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Wednesday, 13 October, 1999, 17:22 GMT 18:22 UK
The legacy of community care
Hospital corridor
Many mental hospitals have closed as a result of the move to community care
The introduction of major legislation on community care was the subject of much controversy.

Mental Health
Mental health campaigners welcomed the move towards giving patients more independence and away from institutionalised care.

But they argued that care in the community, which covers everything from mental health to learning disabilities, was more expensive, if properly funded, than care provided in hospitals.

They said this was because it required a range of alternatives to hospital, including sheltered accommodation, day care and respite facilities and the creation of new posts, such as outreach workers.

And some hospital beds would also have to remain for the severely mentally ill.

Lack of resources

They accused the Conservatives of failing to adequately fund the NHS and Community Care Act 1990 and using it as a cost-cutting measure.

The Mental Health Foundation expressed concerns that "resources allocated for community care services do not match need" and conducted a major inquiry in 1994.

The Act set out arrangements for assessing and caring for patients and how this is financed.

The Act gives local authorities overall responsibility for coordinating social and residential care, including home help and day care facilities.

They must decide whether an individual qualifies for help, based on an assessment conducted by a range of care workers, including social workers, psychiatric nurses and doctors.

If they do, the local authority is responsible for arranging their care.

In doing so, it must promote the voluntary and private sector.

However, if a patient has been in hospital, they are more likely to come under the responsibility of the local health authority.

Health workers have to draw up an after-care programme and liaise with other service providers to ensure support is in place before discharge.

The Mental Health Foundation says this two-pronged approach "can cause confusion and uncertainty as to which agency has responsibility".

Mental health charity Mind says lack of coordination between agencies and poor risk assessment are the major reasons for killings by community care patients.

The confusion has prompted controversial proposals by Age Concern for the setting-up of community care authorities to coordinate care and ensure there are no unnecessary delays in patients getting the services they need.

The new Labour government has not gone so far.

Instead, it is proposing that one agency - an NHS trust, primary care trust or social services department - becomes lead commissioner to be responsible for overall decisions about commissioning health and social care.

It also backs the pooling of health and social services budgets.

Beds

The government has also pledged more money for in-patient beds, outreach support and crisis care.

Mental health charities have welcomed the increased funding, but fear it may not be enough to address the shortfall in cash for what they call "the Cinderella service".

Psychiatrists in inner city areas, for example, have complained that there are often not enough beds for them to offer patients who may be a danger to the public and themselves.

Lack of funding is also blamed for inadequate provision of sheltered accommodation for the mentally ill.

Another problem concerns difficulties ensuring community care patients take their medication.

The government is expected to address this by proposing that those deemed at risk be readmitted to hospital if they fail to take their recommended drugs.

But Mind says it would be better if they put more money into outreach work to give the mentally ill people the support they need.

The government has also announced reforms aimed at improving carers' rights. Under the Carers Act 1996, introduced by the Conservatives, carers can ask for an assessment of their ability.

This is meant to ensure local authorities provide services if a carer is deemed unable to look after all their charge's needs.

Labour has announced a national carers' strategy to give them more support.

See also:

17 Sep 98 | Health
Bringing down the 'Berlin Wall'
19 Apr 99 | Health
Mentally ill 'need more support'
13 Oct 99 | Health
The origins of community care
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