Beyond modernisation? Social care and the transformation of welfare governance

This article reflects on the process and outcomes of modernisation in adult social care in England and Wales, drawing particularly on the recently completed Modernising Adult Social Care (MASC) research programme commissioned by the Department of Health. We begin by exploring the contested status of ‘modernisation’ as a descriptor of reform. We then outline some of the distinctive features of adult social care services and suggest that these features introduce dynamics likely to shape both the experiences and outcomes of policy ambitions for modernisation. We then reflect on the evidence emerging from the MASC studies and develop a model for illuminating some of the dynamics of welfare governance. Finally, we highlight the emerging focus on individualisation and on user-directed and controlled services. We argue that the current focus of modernisation involves a reduced emphasis on structural and institutional approaches to change and an increased emphasis on changes in the behaviours and roles of adult social care service users. This focus has implications for both the future dynamics of welfare governance and for conceptions of citizenship. Introduction Social care services are becoming the subject of reform as welfare states across Europe face increasing pressures on existing provision and anticipate growth in future demand. Many countries are actively engaged in spatial reorganisations of care, developing integrated models of service provision, reviewing and adapting insurance-based schemes, or experimenting with models of ‘cash for care’. Those involved in reform within continental Europe look across the Channel to the UK experience, regarding it as a model to follow, a warning of what might be to come, or some uneasy mix of the two. This article focuses on the experience of reform in England and Wales, teasing out lessons from a recently completed programme of research commissioned by the Department of Health.1 We begin by setting out the context of the reform programme (badged, like other UK