COMMUNITY CARE / Three years' preparation ends with a scramble

IN OXFORDSHIRE they are as ready as they will ever be. The administrative computer systems are in place. The management team have all completed their financial and forward planning - just. And the social workers, home care organisers, care assistants and newly-titled care managers have been trained how to assess, plan and deliver community care, writes Rosie Waterhouse.

For three years they have been building co-operation with other agencies, which must all work together if community care is to succeed - the social services department, Oxfordshire district health authority, the Family Health Services Authority, fund holding GPs, district nurses and hospital doctors.

But even in Oxfordshire there were unexpected last-minute hitches. Until last week the community care planning team had omitted to include the unusually high number of homeless mentally ill people in its budgets. In the city of Oxford 2,500 people use the Luther Street medical centre for homeless people. An estimated 520 people are in hostels for the homeless each night while 100 sleep rough. Hard choices must now be made about which other services must be cut to find pounds 234,000 extra for the homeless mentally ill.

Another cause of last-minute panic was the community care plan that all local authorities must publish annually. One of its most controversial aspects was a list of priorities that showed 'rationing' was inevitable.

Response times range from assessment within 10 working days and some service with 14 days for high priorities, to assessment within 15 days and some service within 28 days for medium priorities, to 'if available, service within one month' for low priorities.

Oxfordshire staff were optimistic that in the long term people would benefit from a more 'user friendly' system, catering for their individual needs. But progress would be undermined by lack of resources.

Ian White, Oxfordshire's director of social services, has a nightmare that they have underestimated the number of elderly people who will need residential care which would upset the rest of the budget. Or they could have miscalculated the number of beds they might need to keep discharges from hospitals flowing. If so, waiting list targets will be missed, and relations with the hospital staff will be strained. Or if the private homes increase prices there will be less money to spend on care in people's homes.

Angela Avis, professional head of district nursing for Oxfordshire, says: 'If the needs are assessed and the social services cannot afford to provide the services then the health service will have to step in to provide the service. For instance the district nurse may find herself helping an elderly person get up, washed and dressed, which should be the home care worker's job.'

Gill Duncan, senior nurse in district nursing, fears for the vulnerable frail elderly: 'Because more money will be tied up in residential homes there will be less money for care in people's homes. From the health side of things the fear is we will be left to pick up the bill, social services can't afford to provide proper care in their own homes, so they must stay in hospital, the system gets silted up and no new people can get into hospital. Those who will slip through the net are those considered lower priorities, people with drug and alcohol problems and the homeless.'