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  • Author or Editor: Liz Lloyd x
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Professional practices and the implications of policies for service provision are the focus of this chapter. Continuities and changes in professional perceptions of carers are discussed as well as key changes in the policy framework of practice. These changes include carers’ rights to assessment and support. In this discussion a more detailed view of the gap between the rhetoric of policies and the reality of practice is identified. Key elements of this concern the tensions that have arisen between the rights of carers and disabled people in the personalisation agenda as well as the organisational changes and diminished resources in local authorities. The changing role of carers’ organisations as participants in the development local services and as service providers is critically analysed.

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This chapter provides an account of the key policies and strategies to support unpaid carers since the 1990s throughout the UK. It identifies similarities and differences in approaches of governments in the four constituent countries, discussing the aims and outcomes of these. Key themes arising from policies are identified, providing a basis for the discussions in Chapters 4 and 5. These themes include the role of policies in shaping recognition of carers; the focus on support for carers in their own right; a shift in the balance of responsibility for care and support between the state and unpaid carers; the personalisation agenda in social care and its impact on unpaid carers; and the changing roles of carers in the policy process and service planning.

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In this chapter, the analysis of policies and practices on unpaid care is developed with reference to theories of the policy process. The economic and political contexts of policies on unpaid care since the 1990s, particularly the impacts of austerity and the reduction in the role of statutory authorities, are discussed. A key question addressed is why, when policies have introduced new rights for carers, resources have been so consistently inadequate to make these a reality. The chapter considers the framing of unpaid care as a policy issue. It is argued that wider economic and political agendas should be understood not as impediments to but as core elements of policies on unpaid care. Local policy networks, including carers’ organisations, are discussed with reference to the concept of governance.

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This chapter discusses the development of knowledge about unpaid care since 1990 and explores the increase in interest in unpaid care. Perceptions of demographic trends and their influence on policies are considered. The chapter examines the different research methods used, the different groups involved in producing knowledge, including feminist and disabled researchers. Key findings from research are identified. The development of knowledge has paralleled the development of policies and strategies throughout this period and the relationship between research and policy development is considered. The chapter also discusses the ways in which knowledge has shaped ideas about unpaid care and unpaid carers more broadly, including the emergence of the term ‘carer’. The theoretical framework developed in subsequent chapters is introduced.

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The discussion broadens in this chapter to reflect on the ethical and philosophical issues raised in previous chapters. It discusses the tension between perceptions of unpaid care as a widespread activity and of carers as a distinctive group. It provides a critical analysis of the ethic of care approach, including by disability theorists, and considers the potential for an ethic of justice in care relationships. A discussion of the care deficit draws attention to the impacts of neoliberal policies on care provision and on individuals’ experiences of dependency through the life course. Potential alternative approaches to policies are suggested, which draw upon the feminist ethics of care, recent theorising on risk and precarity in critical gerontology, and on ideas about care as a social risk in social policy theory.

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This chapter sets out the aims of the book. It poses key questions about the place of care within the social and cultural contexts of the UK. It highlights the gap between the rhetoric and realities of policies and strategies to support unpaid carers since the 1990s and points to the way in which this will be examined in subsequent chapters. The historical approach is explained and the chapter provides an overview of the policy background to policies on unpaid care and carers, drawing attention to the impact on unpaid care of deinstitutionalisation and the introduction of care in the community on unpaid care in 1990. An overview of each chapter is provided to guide the reader to the organisation of the content.

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Conclusions are drawn from the reflections on historical trends in policies and on their role in shaping experiences of unpaid care. The need to overturn the marginalisation of unpaid care within professional practice is discussed. The discussion in Chapter 6 is developed to conclude the critique of policies that have emphasised the carer identity and unpaid carers’ rights. An alternative policy paradigm is proposed that emphasises care as a widespread and diverse activity that involves us all and merits a collective response. It calls for care to be understood as a social risk, with sufficient resources to ensure a fair balance between unpaid care and formal services. It also calls for the organisation of care to be based on principles that are supportive of relationships of care.

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Rights, Resources and Relationships
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This book examines policies on unpaid care throughout the UK since the 1990 NHS and Community Care Act. It questions why, after decades of policies and strategies, unpaid care remains in a marginal position in the social care system and in society more broadly, as demonstrated during the COVID-19 pandemic.

It provides critical analysis of key policies and professional practice over three decades and highlights the continuing challenges faced by people in caring relationships, as well as reflecting on developments in the position of unpaid carers in the system of social care.

By questioning why this crucially important sphere of human life remains under-resourced, it sheds light on the ways in which care is understood and how policy makers and service providers perceive the need for support.

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The debates and controversies surrounding the personalisation agenda that have already been identified in this text are clearly evident in the context of services for older people. The development of any policy can be understood as a battle of ideas in which there will be winners and losers (Colebatch, 2005). In this case, as Needham (2011b) has pointed out, the personalisation agenda has gained enormous popularity in the field of social care policy, having now become effectively ‘the only game in town’. However, the ambiguous nature of the concept effectively means that the battle of ideas is still continuing. On the one hand, personalisation is characterised as a revolution in social care, a wholesale cultural shift in the perceptions about how people who need support should be able to exercise control over how it is given. On the other, it is more prosaically seen in terms of the levels of implementation of personal budgets (PBs) and direct payments (DPs) to individual service users, which redistributes responsibility from the state to individuals. Since services for older people constitute more than half of social services expenditure (HSCIC, 2012), it is unsurprising that much attention is being paid to the implementation of personalisation in this sphere, although older service users appear to be less enthusiastic than others about PBs and DPs (Glendinning et al, 2008; Hatton and Waters, 2011). The pressure on councils to increase their uptake raises questions about whether older people are also under pressure to accept PBs or DPs, thus undermining the claims to increased choice and control that are made for them.

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