Community Care, Secondary Health Care and Care Management
Edited by
DAVID CHALLIS
ROBIN DARTON
KAREN STEWART
First published 1998 by Ashgate Publishing
Reissued 2018 by Routledge
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Chapters 1, 4 and 10 Crown Copyright 1998
Chapter 2 Bob Welch 1998
Chapter 3 Jackie Morris 1998
Chapter 5 Peter Carr and Sally Ann Kelly 1998
Chapter 7 Iain Carpenter 1998
Chapter 8 Peter Huxley 1998
Chapter 9 Ken Wright 1998
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A Library of Congress record exists under LC control number: 98073022
Typeset by Jane Dennett at the PSSRU, University of Kent at Canterbury
ISBN 13: 978-1-138-32142-7 (hbk)
ISBN 13: 978-0-429-45253-6 (ebk)
Contents
David Challis, Robin Darton and Karen Stewart
Bob Welch
Jackie Morris
David Challis, Robin Darton and Karen Stewart
Peter Carr and Sally Ann Kelly
Douglas MacMahon, Christine McKee and Ken Buckingham
Iain Carpenter
Peter Huxley
Ken Wright
David Challis, Robin Darton and Karen Stewart
Ken Buckingham Health Economist, Cornwall and Isles of Scilly District and Family Health Services Authorities
Iain Carpenter Senior Lecturer in Health Care of the Elderly, Kings College School of Medicine and Dentistry and Centre for Health Services Studies, University of Kent at Canterbury
Peter Carr Consultant Physician, Department of Geriatric Medicine, Darlington Memorial Hospital
David Challis Professor of Social Work and Community Care, Personal Social Services Research Unit, School of Psychiatry and Behavioural Sciences, University of Manchester, and University of Kent at Canterbury
Robin Darton Research Fellow, Personal Social Services Research Unit, University of Kent at Canterbury
Peter Huxley Professor of Psychiatric Social Work, School of Psychiatry and Behavioural Sciences, University of Manchester
Sally Ann Kelly Senior Occupational Therapist, Darlington Memorial Hospital
Christine McKee Project Leader, Eldercare Unit, Cornwall Healthcare Trust, Barncoose Hospital, Redruth, Cornwall
Douglas MacMahon Consultant Physician and Medical Director, Eldercare Unit, Cornwall Healthcare Trust, Barncoose Hospital, Redruth, Cornwall
Jackie Morris Consultant Physician in Old Age Medicine, Royal Free Hospital, London
Karen Stewart (Formerly Karen Traske) Research Officer, Personal Social Services Research Unit, University of Kent at Canterbury
Bob Welch Formerly Inspector, Social Care Group Central Region, Social Services Inspectorate, Department of Health
Ken Wright Formerly Deputy Director, Centre for Health Economics, University of York
This book has grown out of the study of the Darlington Community Care Project. The Darlington Project was a special intervention funded under the Care in the Community Initiative, designed to provide frail elderly people with enhanced home care as an alternative to long-stay hospital care. The service consisted of care managers with budgets and control over multipurpose home care assistants who could act as assistants to nurses and therapy staff, and perform home care tasks in peoples own homes. The project was one of the PSSRU family of care management projects evaluating intensive care management in a variety of settings, in this case a geriatric multidisciplinary team.
Following the publication of the book Care Management and Health Care of Older People, a conference was held at which the papers included in this book were presented. A key theme arising from the project and the conference is the role of secondary health care services in the provision of community care, and their link to intensive care management. We are particularly grateful to all those who presented the material in this book, and who have responded so generously to our editorial suggestions. The organisation of the conference itself would have not been possible without the painstaking hard work of Anne Walker and Glenys Harrison.
The manuscript has been typeset and edited by Jane Dennett at the PSSRU, and the diagrams were prepared by Nick Brawn at the PSSRU. We are grateful to the NHS Health Advisory Service for permission to reproduce (with amendments) a figure from their 1994 publication, Comprehensive Health Services for Elderly People, which appears as are reproduced from the RAI-Home Care (RAI-HC) Assessment Manual, by Morris et al., interRAI Corporation, Washington, DC, 1997. We should also like to thank the Department of Health and Ruth Chadwick, our liaison officer, for their support, and Professor Bleddyn Davies, the Director of the PSSRU, for his commitment to, and enthusiasm for, the research process.
David Challis, Robin Darton, Karen Stewart (formerly Traske), April 1998
David Challis, Robin Darton and Karen Stewart
Community care has been a longstanding policy objective in the UK for all client groups. However, despite this formal commitment, a rapid growth in the residential and nursing home sectors during the 1980s, supported by social security funds, led to a perverse incentive towards institutional care (Audit Commission, 1986). The Government appointed a special adviser to identify possible solutions, and the report was published in 1988 (Griffiths, 1988). This recommended a more coordinated approach to the funding and management of care, placing the responsibility for the allocation of funds, assessment of need and coordination of care with the local authority social services department, and proposed care management to ensure a more effective use of resources. After this lengthy gestation period, the community care reforms in the UK emerged following the 1989 White Paper Caring for People (Cm 849, 1989) and the 1990 National Health Service and Community Care Act. Full implementation commenced in 1993. Underlying this change in policy were a set of six key objectives for service delivery:
to promote the development of domiciliary, day and respite services to enable people to live in their own homes wherever feasible and sensible.
