‘Care in the community’ took off in the 1970s and 80s. At that time, NHS bosses were facing up to the high cost of running a vast network of hospitals, alongside most people’s wish to receive care at home whenever possible. It seemed to make sense that small, roving teams of nurses could deliver equally good care to people in their own homes, saving the NHS money, and allowing patients more privacy and comfort than hospital can offer. Around the same time, the monolithic Social Work (Scotland) Act 1967 placed a statutory framework around a wide range of child and adult welfare services that were previously the preserve of churches, charities and dispassionate local bureaucrats. Central to the development of community care was the car.
In community services, most workers use a car. We rove from house to house, dispensing everything from pain relief to parenting advice, in a sector that first blossomed in the era of cheap petrol and motorway construction. The areas we cover are often geographically disparate: large towns or districts that might share the same postcode or town hall but which sprawl out to distant historical or administrative boundaries.
Throughout the sector, job descriptions routinely specify that the applicant ‘must have own car’ – quite a tricky requirement when you’re recruiting front line home care staff to be paid less than eight pounds an hour. Our expenses claims are routinely referred to as ‘mileage’ despite that they encompass public transport expenses and other costs too.
But we care for people who have little chance of owning a car any time soon. We work with vulnerable young families experiencing severe poverty and with adults whose disabilities mean they could never get a driving license, or have had to give theirs up. There are times when having a car assists us in carrying out our duties – in the course of my work I have helped people load every single one of their belongings into the boot of my car as they move between homeless accommodations – but there remains a discrepancy between a workforce that relies on cars, and a clientele that can scarcely imagine owning one.
Meanwhile the cost of petrol, and the visible impacts of climate change, render driving an increasingly expensive and guilt-ridden task for us all. As the current regime of austerity brings greater centralisation of services; we are seeing the closure of community buildings, health clinics and even local sheriff courts, causing longer journeys for all concerned.
The cost of owning a car continues to rise, while wages remain stagnant and glaciers melt; but our local public services continue to live by the outdated ethos that care is by car.