Since the Community Care Act reforms of the 1990s, social care in the UK has been transformed into a multibillion-pound industry where a range of providers now compete in a market (Fotaki et al, 2013). The effects of the privatisation and marketisation of social care systems on the day-to-day realities of giving and receiving care, however, have been the subject of much critical scholarly attention (MacDonald and Merrill, 2002; Lynch, 2007). Concerns have been raised about whether the introduction of profit motives gives priority to commercial agendas to the detriment of service quality. At the same time, social care services in general are under threat from the impact of fiscal austerity. Local authority budgets in many parts of the UK have been heavily reduced, having an impact on the ability for care providers to meet service user needs. Evidence would suggest that services for older people have experienced worsening quality, the introduction of new or higher charges as well as declining accessibility (Age UK, 2014, p 2).

Speaking to these wider concerns, this chapter uses covert ethnographic data collected in an elderly residential home to show how forms of abuse and neglect can become embedded within the routines and practices of care work. It has been argued that marketisation and privatisation have both had a negative impact on the way in which care is performed. It seems that workers’ rights have been affected by a drive across the sector to maintain and sustain low pay. When care is done for profit, services can become subject to a process of extreme rationalisation as providers strive to decrease costs in order to increase profits. Many aspects of the service can be affected, including staffing levels, funding for medical supplies or extras such as entertainment and social budgets, and a generalised pressure is exerted on the quality of care (Lopez, 1998; Folbre, 2006). A growing theme in this literature is the existence of a rift between the expectations of care workers held by employers and state regulatory frameworks, and the actual ability for frontline workers to deliver the sort of care that is being asked of them. A recent article by Bolton and Wibberley (2014), for example, shows how the formal management of domiciliary care work through rotas and care plans fails to capture the complex and demanding requirements of those relying on the service to meet their needs.