Care in the Community
Encyclopedia
Care in the Community is the British policy of deinstitutionalization, treating and caring for physically and mentally disabled people in their homes rather than in an institution. Institutional care was the target of widespread criticism during the 1960s and 1970s, but it was not until the 1980s that the government of Margaret Thatcher
adopted a new policy of care after the Audit Commission published a report called 'Making a Reality of Community Care' which outlined the advantages of domiciled care.
The Guillebaud Committee reporting in 1956 summed up the assumption underlying policy. It suggested that:
Policy should aim at making adequate provision wherever possible for the care and treatment of old people in their own homes. The development of domiciliary services will be a genuine economy measure and also a humanitarian measure enabling people to lead the life they much prefer
Three key objectives of Community Care policy:
An important point to note though is: that NHS services are free, whereas social services have to be paid for. So how the care you require is defined, that is health or social care, determines whether or not it will be free.
had already been invited by Margaret Thatcher to produce a report on the problems of the NHS. This report was influenced by the ideology of managerialism
. That is it was influenced by the idea that problems could be solved by 'management'. Griffiths firmly believed that many of the problems facing the Welfare State
were caused by the lack of strong effective leadership and management. Because of this previous work, which was greatly admired by the Prime Minister, Griffiths was asked to examine the whole system of community care. In 1988 he produced a report or a Green Paper
called 'Community Care: Agenda for Action', also known as The Griffiths Report.
Griffiths intended this plan to sort out the mess in 'no-man's land'. That is the grey area between health and social services. This area included the long term or continuing care of dependent groups such as older people, disabled and the mentally ill
.
In 1988 Griffiths said of community care that it was everybody's distant cousin but nobody's baby.
Basically he was saying that community care was not working because no one wanted to accept the responsibility for community care.
Community Care: Agenda for Action made six key recommendations for action:
The majority of long term care was already being provided by Social Services, but Griffiths' idea was to put community nursing staff under the control of local authority rather than Health Boards. This never actually happened. The Griffiths Report on Community Care seemed to back local government whereas, the health board
reforms in the same period, actually strengthened central government control.
It did however; identify six key objectives which differed slightly from Griffiths Report.
These objectives required new legislation which was enacted in the National Health Service and Community Care Act 1990
.
Means and Smith (1998) claim that the reforms:
, people with mental health problems were able to remain in their own homes whilst undergoing treatment. This situation raised some concerns when acts of violence were perpetrated against members of the public by a small minority of people who had previously been in psychiatric hospital
s.
The National Health Service and Community Care Act 1990
was passed so that patients could be individually assessed, and assigned a specific care worker; in the unlikely event that they presented a risk they were to be placed on a Supervision Register. But there have been some problems with patients "slipping through the net" and ending up homeless on the street. There have also been arguments between Health and Social Services departments on who should pay.
In January 1998, the Labour Health Secretary, Frank Dobson, said the care in the community programme launched by the Conservatives had failed.
Margaret Thatcher
Margaret Hilda Thatcher, Baroness Thatcher, was Prime Minister of the United Kingdom from 1979 to 1990...
adopted a new policy of care after the Audit Commission published a report called 'Making a Reality of Community Care' which outlined the advantages of domiciled care.
Aims of community care policy
The main aim of community care policy has always been to maintain individuals in their own homes wherever possible, rather than provide care in a long -stay institution or residential establishment. It was almost taken for granted that this policy was the best option from a humanitarian and moral perspective. It was also thought to be cheaper.The Guillebaud Committee reporting in 1956 summed up the assumption underlying policy. It suggested that:
Policy should aim at making adequate provision wherever possible for the care and treatment of old people in their own homes. The development of domiciliary services will be a genuine economy measure and also a humanitarian measure enabling people to lead the life they much prefer
Three key objectives of Community Care policy:
- The overriding objective was to cap public expenditurePublic financePublic finance is the revenue and expenditure of public authoritiesThe purview of public finance is considered to be threefold: governmental effects on efficient allocation of resources, distribution of income, and macroeconomic stabilization.-Overview:The proper role of government provides a...
on independent sector residential and nursing homeNursing homeA nursing home, convalescent home, skilled nursing unit , care home, rest home, or old people's home provides a type of care of residents: it is a place of residence for people who require constant nursing care and have significant deficiencies with activities of daily living...
