Skip to main content Accessibility help

Integrating Carers into the Service System: Six Strategic Responses

  • Julia Twigg (a1)


This paper discusses the mechanisms whereby the needs and interests of carers might be integrated into the service delivery system. Over the last decade, informal care has emerged as a major subject for research and discussion, and much work has been undertaken exploring the experiences, burdens and needs of carers. Carers are increasingly recognised as central to community care, but little work has so far addressed the means whereby their needs and interests might be integrated within mainstream service provision. The mechanisms for achieving this are underdeveloped. This paper puts forward six possible strategic responses, and discusses the merits and demerits of each. The responses are: taking evaluation a step further; consumerism; case management; performance or service indicators; rights; and targets. The issues raised in the discussion have relevance beyond the subject of informal care, and address questions that are central to the provision of welfare services generally.



Hide All
Barnes, M. and Wistow, G. 1991. Changing Relationships in Community Care: An Interim Account of the Birmingham Community Care Special Action Project. Nuffield Institute for Health Service Studies, Leeds.
Carter, N. 1989. Performance indicators: “backseat driving” or “hands off” control. Policy and Politics, 04, 17, 2.
Carter, N. 1991. Learning to measure performance: the use of indicators in organisation. Public Administration, 69, 85101.
Challis, D. and Davies, B. 1986. Case Management in Community Care: An Evaluated Experiment in the Home Care of the Elderly. Gower, Aldershot.
Challis, D., Barton, R., Johnson, L., Stone, M., Traske, K. and Wall, B. 1989. Supporting Frail Elderly People at Home. Personal Social Services Research Unit, University of Kent, Canterbury.
Challis, D., Darton, R., Johnson, L., Stone, M. and Traske, K. 1991a. An evaluation of an alternative to long stay care for frail elderly patients: part I the model of care. Age and Ageing, 20, 236244.
Challis, D., Darton, R., Johnson, M., Stone, M. and Traske, K. 1991b. An evaluation of an alternative to long stay hospital care for frail elderly patients: part II costs and effectiveness. Age and Ageing, 20, 245254.
Craig, G. 1992. Cash or care: a question of choice? Cash, community care and user participation. Social Policy Research Unit, York.
Cranston, M. 1976. Human rights, real and supposed. In Timms, N. and Watson, D. (eds) Talking about Welfare. Routledge, London.
Croft, S. and Beresford, P. 1990. From Paternalism to Participation: Involving People in Social Services. Open Services Project, London.
Culyer, A. J. 1973. ‘Is medical care different?’ In Cooper, M. H. and Culyer, A. J. (eds) Health Economics: Selected Readings. Penguin, Harmondsworth.
Davies, B. and Challis, D. 1986. Matching Resources to Needs in Community Care. Gower, Aldershot.
Davies, B. and Knapp, M. 1981. Old People's Homes and the Production of Welfare. Routledge, London.
Davies, B., Bebbington, A., Charnley, H. and colleagues 1990. Resources, Needs and Outcomes in Community Based Care. Avebury, Aldershot.
Davies, B. and Goddard, M. 1987. The brokerage-only BRITSMO: the BRITSMO concept: summary. PSSRU Discussion Paper, University of Kent, Canterbury.
Department of Health 1990. Community Care in the Next Decade and Beyond: Policy Guidance. HMSO, London.
DHSS with Coopers and Lybrand 1988. Comparing Health Authorities: Health Service Indicators 1983–86. DHSS, London.
Finch, J. and Groves, D. eds 1983. A Labour of Love: Women, Work and Caring. Routledge, London.
Finch, J. and Mason, J. 1992. Negotiating Family Responsibilities. Routledge, London.
Flynn, N. 1989. The new right and social policy. Policy and Politics, 17 (2), 97110.
Foster, C. and Maitland, N. 1986. Empowering carers: Bexley ACE, the Bexley Community Care Scheme and the Health Service. Unpublished paper, Bexley Social Services.
Gilligan, C. 1982. In a Different Voice: Psychological Theory and Women's Development. Harvard University Press, London.
Graham, H. 1983. Caring: a labour of love. In Finch, J. and Groves, D. (eds) A Labour of Love: Women, Work and Caring. Routledge, London.
Graham, H. 1991. The concept of caring in feminist research. Sociology, 25, 1.
Green, H. 1988. Informal Carers: A Study Carried out on Behalf of the Department of Health and Social Security as Part of the 1985 GHS. HMSO, London.
Hoggett, P. 1991. Modernisation, Political Strategy and the Welfare State: An Organisational Perspective. SOAS, Bristol.
Jowell, T. 1989. More care for the carers. The Guardian, 09 20, p. 27.
Kestenbaum, A. 1992. Cash for Care: The Experience of Independent Living Fund Clients. Independent Living Fund.
Kind, P., Gudex, C. and Godfrey, C. 1990. What are QUALYs?' In Baldwin, S., Godfrey, C. and Propper, C. (eds) Quality of Life: Perspectives and Policies. Routledge, London.
