Impacts of the social care market

A letter from the June issue.

I would like to draw the attention of readers of The Psychologist to a report that has just been published by the Centre for Welfare Reform – Who cares? The Impact of Ideology, Regulation and Marketisation on the Quality of Life of People with an Intellectual Disability (

The report argues that there is a risk that the macro-institutionalisation of the 19th century, a notorious episode in our social history, is in the process of being replaced by an equally shaming process of extensive micro-institutionalisation, where people with an intellectual disability are placed in underresourced, inadequately staffed and socially and physically isolated residences in the community.

The content of this report should be of interest to readers of The Psychologist because one of the consequences of the marketisation of social care has been the growing marginalisation of professional workers (e.g. educational psychologists, clinical psychologists, social workers, general practitioners) in decision-making processes related to assessment and placement of people with an intellectual disability. Decisions are increasingly being taken by local authority commissioners for services. Thus a process of de-professionalisation is occurring in which the role of those with relevant knowledge, expertise and experience and who are well placed to make informed decisions concerning the individual needs of clients are being sidelined. These changes appear to be driven by cost and not quality-of-life considerations.

The report makes the point that the propagation of the policy of inclusion within a crusade, as is happening at this time, is both dangerous and counterproductive, for it can foster professional intolerance, division and disaffection; lead to the application of powerful and insidious pressures on professional staff to conform; devalue the worth of those who, for valid professional reasons, find ground for criticism; promote the growth of a propaganda industry which places a low value on objectivity and truth; prompt the use of strategies and techniques that indoctrinate rather than teach; encourage poorly trained professional staff to believe that the application of a simple formula will resolve the complex problem of delivering effective and humane services; and result in the creation of an inflexible service that is unresponsive and insensitive to the needs of people with intellectual disabilities.

The report also highlights the fact that in order to tackle the issue of staff costs, an increasing number of care companies are introducing CCTV to monitor residents and staff. It is argued in defence of this practice that it protects both the resident and staff member: acting as a safeguard, preventing abuse and encouraging good practice. However, the report argues that the adoption of such technology runs the risk of reintroducing some of the salient characteristics of the ‘total institution’ identified by Goffman (1961): (a) individuals progressively losing their identity; (b) constraints being placed on basic liberties (e.g. freedom of movement and action); (c) life within a setting becoming routinised and closely regulated; and (d) staff maintaining a social distance between themselves and residents.

Dr Robin Jackson
Visiting Research Fellow
University of Hertfordshire

Goffman, E. (1961). Asylums: Essays on the social situation of mental patients and other inmates. San Francisco: Anchor Books.

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