2.2.11 Scandals, treatments and cost saving
In the 1960s critics of the quality of care for older people, such as Peter Townsend, The Last Refuge (1962), and Barbara Robb, Sans Everything (1967), added their voices to growing criticisms of institutional care, not only for older people but for users of mental health services and people with learning difficulties too. Government had already begun to take account of its responsibilities for the dire state and cost of many of these institutions and in a famous speech in 1961 Enoch Powell, the then Minister of Health, spoke in damning terms:
There they stand, isolated, majestic, imperious, brooded over by the gigantic water tower and chimney combined, rising unmistakable and daunting out of the countryside–the asylums which our forefathers built with such immense solidity.
(Quoted in Timmins, 1996, p. 211)
Powell set up a 10-year plan but little was achieved at that stage. Successive governments inherited the scandals and, without a convincing or funded alternative, his words did little more than start a process of change. The campaigns of the 1950s and 1960s led by voluntary organisations, academics and some professionals, as well as by patients and their families, fuelled a general move away from institutional care which was given statutory support in the 1990 NHS and Community Care Act. There were other changes too. The introduction of drug treatment from the 1950s offered the possibility of non-custodial care and ideas about the origins and development of conditions began to change too. More psychological and psychotherapeutic as opposed to physiological theories took over, and ideas about correcting or treating behaviour began to lose their force (Parker, 'The persistent image').
Institutions were never the major providers of care in the UK; a range of other types of provision coexisted so that those in institutional care were always a minority of those receiving care. But institutions have tended to be the lynch pin as such terms as ‘preventive care’, ‘after care’, ‘care after discharge’ suggest. All these ‘other’ forms of provision relate back somewhere to institutional care. As Parker suggests, institutions always dominated the landscape of care provision. The training they provided to nursing and medical staff, their care regimes and their position as a last resort, meant that they constituted a powerful source of authority and control in the lives of people who, for whatever reason, came within their confines.