There has been considerable progress in the last forty years in the delivery of care services, for example in the field of disability - to a great extent through the efforts of people with disabilities themselves. Institutional care, where it still exists, is subject to continuing review - while 'care in the community' has gone through a succession of policy transformations, with increasing emphasis on person-centred care and now individual budgets and personalisation of services. Even Alzheimer's disease, the most recalcitrant of illnesses to modern medical science, is receiving much greater attention than before, with media interest, celebrity involvement and the UK government publication of a dementia care strategy. At the same time, the author argues that there are significant ways that the world has got tougher for the most vulnerable in our society. A culture of enterprise and opportunity, put to good use by the disabled people's movement, does have a downside - a wide-ranging lack of respect for dependency, even where this is necessary and appropriate, in human relationships.
The culture of targets and audit in the delivery of public services - a distortion of organizational theory developed in other sectors - has made the effective delivery of humane and responsive care more difficult to achieve and maintain. This book addresses the questions facing the survival of the vulnerable in society at a time of continuing uncertainties in local and global economic and political life.