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Equity and Efficiency in Community Care: Supply and Financing in an Age of Fiscal Austerity*

  • Bleddyn Davies (a1)

Abstract

From the confrontation of fiscal austerity and growing needs in the United Kingdom has come a new ideology: ‘efficiency-focused mana-gerialism’. Common arguments and the adaptation of structures to reflect them can be seen in all areas of policy, but nowhere more clearly than in the long-term social care of the elderly, the subject of this paper. Perhaps the strand of policy analysis which most influences and epitomises the new managerialism is the work of the Audit Commission for Local Authorities in England and Wales, whose arguments and proposals have gained great and widespread influence. The commission's ‘three Es’ – economy, efficiency and effectiveness – have become among the most fashionable slogans of our time.

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NOTES

1 Audit Commission, 1975, op. cit.

2 Audit Commission, 1975, op. cit.

3 Davies, B. P.Social Needs and Resources in Local Services. Joseph, London, 1968.

4 Davies, B. P.Planning Resources for Personal Social Services. Department of Social Administration, Edinburgh, 1982.

5 Bebbington, A. C. and Davies, B. P.Equity and efficiency in the allocation of the personal social services. Journal of Social Policy, 12 (1983), pp. 289308.

6 Audit Commission, 1975, op. cit.

7 Davies, B. P. and Challis, D. J.Matching Resources to Needs in Community Care. Gower, Aldershot, 1986.

8 Goldberg, E. M. and Connelly, N.The Effectiveness of Social Care for the Elderly. Heinemann, London, 1982.

9 Bebbington, and Davies, , 1983, op. cit.

10 Bebbington, and Davies, , 1983, op. cit.

11 Bebbington, A. C. and Tong, S.-Y. (1984). ‘Trends and changes in old people's homes: provision over twenty years’, in Judge, K. and Sinclair, I., Residential Care for Elderly People: Research Contributions to the Development of Policy and Practice. H.M.S.O., London, 1986, pp. 6782.

12 Gorbach, P. and Sinclair, I.Pressure on Health and Social Services for the Elderly. National Institute for Social Work, London, 1981.

13 Davies, B. P., Barton, A. J., McMillan, I. S. and Williamson, V. K.Variations in Services for the Aged. Bell, London, 1981.

14 Bebbington, A. C., Davies, B. P. and Tong, S.-Y.Supporters of the Dependent Elderly. Discussion Paper 326, Personal Social Services Research Unit, University of Kent, Canterbury, England.

15 Audit Commission, 1985, op. cit.

16 Darton, R. and Knapp, M. J.The cost of residential care for the elderly. Ageing and Society, 4 (1984), 157183.

17 Davies, B. P. and Knapp, M. J.Old People's Homes and the Production of Welfare. Routledge, London, 1981.

18 Bebbington, A. C., Charnley, H., Davies, B. P., Ferlie, E. B., Hughes, M. D. and Twigg, J.The Domiciliary Care Project: Meeting the Needs of the Elderly, Interim Report. Discussion Paper 456, Personal Social Services Research Unit, University of Kent, Canterbury, 1986.

19 Bebbington, A. C., Charnley, H., Davies, B. P., Ferlie, E. B., Hughes, M. D. and Twigg, J.Needs, Resources and Outcomes: a Comparative Study of Community-Based Services for the Elderly. Gower, Aldershot, Surrey, (1987).

20 Latlo, S.The Coventry Home Help Project. Coventry Social Services Department, Coventry, 1984.

21 Golding, K. and Cooper, M.Alternatives to Residential Provision for the Elderly: Final Report. Essex County Council Social Services Department, Chelmsford, 1981.

22 Davies, and Challis, , 1986, op. cit.

23 Larder, D., Day, P. and Klein, R.Institutional Care for the Elderly: the Geographical Distribution of the Public/Private Mix in England. Bath Social Policy Papers no. 10, University of Bath, Bath, Wilts. 1986.

24 Day, P. and Klein, R.Towards a new health care system? British Medical Journal, 291 (1985), 12911293.

25 Webb, A. L. and Wistow, G.Planning, Need and Scarcity. Allen and Unwin, London, 1986.

26 Audit Commission for Local Authorities in England and Wales, Making a Reality of Community Care. H.M.S.O., London, December 1986.

27 Davies, B. P., ‘Strategic goals and piece-meal innovations’, in Goldberg, E. M. and Hatch, S. (eds.), A New Look at the Personal Social Services. Policy Studies Institute, London, 1981, pp. 4667.

28 Davies, B. P. and Ferlie, E.Efficiency-promoting innovation in social care: social services departments and the elderly. Policy and Politics, 10 (1982), Table 1.

29 Ferlie, E., Challis, D. J. and Davies, B. P.Models of innovation in the social care of the elderly. Local Government Studies, 10 (1984), 6782.

30 Ferlie, E., Challis, D. J. and Davies, B. P.A Guide to Efficiency-Improving Innovations in the Social Care of the Frail Elderly. Personal Social Services Research Unit, University of Kent, Canterbury, 1984.

31 Capitman, J., Evaluation of Coordinated Community-Orientated Long-Term Demonstration Programs. Berkeley Planning Associates, Berkeley, California, 1985.

32 Davies, B. P. and Challis, D. J., 1986, op. cit., pp. 317.

33 Davies, B. P. and Challis, D. J., 1986, ibid., p. 22.

34 Hodgson, J. H. and Quinn, J. L.The impact of the TRIAGE health care delivery system upon client morale, independent living and the cost of care. The Gerontologist, 20, (1980), p. 370.

35 Weinrobe, M.Home Equity Conversion for the Elderly in the United States: an Examination of the Initial Experience. Clark University, (1984).

36 Wheeler, R. (1985), Don't Move: We've Got You Covered. Institute of Housing, London.

37 Davies, and Challis, , 1986, op. cit., pp. 537542.

38 Davies, B. P. (1986a), American lessons for British policy and research on the long-term care of the elderly. Journal of Social Affairs, 2, 321355.

* Text of a paper read to the meeting of the International Epidemiological Association at Paris, November 1986.

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