The ideological thinking behind Community Care was intended for the traditional groups who were under the care of the Social Service Departments, namely elderly persons, parents and families, adolescents, young children and those with physical mental handicaps and those with a history of mental illness including dementia, people with sensory impairment, drug and alcohol related disorder, people with progressive illness such as AIDS or MS. The Local Authority philosophy of care is to help people achieve as normal a life as possible, fully integrated members of the community.
The social services Act of 1970 was formed so that Local Authorities became responsible for providing services for the people in its local authority. Previously Social Services were divided into Departments; for example Children Services was different from Welfare Services, and Social Workers had to work independently within their roles without liasing with each other. As a result of this, different Social Workers had to deal with say a child in the family and another with the parents. This legislation brought them all together. The Community Care Reform was to make services, needs-led rather than service-led.
In the past, Community Care had been provided by the number of agencies, and the two main ones were the Health Service and the Local Authority Social Services. With the implementation of the 1990 Act, the Local Authority was given the main responsibility for the care of the people in its Local Authority. This included the elderly, people with physical disabilities, and people with learning disabilities.
The main principle of Community Care is to enable the vulnerable people who are in need of long term care to be able to live an independent life in their own homes or in “homely” settings in the community instead of in institutional settings or in residential homes.
Before the government White Paper on the Community Care Reforms of 1989, the greater part of care for people in the community who need care on a regular basis has been provided by families, friends and sometimes neighbours.
The proposal of the White Paper was to meet present and future challenges of the people in Local Authorities and to give the people a much better opportunity to secure a tailored service to their needs. The aim was to promote choice as well as independence. This offers the prospect of a better deal for people who need care and for those who provide care.
The Local Authorities were instructed by the government to produce and publish clear plans for Community Care in their areas. In return, the government allocates the money directly to the Local Authorities to run their own services independently.
Once the Local Authorities receive the money, they will then have the responsibility of working out the budget for the different groups in the community and how to buy and provide for the activities of the people who need care in the community.
Since the introduction of the Community Act in 1990, and the implementation of the Act in 1993, social workers are the main purchasers of services for the elderly or those with disabilities and many others who need care in the community. They act as ‘Care Managers’.
From 1993, any body wanting services will have to be means tested first. Legally the social services have a duty to assess for needs but not to provide.
If an individual needs support or care over a long term, the council has a duty to assess the clients needs. This is called Community Care Assessment and provides a suitable service or services to meet the clients’ individual needs.
The assessment will usually be done by a Social Worker but sometimes it is done by occupational therapy or Nursing staff. This assessment is done to get a clear picture of the client’s situation and social, health and housing needs.
The aim of the Act was to work towards meeting the present and the future challenges of the communities. And to give the people a much better opportunity to live independently and for the families and friends of those who need long term care to be able to support their loved ones at home instead of in residential care.
Depending on the needs of the client, the Social Worker might have to work with other agencies (networking) together with the client to understand the individual’s needs and decides the best way to meet them.
The assessment is usually done in the clients own home, in a day or residential centre or in a hospital setting.
If the Community Care needs of the client is straight forward, the assessment will usually take one interview. If a client is facing a major change because of an illness or disability. The Case Manager will have to involve other staff from housing, health for example nursing and other care agencies. This is called a multi-disciplinary assessment.
Multi-disciplinary assessment allows for a thorough look into an individual circumstance, and can be very effective in that it allows the different members of the team to share their knowledge and skills to meet the needs of the client assessed.
The services and facilities provided that are intended to help the client to get good quality Community Care are:
help with personal and domestic tasks such as cleaning, washing and preparing meals, (home help), disablement equipment and home adaptations, transport, budgeting and other aspects of daily living;
suitable good quality housing and day care, respite care, leisure facilities, employment, and educational opportunities to improve the quality of life for the people with care needs in the community.
After the assessment a care plan is devised that will suit the individual needs. The care plan describes the services the client will receive, for example: who will be coming to help the client, when they will be coming; how long they will stay; what they will do; how much the client will have to pay for each service etc.
For clients with mental health problems, the assessment of needs will be done using the Care Programme Approach (CPA).
