Abstract
‘Community’ is and has been one of the most overused and least defined words in the social science lexicon; ‘community care’ may well occupy a similar place in the social policy literature. The confusions about the meanings of the term community defy simple summary, so it should be no surprise that community care has ‘confused boundaries’ (Land, 1991). Among the confusions of community care are whether it means care in or care by the community; the distinction between health care and social care; and the fact that, despite its title, effective community care does require the availability of inpatient treatment facilities. Given that the main responsibility for community care now falls on local government, it may seem out of place to include an extended discussion of it. However, given that adequate community-based services are necessary for those discharged from hospitals, consideration of community care policies is relevant to discussion of the NHS reforms (which are predicated on an increase in efficiency and the discharge of patients not requiring hospitalisation). Furthermore important issues are raised by community care, notably the boundary between the responsibilities of the health and social services.
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Notes and References
This was echoed by the Health Committee (1994, para. 20) which commented that the pressure on acute services was such that voluntary patients were rarely admitted to hospital, thus leaving open the possibility that their condition would deteriorate, leading them to make heavier demands on acute services in due course.
This was provoked by the public reaction to incidents such as a murder committed by a discharged psychiatric patient, and the mauling of another by lions in London Zoo. It also led to suggestions for supervised discharge schemes as alternatives to continued institutionalisation, largely to allay public fears.
‘Closing mental hospitals: simple information about hospital closures is not available’. BMJ, vol. 306, pp. 471-2, 475. This reported on a survey undertaken by the National Schizophrenia Fellowship, which had shown that 45 hospitals were due to close between 1993 and 2000. However, Tim Yeo, the minister with responsibility for community care, had been unable to say how many hospitals in England were due to close, because no information was held centrally (HC Deb., v. 217, c. 387, 21 January 1993) (he had previously suggested that 29 mental illness hospitals were to close by 1997). Although the government had appointed a mental illness task force for a two-year period while it was monitoring the progress of community care initiatives the closure process would presumably continue.
While Tony Newton accepted the need for stringent controls, he drew attention to the excessive rigidity with which local authorities were imposing registration requirements on the private sector and argued that those authorities should not be seeking to apply standards higher than those that would apply to their own properties. The then minister for health, Barney Hayhoe, insisted that the government had no intention of relaxing regulatory standards (Social Services Committee, 1986, Evidence, Q 330-333).
The DoH had written to proprietors of nursing and residential homes asking whether current levels of inspection were too onerous and costly (BMJ, vol. 307 18 September 1993), p. 702.
R. Cook, HC Deb., v.169, c. 200, 13 March 1990.
HC Deb., v.169, c. 206, 13 March 1990.
HC Deb., v.169, c. 208, 13 March 1990.
The government was defeated in a Commons vote on this issue, with 32 Conservatives voting against the government. However, Labour’s proposed amendment was not accepted due to a procedural technicality.
A government survey revealed variations in weekly costs for residential care that ranged from £143 to £217 per week (in Lancashire and Strathclyde respectively), or some 50 per cent, and evidence to the Social Security Committee (1991) showed large variations even within regions. Yet the government’s view was that there was ‘no pattern or basis which left us with the view that there was a secure basis for coming forward with a regional or local scheme’ (Tony Newton, social security minister, in Social Security Committee, 1991, Evidence, Q262). This was strongly criticised; for example the National Association of Citizens’ Advice Bureaux (1991) berated the government for adhering to ‘this very crude national assessment’ of maximum charges that would be met by social security.
This was the subject of a television documentary shown nationally in January 1992.
Social Security Committee, 1991, Evidence, Q89.
M. Henwood and G. Wistow, evidence to Social Security Committee, 1991.
Community Care, 2 September 1993, pp. 16-17, ‘Who foots the bill?’
‘Care ruling could cost NHS dear’, Guardian, 3 February 1994, p. 8. The man had been placed in a nursing home and although he continued to receive income support covering part of the fees, the shortfall on fees was some £6000 per annum.
‘Crumbling of care’, Guardian, 4 February 1994, p. 19. This editorial commented that, in a survey carried out in 1990, 77 per cent of health authorities had reduced continuing care beds, and most authorities had not replaced them with contractual beds in the private sector. This ran counter to procedural guidelines issued by the DoH in 1989, which stated that patients should not be transferred to private nursing homes if it meant that they or their families would have to pay.
Guardian, 6 July 1993.
DoH evidence to Health Committee, 1993c, p. 37.
Community Care, 1 April 1993, p. 1.
HC Deb., v. 218, c. 1150, 11 February 1993.
Community Care, 5 August 1993.
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© 1995 John Mohan
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Mohan, J. (1995). Imagined and Imaginary Communities: Rhetoric and Reality in Community Care Policy. In: A National Health Service?. Palgrave, London. https://doi.org/10.1007/978-1-349-23897-2_5
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DOI: https://doi.org/10.1007/978-1-349-23897-2_5
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