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Open Journal of Social Science Research

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OJSSR 2013, 1(4):94-98 DOI: 10.12966/ojssr.07.03.2013

The Impact of Community Care Policy on Older People in Britain. 1970s-1990s

Flourish Itulua-Abumere*
University of Roehampton Alumna Daytona Global Enterprise Limited VGC, Ajah. Lagos, Nigeria
*

Corresponding author (Email: flourishabumere@yahoo.com)

Abstract - Towards the end of the 1970s the concept of community care was emerging as the preferred alternative to institutionalized service provision. For feminist writers it presented a potential problem in that the family was identified as the location within which this community-based care would be provided and that the burden, therefore was likely to fall on women. Community care has been presented as the ideal form of provision on the grounds of cost-effectiveness, moral responsibility (family members have a duty to care for one another) and as a safeguard against the abuse of individual that may occur in institutional settings. The community care bandwagon continued to gain momentum throughout the 1980s. The National Health Service became separated and there was subsequent criticism of the fragmentary nature of social provision. The Griffiths Report of 1988 identified the role of social service as an enabling body rather than a service provider. In keeping with government policies, Social Service Departments were to make use of both private and voluntary sectors in purchasing services, and this was adopted in the 1990 National Health Service and Community Care Act. Keywords - Community Care, Older People, Social Service, Policy, Reforms, Community Care Act, Audit Commission

1. Introduction: Community Care

The word community care can sometimes be referred to as domiciled care or care in the community which under the British policy is a way of treating, caring and deinstitutionalization for people with physical and mental disability in their homes instead of caring for them in the usual institution. Institutional care was the primary objective of well-known criticism during the 1960s and 1970s (Socialist Health Association, 2010). However, in 1983 the government of Margaret Thatcher implemented a new policy of care after the Audit Commission which was published as a report called 'Making a Reality of Community Care which sketched out and made clear the advantages of domiciled care (Audit Commission, 1986) While community care policy has been official to the Margaret Thatcher administration in the 1980s, community care was not in any way a recent initiative. As a policy it had been around since the early 1950s.It had aims and objectives which cost effectiveness by assisting people with mental and physical disability, by taking them away from Victorian institutions, and caring for them in their own homes. Since the 1950s various government administrations had been concerned and contributive to the policy of community care in Britain. In spite of numerous supports for the policy, the amount of in-patients in big hospitals and residential institu-

tions constantly increased. So also, public views and attitude was progressively twisted against long-stay institutions by claims from the media (Bornat, 1993) In the 1980s there was growing condemnation and worry about the worth of long term care for needy people. There were also trepidations about the experiences of people leaving long term institutional care and being left to care for themselves in the community. Nevertheless the government was dedicated to the initiative of community care. In 1986 the Audit Commission published a report called 'Making a Reality of Community Care'. This report detailed the slow development in resettling people from long stay hospitals. It was this report which encouraged the initiative of writing the Green and White papers on community care (Atkinson, 2006)

2. Aims and Objectives of Community Care Policy

The key aim of community care policy has constantly been to sustain individuals in their own homes anywhere it can be achieved, rather than provide care in a long -stay institution or residential institution. This was one of the best options from a humanitarian and moral perspective. It was also thought to be cost-effective (Bornat, 1997) Three key objectives of Community Care policy:

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The principal objective was to limit public expenditure on independent sector residential and nursing home care. This was attained in that; local authorities became responsible for operating a needs-based yet cash-limited system. There was a clear agenda about developing a mixed economy of care, i.e. a variety of providers. The mixed economy provision in residential and nursing home care has been maintained despite the social security budget being capped. And there are now many independent organizations providing domiciliary care services. To redefine the boundaries between health and social care. Much of the continuing care of elderly and disabled people was provided by the NHS. Now much of that has been re-defined as social care and is the responsibility of local authorities. (Langan sited in Wikipedia, 2013)

