Skip to main content
main-content
Top

About this book

This new edition has been updated to reflect recent shifts in community and social care whilst still providing the authoritative account of its historical development. Particular attention is paid to partnerships between health and social care, the regulation of social care, direct payments and individual budgets and user/carer empowerment.

Table of Contents

Chapter 1. Introducing Community Care

Abstract
The first two editions of Community Care: Policy and Practice focused upon progress and problems in the implementation of the far-reaching changes introduced by the National Health Service and Community Care Act 1990. The 1990 Act had given the lead agency role to social services authorities for all the main ‘core’ groups of service users and required the stimulation of a mixed economy of care through encouraging independent providers. At a strategic level, this was to be achieved through the publication of community care plans on the basis of wide consultation with key agencies and groups, including service users and carers. Care management was to be used at the operational level to ensure service users were offered flexible packages of care which were to draw heavily upon the independent sector.
Robin Means, Sally Richards, Randall Smith

Chapter 2. From Institutions to Care in the Community: The History of Neglect

Abstract
This chapter discusses the historical development of social care and health provision for older people and for people with physical impairments, learning difficulties and mental health problems. The response to the perceived needs of all these groups was overwhelmingly institutional in the nineteenth and early twentieth centuries. Current services for these groups carry this institutional legacy, and present community care policies are, at least in part, an attempt to shake off that legacy. The history of community care services is highly complex. Therefore tackling this theme in one chapter of a textbook risks the danger of oversimplifying events and issues. No attempt will be made to provide a detailed history for all services since such accounts exist elsewhere for most of the main care groups. Rather the focus will be on the extent of service neglect in terms of priority for resources and in terms of the quality of what has been provided from the resources made available. In the 1950s and 1960s, critics of this neglect often referred to the ‘Cinderella services’ or the ‘Cinderella groups’. In terms of priority for resources, they were always waiting for a fairy godmother to arrive and get them to the ball. The second half of the chapter goes on to explore the main explanations which have been put forward to account for this neglect.
Robin Means, Sally Richards, Randall Smith

Chapter 3. Implementing the Community Care Reforms

Abstract
The focus of the last chapter was on the historical neglect of service provision for older and disabled people and for people with mental health problems and learning difficulties. By the late 1980s the pressures for reform had built up and the then Conservative government commissioned Sir Roy Griffiths to review the funding and organisation of community care. His report, Community Care: An Agenda for Action (Griffiths Report, 1988), proposed a radical strategy for reform that reflected the government’s commitment to increasing choice and efficiency through the development of welfare markets. There would be an increased role for the private and voluntary sectors in residential and domiciliary services, but with social services authorities assuming the lead role in purchasing and organising care. His recommendations fed into the White Paper Caring for People (Department of Health, 1989a) and the National Health Service and Community Care Act 1990.
Robin Means, Sally Richards, Randall Smith

Chapter 4. Community Care and the Modernisation Agenda

Abstract
The last chapter focused on the reforms of the 1990s and the implementation challenge facing local authorities as the lead agency for community care. Continuing upheaval and uncertainty followed the election of a Labour Government in May 1997. The incoming government planned to ‘lay the foundations of a modern welfare state in pensions and community care’ (Labour Party, 1997) but gave little indication of an alternative vision for community care to set against the market-orientated approach of its predecessors. Nevertheless, by the time Labour was returned for a third term, in May 2005, significant changes affecting all the agencies involved in community care were in place and further reforms were promised. This chapter stays with the local authorities in England to look at the development of a complex and interlocking set of reforms, intended to transform the regulatory framework for social care and to improve performance in every sector. The following chapter moves the story forward by exploring the impact of health care reform on community care policies and practice.
Robin Means, Sally Richards, Randall Smith

Chapter 5. Health and Social Care: From Collaboration to Incorporation?

Abstract
Labour governments in the late 1990s announced on numerous occasions that they were determined to break down the supposed ‘Berlin Wall’ between health and social care agencies. This chapter focuses on both the shifting boundaries between health and social care and also on the changing approaches to encouraging effective joint working across that boundary. It explores whether or not there has been a fundamental policy shift from an emphasis on collaboration between partners to one where social services are to be largely incorporated into health. The first section, however, provides a short introduction to the problematic nature of joint working.
Robin Means, Sally Richards, Randall Smith

Chapter 6. Housing and Community Care

Abstract
It has long been accepted that the 1989 White Paper on community care was right to stress that ‘suitable good quality housing’ was essential to social care packages (Department of Health, 1989a, p. 9) and that as a result ‘social services authorities … need to work closely with housing authorities, housing associations and other providers of housing of all types in developing plans for a full and flexible range of housing’ (p. 25). This message has been subsequently reinforced through the Audit Commission (1998), independent research (Cameron et al., 2001; Foord and Simic, 2001; Appleton, 2002; Means, 2006) and a range of government reports and policy documents (Sutherland Report, 1999a; Department of the Environment, Transport and the Regions, 2001; Department of Health, 2005a).
Robin Means, Sally Richards, Randall Smith

Chapter 7. Community Care: User Empowerment

Abstract
The preceding chapters have charted significant policy developments and shifts in the main community care sectors in the period since the reforms of the early 1990s. Presented with complex, interlocking and overlapping policy initiatives, combined with continuing organisational turbulence, even experienced care practitioners may be unable to keep abreast of developments outside their immediate sphere. A far greater challenge is faced by users and carers, many of whom negotiate their way through the intricacies of care provision with little prior experience and at a crisis point in their lives. One solution, from the perspective of users and policy-makers alike, is increasing user empowerment. User empowerment, to enable service users to provide a counterweight to provider interests, has been part of the rhetoric of reform from the beginning. However, under New Labour, the development and embedding of strategies for user empowerment is an increasingly prominent policy aspiration.
Robin Means, Sally Richards, Randall Smith

Chapter 8. International Perspectives on Community Care: Lesson Drawing or Policy Learning?

Abstract
The focus of this chapter is on the practice of community or social care activities in other ‘first world’ countries followed by illustrations of their influence on developments in policy and practice in the United Kingdom. Hill (2006, pp. 140–52) outlines how difficult it is to compare social care policies between different societies, so this chapter confines itself to a few examples of transfer of policy and practice. It can take a number of different forms. The literature is wide ranging and attempts to provide overviews have drawn on notions such as policy convergence, policy diffusion, policy learning and lesson drawing (Dolowitz and Marsh, 1996; Evans and Davies, 1999). For the purpose of this chapter, it is assumed that community care is broadly a ‘low politics’ activity whereby policy learning and lesson drawing are more germane than policy convergence or diffusion.
Robin Means, Sally Richards, Randall Smith

Chapter 9. Community Care: New Directions and Old Challenges

Abstract
Our central concern has been the modernisation agenda for public policy of Labour Governments since 1997 and how this has impacted upon community care policy and practice. This final chapter draws the key threads together to reflect upon achievements and failures so far as well as likely future directions.
Robin Means, Sally Richards, Randall Smith
Additional information