Knapp, M. 1984. The Economics of Social Care. Macmillan, London.
Laing, W. 1991. Empowering the Elderly: Direct Consumer Funding of Care Services. IEA Health and Welfare Unit, London.
Le Grand, J. 1990. Quasi Markets and Social Policy. School of Advanced Urban Studies, Bristol.
Levin, E., Sinclair, I. A. C. and Gorbach, P. 1989. Families, Services and Confusion in Old Age. Gower, Aldershot.
Lewis, J. and Meredith, B. 1988. Daughters Who Care. Routledge, London.
Maitland, N. and Tutt, N. 1987. Bexley's trump card. Social Services Insight, 09 18.
Marshall, J. H. 1965. Social Policy in the Twentieth Century. Hutchinson, London.
Meethan, K. and Thompson, C. 1992. The Scarcroft Project Research Report: Stages One and Two. Social Policy Research Unit, University of York, York.
Moore, J. and Green, J. M. 1985. The contribution of voluntary organisations to the support of caring relatives. Quarterly Journal of Social Affairs, 1, 2.
Morris, J. 1991. Pride Against Prejudice: Transforming Attitudes to Disability. Womens' Press, London.
Netten, A. 1993. An economic approach to the social care of elderly people: a perspective on informal care. In Twigg, J. (ed) Informal Care in Europe. Social Policy Research Unit, York.
Oldman, C. 1991. Paying for Care: Personal Sources of Funding Care. Joseph Rowntree Foundation, York.
Oliver, M. 1990. The Politics of Disablement. Macmillan, London.
Parker, G. 1990. With Due Care and Attention: A Review of the Literature on Informal Care. 2nd edition. Family Policy Studies Centre, London.
Parker, G. 1990. Whose care? Whose costs? Whose benefits? A critical review of research in case management. Ageing and Society, 10, 459467.
Peters, T. J. and Waterman, R. H. 1982. In Search of Excellence: Lessons from America's Best Run Companies. Harper & Row, New York.
Pirie, M. and Butler, E. 1989. Extending Care. Adam Smith Institute, London.
Pollitt, C. 1980. Beyond the managerial model: the case for broadening performance assessment in government and public services. Financial Accountability and Management, 2 (3). 155170.
Pollitt, C. 1988. Bringing consumers into performance measurement: concepts, consequences and constraints. Policy and Politics, 16 (2), 7787.
Pollitt, C. 1990. Managerialism and the Public Service: the Anglo-American Experience. Blackwell, Oxford.
Potter, J. 1988. Consumerism and the public sector: how well does the coat fit? Public Administration, 66, Summer 149–64.
Price Waterhouse 1991. Implementing Community Care: Purchaser, Commissioner and Provider Roles. HMSO, London.
Renshaw, J. 1988. Care in the community: individual care planning and care management. British Journal of Social Work, 18 (supplement), 79105.
Rhodes, R. A. W. 1987. Developing the public-service orientation – or let's add a soupçon of political theory. Local Government Studies, 05/06 1989, 6373.
Social Services Inspectorate 1991a. Assessment Systems and Community Care. HMSO, London.
Social Services Inspectorate 1991b. Care Management and Assessment: Summary of Practice Guidance. HMSO, London.
Social Services Inspectorate 1991c. Purchase of Service: Practice Guidelines and Practice Material for Social Services Departments and Other Agencies. HMSO, London.
Spicker, P. 1988. Principles of Social Welfare: An Introduction to Thinking about the Welfare State. Routledge, London.
Torrance, G. W. and Feeny, D. 1989. Utilities and quality adjusted life years. International Journal of Technological Assessment in Health Care. 5, 559–75.
Turner, B. S. 1990. Outline of a theory of citizenship. Sociology, 24 (2), 189217.
Twigg, J. 1988. With carers in mind. Carelink, Summer, 5, 7.
Twigg, J. 1989. Models of carers. Journal of Social Policy, 18, 1.
Twigg, J. (ed) 1992. Carers: Research and Practice. HMSO, London.
Twigg, J., Atkin, K. and Perring, C. 1990. Carers and Services: A Review of Research. HMSO, London.
Twigg, J. and Atkin, K. 1993. Carers Perceived: Policy and Practice in Informal Care. Open University Press, Milton Keynes.
Ungerson, C. 1987. Policy is Personal: Sex, Gender and Informal Care. Tavistock, London.
Wagner, G. and Sinclair, I. 1988. Residential Care: A Positive Choice. HMSO, London.
Warburton, W. 1988. Key Indicators of Local Authority Social Services: A Demonstration Package. Social Services Inspectorate, Department of Health, London.
Watson, D. 1977. Welfare rights and human rights. Journal of Social Policy, 6 (1), 3146.
Weale, A. 1983. Political Theory and Social Policy. Macmillan, Basingstoke.
Williams, A. 1985. Economics of coronary artery bypass grafting. British Medical Journal, 291, 326–9.
Wright, K. G., Cairns, J. A. and Snell, M. C. 1981. Costing Care. Joint Unit for Social Services Research, University of Sheffield, Sheffield.
Wright, K. G. 1974. Alternative measures of the output of social programmes: the elderly. In Culyer, A. J.Economic Policies and Social Goals. Martin Robertson, London.

Integrating Carers into the Service System: Six Strategic Responses

  • Julia Twigg (a1)


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed