Griffiths: the debate has hardly begun

At long last the government has responded to the Griffiths proposals for community care. This announcement is to be welcomed, if only because it means that community care has been taken out of the vacuum it has been stuck in since Sir Roy reported his findings. But where does it take us?

Everyone agrees that people with additional dependency needs are better off being cared for at home, or in a home-like environment. But there remains a conspicuous absence of debate around the setting of policies and priorities within this very broad aim.

Sir Roy’s suggestion that a minister for community care should be appointed, regrettably, has not been taken up by the government and thus an opportunity to carve out a distinct identity for community care has been lost.

Care in the community involves a range of health-and-personal social services; these proposals shift the balance from one to the other. But failure to ringfence funding for community care means that instead of battling for resources against costly high-tech treatment services, it must now compete against the entire range of local authority services — and at a time when there will be additional pressure to keep costs down with the introduction of the poll tax.

Local authorities will therefore be forced to find the cheapest options. This could include a greater reliance on voluntary labour — it is not hard to imagine calls for a ‘good neighbour ‘ scheme, with volunteers replacing paid home helps. Indeed, this would be entirely in line with current thinking. It is also likely that a whole new range of services will become subject to means-testing, in accordance with the current arrangements for social services.

Those most in need of community care are likely to need more specialist treatment services than the population as a whole. For example, elderly people can be helped to live independently, but unless they have prompt access to acute services when necessary their health may be undermined, perhaps leading to long-term admission and institutional care. It is therefore vital that close links exist between hospital and community care services. Yet the proposals introducing an internal market for the NHS will mean that acute provision will no longer be guaranteed at a local level. Moreover, the removal of local authority nominees from district health authorities is unlikely to improve the process of joint planning between the two authorities.

And if people with additional dependency needs are to remain in the community, the community itself must be made a healthy place for them to live. This means action over a range of social and economic policies, for example , ensuring better financial support such as decent pensions and carer allowances as well as a safer, less isolated physical environment.

The aim of community care should not be simply about helping people to continue living at home, but about improving the quality of life of the most vulnerable members of society. This debate has hardly begun.