4. Now Who are The Older People?

The most commonly used approach to the definition of old age is based upon chronological age (sometimes combined with receipt of pension and formal withdrawal from the labour market). Old age therefore is defined by the number of years individuals have lived. With this type of approach we are using chronological age as a surrogate for biological/functional age. 65 years is a broad indicator of entry into the later phases of the life cycle. However the population age 65 years and over is large and it is estimated that, in the UK, nine million people (about 18 percent of the total population) fall with category (Victor, 2000) Elderly people in our societies are most likely to need community care although such generalizations mask the fact that many younger elderly people need care, while many very elderly people need no care at all (Meredith, 1993:19). Some care for elderly people is called geriatric care. This word is most often used in the health services to refer to people over a certain age perhaps 75 or 80. Geriatrics is a medical specialty which focuses on improving the situation of elderly people with illness, taking into account all the medical and social factors needed for their care (Meredith, 1993) The post-war decades in Britain have seen a rising emphasis upon community care as opposed to institutional provision for those groups in society requiring long term care. This will include the elderly. Across the range of western industrial societies there is a trend towards decreased institutional provision and a greater emphasis upon the care and maintenance of older people in their own homes for as long as possible. As the 1981 white paper, Growing Older, commented care in the community must increasingly mean care by the community (DHSS, 1981:3). In the field of care of the elderly it was stated that; The primary objective of department policies is to enable old people to maintain independent lives in the community for as long as possible. To achieve this high priority is being given high priority to the development of domiciliary provision and the encouragement of measures designed to prevent or postpones the need for long term care in hospital or residential homes (DHSS, 1978:13). Thus, it is argued that the care of the elderly is a responsibility which should be shared by all, and not just one which solely involves statutory services. In this case appearance community care is seen as the responsibility of the family with state services only playing a rather residual role (Victor, 1991). There has been a broad consensus about the appropriateness of community care as a social objective. Though, this has not been seen to be a very effective set of policies as it carries along some obstacles which accounted for slow progress in community care. So it has been subject to recent rigorous scrutiny by a series of government reports: the Audit commission (1986), the House of Commons Social Services Committee Report (1985) and the Griffiths Report (1986) which resulted in the 1989 White Paper Caring For People (Victor, 1991).

3. The Impact of Community Care Reforms

The community care reforms sketched out in the 1990 Act have been functioning since April 1993. They have been appraised but no clear conclusions have been reached. Some authors have been extremely decisive of the reforms. Hadley and Clough (1996) claim the reforms 'have created care in chaos' (Hadley and Clough 1996). They claim the reforms have been incompetent, unresponsive and unproductive offering no option or fairness. Other authors conversely, are not quite so negative about the community care policy reforms.(Weller et al., 1993) Means and Smith (1998) also claim that the reforms: bring in a scheme that is no better than the prior more bureaucratic schemes of resource distribution were an exceptional scheme, but received little understanding or commitment from social services as the pilot agency in community care the eagerness of local authorities was undermined by vested professional interests, or the service legacy of the last forty years health services and social services workers have not worked well together and there have been few 'multidisciplinary' assessments carried out in reality little teamwork took place except at senior executive level the reforms have been undermined by serious underfunding by central government the voluntary sector was the main beneficiary of this attempt to develop a "mixed economy of care" (Means & Smith, 1998)

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The Audit Commissions Inquiry into community care came to the same conclusion as countless previous independent studies (Bornat et al, 1993). Joint planning and community care policies are in some disarray. The result is poor value for money. Too many people are cared for in setting costing over 200 pounds a week when they would receive a more appropriate care in the community at a total cost to public funds of 100-130 pounds a week. Conversely, people in the community may not be getting the support they need. (Audit Commission, 1986:3) The Audit Commission proposed various organizational changes aimed primarily at clarifying the overlapping responsibilities of health and social services authorities. For example, the long term care of older people in the community would be financed from single budget established by contributions from the NHS and local authorities. The budget would be under the control of a single manager who would purchase services from the appropriate public or private agency (Audit Commission 1986). The Audit Commissions critical report was much more influential with the government than any previous one had been, including the authoritative analysis by the House of Commons Social Services Committee (Bornat et al 1993). Following the Audit Commission report, Sir Roy Griffiths was appointed, in march 1986, to examine problems in the arrangements for community care between the NHS and local authorities and to explore the option of putting the whole service for older people under the control of a manager who will purchase from whichever public or private agency is appropriate (Bornat et al 1993). The Griffiths review concentrated upon adults who required care and support from others. For instance because they are elderly or physically disabled due to old age. The review was published in March 1988 as a Green Paper Community Care: Agenda for Action (Victor, 1991) Community care: Agenda for Action (The Griffiths Report), 1988 sets out the points of philosophy that were to be incorporated, in the main (barring the call for a minister for community care), by the government when constructing Caring For People and its consequent community care legislation (Bornat et al 1993: 175). The white paper is based upon the assumption that for most people community care is the best form of care available. The ideology underpinning this report, therefore, promotes the ideals of the family as the main source of care and the home as the appropriate place to receive such care. The statement also makes community care the most appropriate for older people who are not chronically ill as some old people will have families around to support them at home (Victor, 1991). There is a clear emphasis upon promoting the choice of individuals in influencing the type of care they receive, providing care outside institutions if at all possible and limiting the amount of care available so as to foster dependence. This later point reflects the concern voiced by this administration to reduce the dependency culture which they felt was promoted by universal and overgenerous state welfare systems

