25:
123:, institutions, and caring for them in their own homes. Since the 1950s various governments had been attracted to the policy of community care. Despite support for the policy, the number of in-patients in large hospitals and residential establishments continued to increase. At the same time, public opinion was gradually turned against long-stay institutions by allegations from the media.
617:
647:
550:, the Minister of State for Care and Support launched a twelve-week consultation process on how the changes to services should be implemented. While welcomed by most, others saw progress as lamentably slow on the identified issues for what amounts to community care for people with learning disability and
494:
was passed so that patients could be individually assessed, and assigned a specific care worker. in the unlikely event that they presented a risk they were to be placed on a
Supervision Register. There have been problems with patients "slipping through the net" and ending up homeless on the street.
537:
After this, health authorities promised to reduce the number of placements in large units where people were cared for inadequately, far from home, and on a long term basis. It was planned to have a reduction in the number of these placements, with alternative more satisfactory small scale services
422:
The community care reforms outlined in the 1990 Act came into effect in April 1993. They have been evaluated but no clear conclusions have been reached. A number of authors have been highly critical of the reforms. Hadley and Clough (1996) claim the reforms 'have created care in chaos' (Hadley and
186:
for dependent people. There was also concern about the experiences of people leaving long term institutional care and being left to fend for themselves in the community. Yet the government was committed to the idea of 'care in the community'. In 1986 the Audit
Commission published a report called
514:
and others have emphasised, needs assessments were often distorted so a person's "needs" were interpreted to fit the available resources. The development of personal budgets, where the person was given control of resources, rather than provided with services, was intended to tackle this problem.
333:
The majority of long term care was already being provided by Social
Services, but Griffiths proposed putting community nursing staff under the control of local authority rather than Health Boards. This, however, never actually happened. The Griffiths Report on Community Care seemed to back local
199:
The main aim of community care policy has always been to maintain individuals in their own homes wherever possible, rather than provide care in a long-stay institution or residential establishment. It was almost taken for granted that this policy was the best option from a humanitarian and moral
211:
Policy should aim at making adequate provision wherever possible for the care and treatment of old people in their own homes. The development of domiciliary services will be a genuine economy measure and also a humanitarian measure enabling people to lead the life they much
158:
Following the situation at Ely
Hospital a series of scandals in mental hospitals hit the headlines. All told similar stories of abuse and inhumane treatment of patients who were out of sight and out of mind of the public, hidden away in institutions. At the same time
479:, people with mental health problems were able to remain in their own homes whilst undergoing treatment. This situation raised some concerns when acts of violence were perpetrated against members of the public by a small minority of people who had previously been in
542:
highlighted that there had been little change, and proposed the way forward for service improvement. It advocated listening to, and empowering people with disability and their families, and the use of smaller, more local services with different kinds of funding.
275:
were caused by the lack of strong effective leadership and management. Because of this previous work, which was greatly admired by the Prime
Minister, Griffiths was asked to examine the whole system of community care. In 1988 he produced a report or a
96:, treating and caring for physically and mentally disabled people in their homes rather than in an institution. Institutional care was the target of widespread criticism during the 1960s and 1970s, but it was not until 1983 that the government of
531:, which was a private long-term hospital for people with learning disability. This was done in response to disclosures of alleged abuse and of a failure of the authorities, including the regulator to take action on reports of abuse.
565:″Why can't we just get on and do it? To say it's going to go into a green paper fills me with horror. It suggests to me that our successors will be sitting round the table in a couple of years’ time having the same conversation.”
311:
Local
Authorities should have key role in community care. i.e. Social Work / Services departments rather than Health have responsibility for long term and continuing care. Health Boards to have responsibility for primary and acute
144:. This exposure prompted an official enquiry. Its findings were highly critical of conditions, staff morale and management. Rather than bury this report it was in fact deliberately leaked to the papers by the then
357:
A belief that state provision was bureaucratic and inefficient. That the state should be an 'enabler' rather than a provider of care. The UK state at this time was funding, providing and purchasing care for the
322:
Specified what Social
Service Departments should do: assess care needs of locality, set up mechanisms to assess care needs of individuals, on basis of needs - design 'flexible packages of care' to meet these
326:
Promote the use of the
Independent sector: this was to be achieved by social work departments collaborating with and making maximum use of the voluntary and private sector of welfare.
187:'Making a Reality of Community Care'. This report outlined the slow progress in resettling people from long stay hospitals. It was this report which prompted the subsequent Green and
707:
762:
534:
The broadcast programme showed physical and verbal abuse of people, a culture of frustration and boredom, and lack of any structured treatment for the inpatients.
329:
Social
Services should be responsible for registration and inspection of all residential homes whether run by private organisations or the local authority.
