Introduction

This chapter discusses proposals published during 2005 that will potentially transform the organisation and delivery of social care services for adults and older people in England. The chapter locates these proposals within broader historical and organisational contexts and analyses their implications – for the 1993 community care ‘settlement’; for the role of social care within wider local authority responsibilities; and for the interfaces between social care and health care.

Historical contexts

The main community care measures in the 1990 National Health Service (NHS) and Community Care Act came into force on 1 April 1993. The Act gave local authority social services departments lead responsibility for supporting older people, disabled adults and people with mental health problems and learning disabilities. This responsibility included the assessment of individual and locality-wide needs, and the development of a ‘mixed economy’ of voluntary and for-profit services – particularly domiciliary services – that would be purchased flexibly by the local authority. Social services departments were also required to work in close collaboration with a wide range of other agencies, including health and housing. This settlement was the outcome of a long-standing debate that had been framed by key policy documents, including Making a Reality of Community Care (Audit Commission, 1986), Community Care: An Agenda for Action (Griffiths Report, 1988) and the White Paper on Caring for People: Community Care in the Next Decade and Beyond (DH, 1989).

The drivers behind this settlement were complex but are widely considered to include three main factors. The first was government frustration at the slowness of moving people with mental health problems and learning disabilities out of long-stay hospitals into the community, a problem often explained in terms of the failure of joint working between health and social services (Means et al, 2002). The second was concern at the mushrooming public expenditure costs of supporting people in independent sector residential and nursing homes through a social security system that conducted no assessment of the need for such care. The 1993 changes therefore gave social services departments responsibility for assessing needs, together with a cash limited budget with which to purchase services in response to eligible needs.