(Means & Smith, 1994; Victor 1991) With these objectives in mind the White Paper states that the proposed changes intended to enable people especially the elderly to live as normal a life as possible in their own homes or in a homely environment in the community, so also to provide the right amount of care and support to enable people to achieve maximum independence and to provide people with greater say in how they live their lives and the services they need. Six main objectives are indicated by the government for service delivery and they all have a positive impact on older people (Victor, 1991). These are stated as: 1) Promoting the development of domiciliary, day and respite services to enable people to live in their own homes 2) Ensuring that service providers make support for informal careers a high priority 3) Making proper assessment of need and good case management the key to the provision of good quality care 4) Promoting the development of the independent sector 5) Clarifying the responsibilities of agencies to increase accountability 6) Securing better value for money. (Means & Smith, 1994; Victor, 1991) 7) The white paper does set specific priorities for the elderly and disabled people. This report indicates that for the government at least, old age and disability are synonymous (Victor, 1999: 140) Table. 1
Expenditure on core community care services in Great Britain, 1987-1988 Local authority domiciliary care: Million (Pounds) Home helps 535 Meals on wheels 59 Aids and adapta49 tions Day care (elderly) 77 Day care (other) 78 Adult training 167 Social Work 202 Total 1167 Local authority residential care: Elderly 914 Others 269 Total 1183 Social security Residential, nursing home residents 774 income support

(Department of health, 1989b) Here, we expend considerable amount of money upon the formal community care services (Table 1). Of the 3124 million pounds spent on community care in the year 1987-1988 a considerable amount is spent on older people; 63

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per cent of all expenditure is spent on residential care (Department of health, 1989b) There are other community care policies in Britain which have also significant impact on older people. The Health Services and Public Health Act 1968 is one of the community care legislation. Section 45(1) of this Act gives local authorities powers, which with the approval of the Secretary of State, to make arrangements to promote the welfare of old people: An authority may, with the approval of the Secretary of State, and such an extent as he may direct shall, make arrangements for promotion of the welfare of older people (Meredith, 1993: 159) Circular 19/71 described possible services to be provided under the Act, which could include: 1. Provision of meals and recreation 2. Assistance in travelling services 3. Help in finding households for boarding elderly persons 4. Provision of practical assistance in the home, including assistance in the carrying out works of adaptation or the provision of any additional facilities designed to secure greater safety, comfort or conveniences; 5. Provision of warden services for occupiers of private housing 6. Provision of visiting and advisory services and social work support This circular made a positive impact on older people as they had more opportunities to access services in the community (Meredith, 1993). From Knight 1989 discussion if correct, attempts to locate dependency within the elderly, may be particularly threatening to identity in older age. Both Macdonald and Rich (1984) and Morris (1991) emphasize the pressure on older people to pass, to be accepted as normal. This requires a personal that denies an ageing identity lest this disqualifies them from meaningful social interaction. The true identity, never acted out, can lose its substance, its meaning even for ourselves (Macdonald and Rich, 1984: 55). But in today society policies on community care supporting and promoting older people dependency has shift the identity of the elderly whereby they are now treated or accepted as normal and they are now encouraged to involve in social interaction without discrimination (Biggs, 1993) Differences in the pattern of informal care have also provoked debate on who should be included within the states definition of careers requiring formal support. An original figure of approximately 6 million careers in UK (OPCS, 1985), the majority of whom were women between the ages of 45 and 64, provoked considerable unease amongst policy makers in view of increased demand expected on services (OPCS, 1985 sited in Biggs, 1993). A closer analysis of the same data which was funded by the department of health, has revised this figure downward to 1.29 million once a higher threshold of 20 hours caring and a focus on personal care such as dressing, bathing and toileting were used as criteria (Parker, 1990). The most vulnerable