care. This was achieved in that local authoritiesLocal governmentLocal government refers collectively to administrative authorities over areas that are smaller than a state.The term is used to contrast with offices at nation-state level, which are referred to as the central government, national government, or federal government...
became responsible for operating a needs-based yet cash-limited system. - There was a clear agenda about developing a mixed economyMixed economyMixed economy is an economic system in which both the state and private sector direct the economy, reflecting characteristics of both market economies and planned economies. Most mixed economies can be described as market economies with strong regulatory oversight, in addition to having a variety...
of care, i.e. a variety of providers. The mixed economy provision in residential and nursing home care has been maintained despite the social securitySocial securitySocial security is primarily a social insurance program providing social protection or protection against socially recognized conditions, including poverty, old age, disability, unemployment and others. Social security may refer to:...
budget being capped. And there are now many independent organisations providing domiciliary care services. - To redefine the boundaries between health and social careHealth and Social CareIn the UK, Health and Social Care is a broad term that relates to integrated services that are available from health and social care providers...
. Much of the continuing care of elderly and disabled people was provided by the NHS. Now much of that has been re-defined as social careSocial workSocial Work is a professional and academic discipline that seeks to improve the quality of life and wellbeing of an individual, group, or community by intervening through research, policy, community organizing, direct practice, and teaching on behalf of those afflicted with poverty or any real or...
and is the responsibility of local authorities.
An important point to note though is: that NHS services are free, whereas social services have to be paid for. So how the care you require is defined, that is health or social care, determines whether or not it will be free.
The Griffiths Report: 'Community Care: Agenda for Action'
Sir Roy GriffithsRoy Griffiths
Sir Ernest Roy Griffiths was a British businessman. He was a director of Monsanto Europe , and a director and deputy chairman of J...
had already been invited by Margaret Thatcher to produce a report on the problems of the NHS. This report was influenced by the ideology of managerialism
Managerialism
Managerialism is the belief that organisations have more similarities than differences, and thus the performance of all organisations can be optimised by the application of generic management skills and theory. To a practitioner of managerialism, there is little difference in the skills required...
. That is it was influenced by the idea that problems could be solved by 'management'. Griffiths firmly believed that many of the problems facing the Welfare State
Welfare State
The Welfare State is a commitment to health, education, employment and social security in the United Kingdom.-Background:The United Kingdom, as a welfare state, was prefigured in the William Beveridge Report in 1942, which identified five "Giant Evils" in society: squalor, ignorance, want, idleness...
were caused by the lack of strong effective leadership and management. Because of this previous work, which was greatly admired by the Prime Minister, Griffiths was asked to examine the whole system of community care. In 1988 he produced a report or a Green Paper
Green paper
In the Commonwealth, the Republic of Ireland and the United States a green paper is a tentative government report of a proposal without any commitment to action; the first step in changing the law...
called 'Community Care: Agenda for Action', also known as The Griffiths Report.
Griffiths intended this plan to sort out the mess in 'no-man's land'. That is the grey area between health and social services. This area included the long term or continuing care of dependent groups such as older people, disabled and the mentally ill
Mental illness
A mental disorder or mental illness is a psychological or behavioral pattern generally associated with subjective distress or disability that occurs in an individual, and which is not a part of normal development or culture. Such a disorder may consist of a combination of affective, behavioural,...
.
In 1988 Griffiths said of community care that it was everybody's distant cousin but nobody's baby.
Basically he was saying that community care was not working because no one wanted to accept the responsibility for community care.
Community Care: Agenda for Action made six key recommendations for action:
- Minister of StateMinister of StateMinister of State is a title borne by politicians or officials in certain countries governed under a parliamentary system. In some countries a "minister of state" is a junior minister, who is assigned to assist a specific cabinet minister...
for Community Care to ensure implementation of the policy - it required ministerial authority. - Local Authorities should have key role in community care. i.e. Social Work / Services departments rather than Health have responsibility for long term and continuing care. Health Boards to have responsibility for primary and acute care.
- Specific grant from central governmentCentral governmentA central government also known as a national government, union government and in federal states, the federal government, is the government at the level of the nation-state. The structure of central governments varies from institution to institution...
to fund development of community care. - Specified what Social Service Departments should do: assess care needs of locality, set up mechanisms to assess care needs of individuals, on basis of needs - design 'flexible packages of care' to meet these needs
- Promote the use of the Independent sector: this was to be achieved by social work departments collaborating with and making maximum use of the voluntary and private sector of welfare.
