The Impact of Community Care Policy on Older People in Britain. 1970s-1990s (original) (raw)
Related papers
Health care policies in the UK
Reviews in Clinical Gerontology, 1993
Although government policy statements in 1978 and 1984 stressed the high priority to be given to health services for elderly people in the UK, 1-2 this sense of concern was not translated into any highly prominent or funded new policies. The main event of the 1980s was a shift to greater private involvement in long-term care. A new inadvertent but irreversible public subsidy greatly increased the role of private nursing and residential homes, leading to an unpredicted rise in numbers of elderly people living in long-term institutional settings. Official reports by the Audit Commission and by Sir Roy Griffiths made a powerful critique of the change and stimulated a new initiative in funding and managing community care in a more integrated way. 3-4 The 1990 Community Care Act and its implementation seem likely to form the
Aspirations and realities: community care at the crossroads*
Health & Social Care in the Community, 2007
The community care reforms in the United Kingdom were a response to a broadly based critique of the policy's failure. After an apparently successful first year's implementation, their robustness is increasingly under question. This paper reviews evidence about the early implementation of the reforms. While attention has focused on erecting a structure of systems and processes, the foundations of community care are in danger of being undermined by internal and external policy contradictions. The twin objectives of improved service access and expenditure control are already proving difficult to reconcile. In addition, radical changes in the delivery of acute services are creating additional pressures which the reforms were not designed to bear.
What is (Adult) Social Care in England? Its origins and meaning
2019
The term ‘social care’ emerged in both official and academic publications in England in the 1990s but has not been defined in legislation. How the phrase has varied in usage over the last 20 plus years is outlined in this article. Whilst the element of ‘personal care’ has been present in the range of descriptions of ‘social care’, the policy context has changed dramatically, affecting the broader debate about priorities in public support for vulnerable adults. What ‘social care’ means as a policy rather than a practice has changed over time. The notion of indeterminacy provides a plausible explanation of changes in terminology and meaning in policies and practices.
Halfway There? Policy, Politics and Outcomes in Community Care
Social Policy & Administration, 1996
The community care reforms which followed the 1989 White Paper "Caring for People" were apparently focused on addressing the needs o fpeople requiring long-term care, and on achieving improved outcomes and better quality of life. The agenda set out by the White Paper was for community care in the next decade and beyond. Half way through this decade, we question the extent to which the objectives of promoting choice and independence f o r users and carers have been achieved. The paper drams particularly on a programme of monitoring conducted jointly ly the ~u~e l d Institute for Health and the King's Fund, based on national and local focus groups meeting over a two-year period. It proposes a framework f o r evaluation which consists of four components: the dejinition of desired outcomes; specijication of service systems necessary to deliver such outcomes; promotion of access to services; and the development of supporting operational policies and resource allocation mechanisms. This framework offers a substantial step beyond much of the monitoring of the community care reforms which has taken place to date. This has assessed progress largely in terms of the establishment o f new systems andprocesses. We conclude that such changes were essential building blocks for delivering better-quality community care services, and in the short term it may have been legitimate to view their establishment as proxies for progress towards delivering user-centred services. However, monitoring and evaluation should now be increasingly oriented towards ensuring that these changes are in fact producing the desired service outputs and user outcomes. We propose that our framework offers one such way forward.
Ageing and Society, 2014
This paper examines how the relationships between the factors (predisposing, enabling and illness) of the Andersen framework and service use are influenced by changes in the caring role in older women of the - cohort of the Australian Longitudinal Study on Women's Health. Outcome variables were the use of three formal community support services: (a) nursing or community health services, (b) home-making services and (c) home maintenance services. Predictor variables were survey wave and the following carer characteristics: level of education, country of birth, age, area of residence, ability to manage on income, need for care, sleep difficulty and changes in caring role. Carer changes were a significant predictor of formal service use. Their inclusion did not attenuate the relationship between the Andersen framework factors and service use, but instead provided a more complete representation of carers' situations. Women were more likely to have used support services if they had changed into or out of co-resident caring or continued to provide co-resident care for a frail, ill or disabled person, needed care themselves, and reported sleep difficulties compared with women who did not provide care. These findings are important because they indicate that support services are particularly relevant to women who are changing their caring role and who are themselves in need of care.
1997
This study sought to assess whether the community care needs of a purposive sample of nine older people aged between sixty-seven and ninety-six years residing in the semi-rural township of Feilding were being met by current service provision. Qualitative interviews were conducted with nine client participants and thirteen key informants selected from service providers to the older population of Feilding. Despite the political turmoil of tendering for contracts for specific community care services, providers were delivering a range of services and were aware of the issues concerning quality, access, appropriateness and coordination of services which were enabling these older clients in Feilding to maintain their independence at home. The major incentive for service providers is to keep clients mobile and out of hospital. However, the lack of information to older clients concerning their eligibility for services provided by service providers, may deter potential clients from accessing community care services, thereby decreasing the demand for services. Providers were constrained by their budget and minimum staffing levels to supply services to meet the potential demand. The older disabled clients of community care in Feilding, faced issues of dependency on formal and informal support services, decreasing mobility, vulnerability and concerns relating to cultural sensitivity, safety in their homes, and the quality of the careworking relationship.