The Scottish Office:
Modernising community care: an action plan
"We must make better use of both new and existing resources to provide people with the services they need."

within this action plan it basically implies that responsibility is not being shifted but more money is being put into the community to give care in a way that is preferred by clients, i.e at home.

Below are some of the main points concerning home-based care in the action plan.

A modern, flexible home care service "Most people want home-based care. We need to shift the balance of current funding and target new resources to increase home-based care."

3.1 One of the central aims of our community care policy is to allow people to be cared for at home, or in homely surroundings. Home-based care, combined with suitable housing, is what most people and those who care for them prefer. Some groups have achieved this aim by resettling users in the community and closing long-stay hospitals.

Shifting resources to home-based care

3.2 However, there has been less progress in helping people, particularly frail older people, to remain in their own homes. Between 1990 and 1996 the volume of services to support these people has increased, but by considerably less than for nursing home care. In some key areas (for example, home help and day care), increases taper off after 1993. Also, in 1996-97, community-based services provided for 84% of people but received less than half of the community care budget. This pattern is not acceptable. We need to increase home-based care by shifting the balance of funding and targeting new resources.

BBC News also had an article looking at the monetary side of community care and the savings that were being made. And that savings could be made as well as pleasing the client.

"A Department of Health spokesman said it was important to remember shifting care was something patients had said they wanted to see happen and was not just motivated by saving money."

"And he added that the study actually showed community care was £100 cheaper on average per patient and provided "an encouraging sign" that money could be saved."

Some points from Chapter 4:
Impact of the NHS and
Community Care Act (1990) on
Informal Carers

Most care for older and disabled people is, and always has been, provided in ‘the community’. Until the 1970s, this was largely taken for granted and rarely excited

policy makers’ attention. Since then, however, there has been increasing emphasis
on the role of the ‘community’, and more specifically family carers, as the main
source of help and support to those who need assistance to live in their own
homes. The reasons for this emphasis are numerous and inter-related and will not
be reviewed in any detail here. The shift was clearly articulated
in the 1982 White Paper Growing Older. The Paper recognised the ‘immense
contribution’ of families, friends and neighbours but underlined a clear message
that the proper role of the state was to enable individuals and families to deliver
community care, not to replace that care: ‘Care in the community must
increasingly mean care by the community’
Policy analysts and researchers in the late 1970s and 1980s questioned the implicit
assumption that women would provide this care, and research began to examine
the costs that reliance on ‘informal care’ (as it had come to be called) imposed.
Despite this growing body of evidence, policy preoccupations from 1985 onwards
were predominantly about the slow transfer of people from long-stay institutional
care, inadequacies of funding or arrangements for the people who were
transferred, and the ‘perverse effect’ of social security funding which had
encouraged the growth of residential and nursing home care for older people
during the 1980s
The Griffiths’ Report (1988), with its brief to review how public funds were used
to support community care and advise on more efficient and effective use of those
funds, is generally seen as Government’s response to the comments of the Audit
Commission about the ‘perverse effect’. The Report again acknowledged the
contribution of informal carers but they were still seen as part of the ‘given’
resources available to support care in the community. Public
services were seen to have a direct role only where informal care had broken down
or could not meet needs.