204:
491:
476:
411:
130:
and she used this to launch a campaign to improve or else close long stay facilities. Shortly after this, the brutality and poor care being meted out in
844:
Weller M.P.I., Sammut R.G., Santos M.J.H. and Horton J. (1993) 'Whose sleeping in my bed?' Bulletin of the Royal
College of Psychiatrists, 17: 652-654.
864:
287:
between health and social services which included the long term or continuing care of dependent groups such as older people, the disabled and the
539:
439:
health services and social services workers have not worked well together and there have been few 'multidisciplinary' assessments carried out
111:
government in the 1980s, community care was not a new idea. As a policy it had been around since the early 1950s. Its general aim was a more
267:
had already been invited by Margaret Thatcher to produce a report on the problems of the NHS. This report was influenced by the ideology of
879:
781:
619:
Report of the Committee of Inquiry into Allegations of Ill – Treatment of Patients and other irregularities at the Ely Hospital, Cardiff
884:
559:
239:
of care, i.e. a variety of providers. The mixed economy provision in residential and nursing home care has been maintained despite the
622:(Government report), Presented to Parliament by the Secretary of State of the Department of Health and Social Security, 11 March 1969
436:
the enthusiasm of local authorities was undermined by vested professional interests, or the service legacy of the last forty years
874:
433:
were an excellent idea, but received little understanding or commitment from social services as the lead agency in community care
763:"No voice unheard, no right ignored – a consultation for people with learning disabilities, autism and mental health conditions"
250:. Much of the continuing care of elderly and disabled people was provided by the NHS. Now much of that has been re-defined as
605:
487:
in 2013 showed that psychiatric patients are actually three times as likely to be victims of crime than the general public.
271:- the idea that problems could be solved by 'management'. Griffiths firmly believed that many of the problems facing the
101:
68:
46:
39:
869:
751:
Beresford, Peter (26 February 2014). "Personal budgets: how the government can learn from past mistakes". Guardian.
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government whereas, the health board reforms in the same period, actually strengthened central government control.
295:
meaning that community care was not working because no one wanted to accept the responsibility for community care.
254:
and is the responsibility of local authorities. Whereas NHS services are free, social services have to be paid for.
167:
both published books which exposed the poor quality of care within certain institutions. The 1981 ITV documentary
104:
published a report called 'Making a Reality of Community Care' which outlined the advantages of domiciliary care.
859:
423:
Clough 1996), claiming the reforms have been inefficient, unresponsive, and have offered no choice or equity.
470:
145:
376:
The White Paper followed the main recommendations of the Griffiths Report but with two notable exceptions:
243:
budget being capped. There are also now many independent organisations providing domiciliary care services.
164:
430:
introduced a system that is no better than the previous more bureaucratic systems of resource allocation
633:
383:
It did not offer a new system of earmarked funds for social care along the lines advised by Griffiths.
495:
There have also been arguments between Health and Social Services departments over who should pay.
484:
135:
33:
466:
247:
93:
50:
827:
Langan, M (1990) Community care in the 90s: the community care White Paper Caring for People,
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for Community Care to ensure implementation of the policy - it required ministerial authority.
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480:
387:
It did however; identify six key objectives which differed slightly from Griffiths Report:
8:
345:
In 1989 the government published its response to the Griffiths Report in the White Paper
562:, on hearing the outlined plans of the health service on these proposed changes, said:
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172:
112:
627:
601:
502:, said the care in the community programme launched by the Conservatives had failed.
443:
305:
160:
140:
108:
97:
207:, reporting in 1956, summed up the assumption underlying policy. It suggested that:
453:
229:
171:
which spotlighted the conditions of mental patients at the Borocourt Hospital near
148:
524:
240:
168:
280:
called 'Community Care: Agenda for Action', also known as The Griffiths Report.
555:
288:
283:
The Griffiths Report Proposed a solution to the issue of 'no-man's land' - the
221:
183:
581:
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the reforms have been undermined by chronic underfunding by central government
284:
853:
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was the main beneficiary of this attempt to develop a "mixed economy of care"
272:
268:
264:
236:
182:
In the 1980s there was increasing criticism and concern about the quality of
126:
In the 1960s Barbara Robb put together a series of accounts in a book called
120:
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258:
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problems and physical disabilities, by removing them from impersonal, often
708:"People with mental health problems at high risk of being victims of crime"
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225:
131:
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277:
251:
188:
152:
648:"Official Inquiry Reports into National Health Service Mental Hospitals"
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became responsible for operating a needs-based yet cash-limited system.
841:
Weller M P I (1989) Mental illness - who cares? 'Nature' 399: 249-252.
