The Conservative governments of 1979–97 were responsible for a series of major changes in the conceptualisation and delivery of community care services (see Box 10.1 for a summary). In particular, this period saw the introduction of a series of private-sector approaches and terminology, as well as the gradual transition of social workers and social services departments into purchasers rather than necessarily the providers of care. As a result of these changes, the community care landscape changed dramatically. Between 1982 and 1991, places in private-sector care homes increased from 46,900 to 161,2000, while the independent sector provided 60% of home care contact hours in 2001 compared to just 2% in 1992 (Means and Smith, 1998; Means et al, 2003). At the same time, the role of social workers began to shift, with practitioners increasingly recast as ‘care managers’ – assessing need and designing care packages from a much more mixed economy of care. With hindsight, many front-line workers seem to have found these changes profoundly deskilling, claiming that current practice is focused much more heavily on administration and bureaucracy than on traditional social work skills such as counselling, group work and community development (personal communications).

At the same time, such changes may also have led to some positives. While many commentators have argued that consumerism is an insufficient basis for reforming community care services (see, for example, Barnes and Walker, 1996), these reforms arguably helped to concentrate the mind of senior managers and leaders and may well have contributed to greater responsiveness and efficiency, up to a point. The concept of care management, moreover, has the potential at least to shift thinking away from very service-led approaches (where the person is assessed with what is currently available very much in mind) towards much more needs-led approaches (where the person's need is identified separately from the subsequent process of finding ways to meet that need) – albeit that this has proved difficult in practice.

Box 10.1: Conservative community care policies, 1979–97

• •Changes in social security regulations in the late 1980s meant that people entering independent-sector residential and nursing homes could seek support from the social security system, based solely on their finances and with no assessment of their care needs. As a result, expenditure on this form of provision spiralled from £10 million per year in 1979 to £459 million by early 1986 (Means and Smith, 1998).