careers, aged over 75, emerged as men in a ratio of 5:3. Although they is claim that this examination emphasizes the heterogeny of the caring population, its policy implications have been to restrict the common sense of care to those in the severest circumstances (Evandrou, 1991). There are also past policies implemented that have negative or rather confusing impact on older people. Some of them are frankly contradictory. The best of many illustrations of this might be in terms of housing policies, obviously in this country, where gestures have been made in the direction of providing more appropriate housing for old people while, at the same time, our extended families have been scattered far and wide by major changes in our city centers which have moved the young families out to suburban housing estates. The old people have left behind, thereby creating a distance problem which is usually difficult and sometimes almost insurmountable (Kinnaird et al, 1981) As regards transport which is relevant in many ways is very disappointing not even directly to the older people as recent legislations has provided support for transport services but instead their families and friends. How? The public transport systems tend to deteriorate in quality and rise in cost every year. The effective cost now of visiting a relative who is in old peoples home, or going to see granny in her own house, may be quite formidable in many places, with the escalating fares for buses, train and the like (Kinnaird et al, 1981) As with regards to employment and retirement policies it has been undertaken in a spirit of opportunism. In time of heavy unemployment there tend to be a cry in favor of early retirement, and in times of over employment, when the labour force is insufficient to meet production demands, it is suddenly found that it is better for people to go on working later in life. More consistent thinking about retirement policies is required (Kinnaird et al, 1981)

5. Conclusion
Community care policy has created a huge impact on older people lives. The creation of new and improved community care policy has developed the delivery of service for older people. So also the impact of community care policy has provided more dignity to elderly care. What we see with community care in our society today is quite different from how it uses to be in the 70s and 80s. They seem to be more improvement as each year goes by. However, because, British society is now an ageing one, the importance of sustaining the community care policy can never be over emphasized. Some things have to stay, while some has to be improved. In as much as we embrace and appreciate Margaret Thatchers community care reform, we cannot ignore the little lapses that come with it such as provision for those who care for the elderly. Families of older people would benefit more if more improvements are done in area of free transport for those who have to travel to and fro looking after an elderly person.

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Lewis, J & Glennester, H (1996): Implementing the New Community Care, Buckingham, Open University Press. Macdonald, B. and Rich, C. (1984): Look me in the Eye. London: The Womens Press. Means, R. and Smith, R. (1994): Community Care, Policy and Practice. London: Macmillian. Means, R & Smith, R. (1998): Community Care: Policy and Practice (2 edition), London, Macmillan Press. Meredith, B. (1993): The Community Care Handbook, The New System Explained. London: AGE Concern. Morris, J. (1992): Pride against Prejudice. London: The Womens Press Morris, J. (1993): Independent Lives: Community Care and Disabled People. Basingstoke: Macmillan. OPCS (1985): General Household Survey. London: HSMO Parker, G. (1990): A Typology of Caring. University of York: SPRU Salvage, A.V., Vetter, N.J and Jones, D.A (1988): Attitudes to Hospital Care Among a Community Sample of People aged 75 and older, Age and Ageing. 17, 270-4 Socialist Health Association (2010): Report of the Committee of Inquiry. Retrieved February 28, 2010 Victor, C.A. (1991): Health and Health Care in Later Life. Buckingham: Open University Press Victor, C. (2000): Promoting the Health of Older People. Setting a Research Agenda London: Health Education Authority Walker, A. (1982): Community Care: The Family, State and Social Policy. Basil Blackwell & Martin Robertson: Oxford Weller M. P.I. (1989): Mental illness - who cares? 'Nature' 399: 249-252. Weller M.P.I. (1993): in 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.

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