600:, Audit Commission for Local Authorities in England and Wales, 1986,
176:
782:"Is the spectre of Winterbourne View finally beginning to shift?"
551:
347:
Caring for People: Community Care in the next Decade and Beyond
808:
Private and Public Protection: Civil Mental Health Legislation
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The White Paper did not propose a Minister of Community Care
259:
The Griffiths Report: 'Community Care: Agenda for Action'
442:
in reality little collaboration took place except at
337:
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Means and Smith (1998) also claim that the reforms:
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National Health Service and Community Care Act 1990
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National Health Service and Community Care Act 1990
460:
412:
National Health Service and Community Care Act 1990
400:
Development of needs assessment and care management
368:
151:, who hoped to obtain increased resources for the
138:in Cardiff, was exposed by a nurse writing to the
291:. In 1988 Griffiths said that community care was
851:
200:perspective. It was also thought to be cheaper.
179:, Surrey brought the issue into the public eye.
107:Although this policy has been attributed to the
672:. Socialist Health Association. 10 January 1956
216:Three key objectives of Community Care policy:
498:In January 1998, the Labour Health Secretary,
403:Promotion of domiciliary, day and respite care
293:everybody's distant cousin but nobody's baby -
410:These objectives were legislated for in the
361:Separation of the purchaser / provider roles
235:There was a clear agenda about developing a
650:. Socialist Health Association. 6 June 1981
406:Development of practical support for carers
364:Devolution of budgets and budgetary control
690:
750:
538:provided. However, after four years, the
301:made six key recommendations for action:
69:Learn how and when to remove this message
417:
353:and shared the same general principles:
32:This article includes a list of general
865:Mental health law in the United Kingdom
779:
397:Agency responsibilities clearly defined
100:adopted a new policy of care after the
852:
734:"Care in the community to be scrapped"
695:(2 ed.). London: Macmillan Press.
319:to fund development of community care.
224:on independent sector residential and
591:
523:BBC Panorama's team in 2011 filmed a
194:
838:, Buckingham, Open University Press.
834:Lewis, J & Glennester, H (1996)
575:
518:
220:The overriding objective was to cap
18:
836:Implementing the New Community Care
824:, Edinburgh, The Stationery Office.
810:, Edinburgh, Dunedin Academic Press
780:Grindle, David (15 February 2015).
705:
693:Community Care: Policy and Practice
505:
394:Promotion of the independent sector
246:To redefine the boundaries between
13:
880:Homelessness in the United Kingdom
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598:Making a Reality of Community Care
582:Report of the Committee of Inquiry
38:it lacks sufficient corresponding
14:
896:
885:Social care in the United Kingdom
299:Community Care: Agenda for Action
461:Mental health and community care
349:. This was a companion paper to
228:care. This was achieved in that
175:and the St Lawrence Hospital in
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134:, a long stay hospital for the
875:Politics of the United Kingdom
813:Bornat, J et al. (1993, 1997)
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471:Assertive community treatment
146:Secretary of State for Health
822:Domiciliary Care in Scotland
588:, Retrieved 28 February 2010
586:Socialist Health Association
7:
691:Means, R; Smith, R (1998).
115:way of helping people with
10:
901:
820:Curtice, L. et al. (1997)
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92:") is a British policy of
817:, Basingstoke, Macmillan.
560:Public Accounts Committee
815:Community Care: a reader
784:. The Guardian newspaper
870:National Health Service
714:. King's College London
670:"The Guillebaud Report"
483:. However, research by
53:more precise citations.
860:Deinstitutionalisation
829:Critical Social Policy
632:: CS1 maint: others (
467:Deinstitutionalisation
248:health and social care
94:deinstitutionalisation
485:King's College London
481:psychiatric hospitals
418:Impact of the reforms
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82:Care in the Community
16:British health policy
806:Atkinson, J. (2006)
351:Working for Patients
315:Specific grant from
205:Guillebaud Committee
136:mentally handicapped
191:on community care.
740:. 17 January 1998.
317:central government
222:public expenditure
195:Aims of the policy
173:Reading, Berkshire
606:978-0-11-701323-0
529:Winterbourne View
519:Winterbourne View
444:senior management
370:Caring for People
340:Caring for People
338:1989 white paper
306:Minister of State
230:local authorities
161:Michael Ignatieff
141:News of the World
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548:Norman Lamb
540:Bubb report
512:Simon Duffy
278:Green Paper
252:social care
51:introducing
854:Categories
569:References
475:Under the
465:See also:
358:population
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285:grey area
121:Victorian
59:June 2008
788:13 March
738:BBC News
628:citation
177:Caterham
718:30 July
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552:autism
212:prefer
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446:level
323:needs
312:care.
790:2015
720:2021
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