Community care is intended to enable people to lead independent lives at home or in local residential units for as long as they are able to do so. For many years there has been a trend in Britain for care of elderly people and those with mental or physical problems to be shifted from hospitals and into community settings. In 1988 Sir Roy Griﬃths’s report to the Secretaries of State for Social Services, Community Care: Agenda for Action, advised on the best use of public funds to provide eﬀective community care. The White Paper Caring for People, published in 1989, outlined the government’s ideas for developing these proposals further. The plans were then enshrined in law with the National Health Service and Community Care Act of 1990.
Since April 1993, local social-services departments have been responsible for assessing what help people need from community-care services: these can include home helps, meals on wheels, sheltered housing, etc. Recipients of such services are means-tested and make variable contributions towards the costs. Policies on charging vary from one area to another and there are wide geographical variations in the range of services provided free and the charges levied for others.
People with complex needs may be assigned a case manager to coordinate the care package and ensure that appropriate responses are made to changing circumstances. The success of community care hinges on eﬀective coordination of the services of an often large number of providers from the health and social-services sectors. Poor communication between sectors and inadequate coordination of services have been among the most common complaints about the community-care reforms.
Health care for people being cared for in the community remains largely free under the NHS arrangements, although there are regular debates about where the boundaries should be drawn between free health services and means-tested social care. A distinction has been made between necessary nursing care (funded by the state) and normal personal care (the responsibility of the patient), but the dividing line often proves hard to deﬁne.
As care has shifted increasingly into the community, previous hospital facilities have become redundant. Vast numbers of beds in long-stay geriatric hospitals and in-patient psychiatric wards have been closed. There is now concern that too few beds remain to provide essential emergency and respite services. In some areas, patients ﬁt for discharge are kept in hospital because of delay in setting up community services for the elderly, or because of the inability of the local authority to fund appropriate care in a nursing home or at home with community-care support for other patients; the resulting BED-BLOCKING has an adverse eﬀect on acutely ill patients needing hospital admission.
Community care, if correctly funded and coordinated, is an excellent way of caring for people with long-term needs, but considerable work is still needed in Britain to ensure that all patients have access to high-quality community care when they need it. Problems in providing such are are not conﬁned to the UK.