- Social Services should be responsible for registration and inspection of all residential homes whether run by private organisations or the local authority.
The majority of long term care was already being provided by Social Services, but Griffiths' idea was to put community nursing staff under the control of local authority rather than Health Boards. This never actually happened. The Griffiths Report on Community Care seemed to back local government whereas, the health board
Health Board
The Health Board system of the Republic of Ireland was created by the 1970 Health Act. This system was initially created with eight health boards, each of which were prescribed a functional area in which they operated...
reforms in the same period, actually strengthened central government control.
1989 white paper 'Caring for People'
In 1989 the government published its response to the Griffiths Report in the White Paper Caring for People: Community Care in the next Decade and Beyond. This was a companion paper to Working for Patients and shared the same general principles:- A belief that State provision was beaureaucratic and inefficient. That the State should be an 'enabler' rather than a provider of care. The UK state at this time was actually funding, providing and purchasing care for the population
- Separation of the purchaser / provider roles
- Devolution of budgets and budgetary control
Caring for People key objectives
The White Paper followed the main recommendations of the Griffiths Report but with two notable exceptions.- The White Paper did not propose a Minister of community care and
- It did not offer a new system of earmarked funds for social care along the lines advised by Griffiths.
It did however; identify six key objectives which differed slightly from Griffiths Report.
- New funding structure
- Promotion of the independent sector
- Agency responsibilities clearly defined
- Development of needs assessment and care management
- Promotion of domiciliary, day and respite care
- Development of practical support for carers
These objectives required new legislation which was enacted in the National Health Service and Community Care Act 1990
National Health Service and Community Care Act 1990
The National Health Service and Community Care Act 1990 is a piece of legislation which governs health care and social care in the United Kingdom...
.
The impact of the community care reforms
The community care reforms outlined in the 1990 Act have been in operation since April 1993. They have been evaluated but no clear conclusions have been reached. A number of authors have been highly critical of the reforms. Hadley and Clough (1996) claim the reforms 'have created care in chaos' (Hadley and Clough 1996) They claim the reforms have been inefficient, unresponsive, offering no choice or equity. Other authors however, are not quite so pessimistic.Means and Smith (1998) claim that the reforms:
- introduced a system that is no better than the previous more bureaucratic systems of resource allocation
- were an excellent idea, but received little understanding or commitment from social services as the lead agency in community care
- the enthusiasm of local authorities was undermined by vested professional interests, or the service legacy of the last forty years
- health services and social services workers have not worked well together and there have been few 'multidisciplinary' assessments carried out
- in reality little collaboration took place except at senior managementSenior managementSenior management, executive management, or management team is generally a team of individuals at the highest level of organizational management who have the day-to-day responsibilities of managing a company or corporation, they hold specific executive powers conferred onto them with and by...
level - the reforms have been undermined by chronic underfunding by central government
- the voluntary sectorVoluntary sectorThe voluntary sector or community sector is the sphere of social activity undertaken by organizations that are for non-profit and non-governmental. This sector is also called the third sector, in reference to the public sector and the private sector...
was the main beneficiary of this attempt to develop a "mixed economy of care"
Mental health and community care
Under the National Health Service and Community Care Act 1990National Health Service and Community Care Act 1990
The National Health Service and Community Care Act 1990 is a piece of legislation which governs health care and social care in the United Kingdom...
, people with mental health problems were able to remain in their own homes whilst undergoing treatment. This situation raised some concerns when acts of violence were perpetrated against members of the public by a small minority of people who had previously been in psychiatric hospital
Psychiatric hospital
Psychiatric hospitals, also known as mental hospitals, are hospitals specializing in the treatment of serious mental disorders. Psychiatric hospitals vary widely in their size and grading. Some hospitals may specialise only in short-term or outpatient therapy for low-risk patients...
s.
The National Health Service and Community Care Act 1990
National Health Service and Community Care Act 1990
The National Health Service and Community Care Act 1990 is a piece of legislation which governs health care and social care in the United Kingdom...
was passed so that patients could be individually assessed, and assigned a specific care worker; in the unlikely event that they presented a risk they were to be placed on a Supervision Register. But there have been some problems with patients "slipping through the net" and ending up homeless on the street. There have also been arguments between Health and Social Services departments on who should pay.
In January 1998, the Labour Health Secretary, Frank Dobson, said the care in the community programme launched by the Conservatives had failed.