in need of care and attention which is not otherwise available to them’. Section 28 further empowered local authorities ‘to promote the welfare of persons who were blind, deaf or dumb, and others who were substantially and permanently handicapped by illness, injury or congenital deformity’.

These obligations to offer institutional care constituted a clear reflection of Victorian policy solutions. It still remained ultra vires for local authorities to develop preventive services like meals-on-wheels, chiropody, laundry, visiting schemes or counselling – these were viewed as ‘extras’ and therefore the domain of the voluntary sector (Parker, 1965). Changes to this situation took place slowly. The National Assistance (Amendment) Act 1962 for the first time allowed local authorities to provide meal services directly, as opposed to making grants available to the third sector. The Health Services and Public Health Act 1968 further afforded councils a general power to promote the welfare of older people, while a private members bill introduced by Alf Morris MP resulted in the Chronically Sick and Disabled Persons Act 1970, which was designed to compel local authorities to develop comprehensive welfare and support services for disabled people (Means et al, 2002).

These powers to develop preventive services were not matched by the allocation of additional resources, leaving local authority welfare departments small and marginalised. Even the main remit of these departments – residential care – was not undertaken particularly well. In the case of older people, Townsend (1964) noted a lack of investment across all welfare institutions caring for older people. In 1949, 40,000 residents were housed in former workhouses, and by 1960, the figure was still 35,000.