An analysis of the national health service and the community care act of 1990
Community Care: A Reader, O. Methods Statistics were collated from diverse government publications and other authoritative sources.
Social services is one of the highest revenue spending departments for most local authorities, and within social service budgets at the time, residential and domiciliary services for older people consumed the largest amount of revenue. In , the Audit Commission in Balancing the Care Equation: Progress with Community Care claimed that financial resources dominated any change in the delivery of good practice and service delivery. Government reforms in education and the health service, for example, constructed a quasi-market with internal commissioning and provider roles to stimulate the 'buying' and 'selling' of in-house services Means and Smith Abstract Background The NHS and Community Care Act , implemented from 1 April , was expected to alter profoundly the provision of domiciliary services to old people. Allen et al. The value which underpins all of these policy initiatives is a belief that a competitive market and a 'mixed economy of welfare' will inevitably provide better, cheaper services than a protected and bureaucratised public sector Flynn ; Le Grand ; Clarke ; Walker ; Means and Smith According to Wistow et al. Indeed, according to Phillipson and Walker there is a myth that private care enables older people to be in more control and more able to choose the kind of services than in publicly provided services. Henwood's research has indicated that social service departments were adopting a pragmatic approach to the independent sector because of the need to expand community services. Firstly, one of the central planks of UK government policy throughout the 's was the genesis of marketisation into the public sector.
Results Between and there was a progressive contraction of public community and residential services, as well as hospital beds available to the elderly.
This policy essentially channelled public sector funds into the private institutional sector while leaving the domiciliary sector chronically under-resourced.
The lack of any critical analysis of the role and daily practices of care managers constitutes a major weakness of the implementative process of the Act. Henwood, M Making a Difference? There is value in a multiplicity of provision, not least from the consumer's point of view, because of the widening choice, flexibility, innovation and competition it should stimulate Private residential homes flourished and in the absence of community services, older people as 'consumers' had little 'choice' other than the decision about which institution they might enter in the 'residential private sector plc'.
In this study, few older people had much choice in what services they received, any say in the time of the delivery, the person who delivered it or how much they received.
Indeed this is in the context of between and there has been a drop of places in the residential sector fromplaces to 80, ; a massive increase in private provision from 23, places in toin ; a slow growth in the voluntary sector from 40, in to 52, in Laing and Buisson Thus, a 'contract culture' was to be applied to the provision of personal social services and social services departments would need to develop processes to specify, commission and monitor services delivered by other agencies.
Firstly, one of the central planks of UK government policy throughout the 's was the genesis of marketisation into the public sector. To become 'providers' in the internal market, health organisations became NHS trusts, competing with each other.
Mental health act
Government reforms in education and the health service, for example, constructed a quasi-market with internal commissioning and provider roles to stimulate the 'buying' and 'selling' of in-house services Means and Smith Community care services were indeterminate, with many users unable to obtain the services they require. It established GP Fundholding. Allen et al. Indeed this is in the context of between and there has been a drop of places in the residential sector from , places to 80, ; a massive increase in private provision from 23, places in to , in ; a slow growth in the voluntary sector from 40, in to 52, in Laing and Buisson The dangers are that there may be the manifestation of 'elder abuse' unless standards are monitored and inspection takes place Biggs ; Biggs and Powell, The paper has traced the political ideologies which manifested in the s and s which despite privatization and rhetoric of empowerment and self-governance the Act has led to some key implications materialising. The concomitant huge increase in places publicly funded in private old people's and nursing homes appears to have been little affected by the implementation of the NHS and Community Care Act. There are a number of problems in evaluating the success of community care post and they include the lack of information before the reforms, the lack of national standards and structural changes in health and local government which have had an effect on it Meredith ; Lewis and Glennerster
based on 1 review