As UK Government reviews social care, what can it learn from Britain’s first major initiative?

Professor Catherine Needham writes for the Social Sciences Birmingham Forum:

With a green paper on social care forthcoming from the UK Government, it is timely that this month marks the 70th anniversary of the National Assistance Act, which created Britain’s social services.

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. This legislation underpinned care for older people, people with disabilities, and people in need of mental health services until the Care Act 2014.

Here are four lessons from the Act that should inform the Government’s green paper:

1. Don’t forget integration: Weeks after the National Assistance Act received Royal Assent on May 13, 1948, the National Health Service was launched. Bridging the gulf between the local authority-delivered social care system and the nationally-managed NHS remains one of the key policy ambitions of our time.

2. Don’t forget dignity: “An Act to terminate the existing poor law” — the first words of the lengthy sub-title 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, the stigma of destitution was recreated through intrusive means-testing, inadequate financial support, and forced institutionalization. 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 more than half a century. Only four years since the Care Act 2014, it is clear that this has ducked many of the key issues over appropriate provision for older people, people with disabilities, and people using mental health services.