COMMUNITY CARE / Community care launched with modest expectations: After a two-year delay, this week sees the introduction of a radical reform of social welfare, with a new system of payment and provision

ON THURSDAY, without fanfare or much fuss, the long-awaited new system for delivering community care to millions of elderly, mentally ill, disabled and other vulnerable people in Britain will be unveiled.

The lives of most of the population will ultimately be affected, directly or indirectly, as responsibility for the social welfare of the nation changes hands.

The system for paying for and providing social services has undergone changes as radical as those that transformed the National Health Service. Many of the reforms are driven by the same ideological principles and will introduce similar concepts, such as the purchaser/provider split; user, as opposed to patient, choice; mixed markets, using both public and private services; and, most unpredictable of all, prioritising or rationing.

Implementation of community care has been delayed for two years even though preparations have been underway since the 1990 NHS and Community Care Act was passed. They have gathered pace considerably in the past 12 months and reached fever pitch in the last few weeks. From 1 April, local authority social services departments will take over responsibility for assessing needs, purchasing 'social care', and in some cases overseeing 'health care' in the community. Most social care - 85 per cent of councils' transitional grant - must be bought from independent providers, mainly private nursing homes.

The involvement of the Department of Social Security in funding care services such as nursing or

residential care homes and some benefits for disabled people will not apply to new referrals and will gradually be phased out altogether. The Government's six key objectives, set out in the White Paper Caring for People: community care in the next decade and beyond, promise great things: 'To promote the development of domiciliary (care at home), day and respite services to enable people to live in their own homes wherever feasible and sensible; to ensure that service providers give high priority to practical support for carers; to make proper assessment of need and good case management the cornerstones of high-quality care; to encourage the development of a flourishing independent sector alongside good quality public provision; to clarify the responsibilities of social services departments and health authorities and so make it easier to hold them to account for their performance; and to secure better value for taxpayers' money by introducing a new funding structure for social care.'

Everyone - professionals, pressure groups and those for whom community care is intended - agrees that the aims are laudable. But many are sceptical whether they can be achieved without considerably more money than the Government has set aside.

The launch of community care will be a low-key affair. The Government has no special plans for a press conference or publicity drive. The changes would not happen overnight, a press officer said; there would be a long period of transition as they developed over the years.

Ministers, too, have been at pains to lower expectations since people realised that because of cash constraints, the 85 per cent rule and the fact that most cash will be spent on accommodating the highest and largest priority group - frail elderly people - in residential homes, few new services will be apparent in the first year.

Doom-and-gloom merchants predict chaos on a par with that caused by the closure of wards and banning of non-emergency operations in hospitals, as local authorities run out of money towards the end of the financial year.

So what are the hopes and expectations of community care? We have interviewed people from some of the groups that will be most affected by the changes, to find out what they think it will do for them, and we have asked those who are expected to deliver community care whether it will work. We hope to return to them all in a few months' time to see how the new system is performing in practice.

(Photographs omitted)


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