The Care Programme Approach is a plan of care programme of care that describes the help available to meet clients’ needs as well as health services.
Although the objectives of the government is to see that the care needs of less able people in the community are being met, there is evidence that some of the individuals do not suffer a single problem, but suffer from several problems, and in such cases it can be difficult to make a holistic assessment on a clients needs.
Social Services being a statutory organisation tends to use a lot of bureaucracy, which might affect the level of quality in the co-ordination between these different agencies that are involved in the assessment of need of the client. There is also greater difficulty in enforcing uniform standard of quality across the Country because of the difference in the resources that the different local authorities are prepared to put towards Community Care. Therefore, there is an imbalance of services. The quality of care can depend on which part of the Local Authority a client lives in.
To cut cost, some of the Local Authorities are buying cheap and ineffective services for its users. Clients do not have the choice of choosing what services they want. There is no value for money, efficiency in service delivery, and waste of resources, due to customers’ needs unmet.
Inequality of service can lead to discriminatory practice. Another issue for the clients is that clients that live in some of the groups homes face resentment from the communities they live in, because of the attitudes of most people who make them feel unwelcome, or see them as ‘abnormal’. The clients do not feel welcome and can not feel a sense of belonging.
Peoples needs can change and it is essential to monitor and review clients cases on a regular basis, however due to financial constraints, clients are often not monitored to see if the care plan is working or not. Many clients with mental health problems have been failed in the sense that there is not enough supervision for them and they are often left to look after themselves, make their own decisions, which can lead them to neglect themselves and not take their medication. They either harm themselves or others, but mostly themselves.
However, under the Mental Health Act 1983 Guardianship on a number of cases is conferred on Local Authority or other person, that is the guardian.
Some of the most elderly clients with severe disabilities have little opportunities either to complain or to withdraw from the services.
Most clients are still not getting anything at all.
Most people needing Community Care are the elderly and they are the group that is more likely to live alone. Growth will be greatest amongst the very elderly who are most likely to be disabled and in greater need of Community Care. The number of people aged 85 is projected to rise from 695,000 in 1986 to 1,146,000 in 2001.
The number of people aged 65 and over is projected to rise from 8.4 million in 1985 to 9.0 million by 2001. Statistics are from, Caring for People :Community Care in The Next Decade and Beyond. HMSO (1989) page 62.
In a time of financial constraints and increasing emphasis on value for money, there is a risk that funders / purchasers will be forced to cut cost in order to meet unreasonable
financial targets. Quality Assurance may not be high on the list of such an organisation.
When used in such an organisation, Quality Assurance is usually known to be subjective rather than objective. The organisations usually do their own self-assessment on the type of services they are offering the clients.
The outcome of such assessment is that short term it is usually not difficult to assess at least some immediate or short-term result.
In longer term, assessment imparts on individuals, groups or the community may require more complicated or elaborate follow-up; and regularly monitoring result against the standards and targets.
The next step will be to have reviews more regularly to see if the services provided was meeting the needs of the problems Community Care was intended to solve. If there is less money allocated to do this, then the quality of service will be mediocre.
If the local authorities are not willing to evaluate and be critical of their organisation themselves, and their activities, there will be no point for Community Care Services, and the people it was intended for will not be gaining much from the service and the statement of intent. Vulnerable people will become more vulnerable.
By way of recommendation, Local Authorities will need to have clear plans for the development of their Community Care provision and monitoring it regularly.
Services should reflect the service user’s holistic needs.
There should be a central monitoring arrangement from the government to inspect the quality of care provided by the Local Authorities.
Users of services should be included in the decision making about the care they receive. Local Authorities should be accountable to an elected body, and be made to publish their plans for Community Care Services.
The majority of people who need care in the community are vulnerable. They need help because they cannot manage on their own so they will need to rely on other people to do it for them.
Britain is a country that says it believes that everyone in the society should be given an opportunity to make choices, feel valued and maintain dignity.
People in the community need to feel secure and be empowered to live a more independent life as far a possible.
Should it be necessary for its people to feel more valued, then it is wise to return to the basic principle that stipulates that everyone has an equal right to be able to feel a sense of belonging in the society.