Steve Illiffe and Jill Manthorpe may be right in their assertion that the market in social care has failed but the accompanying photograph caption, "The Poor Law's long shadow" provides a succinct insight. The Poor Laws sought to address poverty and the "feckless and the reckless". Care today increasingly addresses the needs of people who have survived well into later life but who are unable to live independently through dementia and frailty, yes many will be poor but few are destitute. Their needs are distinct from traditional social care or traditional primary or secondary health care.
Policy development and ownership is polarised in the Department of Health to "health care" and " community care", yet with more than 3 times the number of care home beds than the whole NHS and fees for care homes dominating social care budgets, the so called market exists in a foggy no-mans land. The importance of effective regulation is beyond question but it cannot fill a policy leadership void.
In recent years social care has taken great efforts to prevent unnecessary care home admissions and health services sought to prevent avoidable hospital admissions. This represents an extraordinary failure of leadership that sadly is not unique to the UK.
For care homes to become respected and valued as a place of beneficence and sanctuary whose purpose is as valued and understood as well as that provided by hospices the key issue of purpose needs to be clarified and generally agreed. We have recently proposed the use of established life trajectories to understand and develop policy and practice and get beyond "the demographic problem", "success of ageing" and morbidity compression and create a new medical approach we have termed "Formative Care". (Clive Bowman and Julienne Meyer Formative Care: defining the purpose and clinical practise of care for the frail 2014 Vol 107(3) 95-98 DOI: 10.1177/0141076813512298)
Practically, policy specific ownership, possibly a third division in the DH and a comprehensive settlement both in terms of national specification and guidance with innovation and effective surveillance maintaining fitness underpinned by regulation are overdue.
Competing interests: No competing interests