Introduction

Chapter Two set out the modernisation agenda of the 1997-2001 Labour government and its implications for community care. A Labour government was re-elected in 2001 with a clear mandate to continue its modernisation agenda for public services. This last chapter therefore reflects on lessons and issues from this study in terms of the challenge to develop further community care in the new millennium.

A lack of policy direction? A lack of priority?

The period, 1971 to the mid-1980s, was characterised by a lack of priority and policy direction with regard to health and welfare services for older people. It could be argued that this situation was changed by the quasi-market reforms in community care of the early 1990s and was further influenced by the modernisation policies of recent Labour governments. More specifically, many would feel that this situation has been transformed through the establishment of a National Service Framework for Older People (DoH, 2001b), which sets out eight standards relating to age discrimination, person-centred care, intermediate care, general hospital care, stroke, falls, mental health in old age and health promotion (see Figure 8.1). It is hard to argue that we lack a comprehensive policy direction.

This is true, but only to a limited extent for three reasons. First, there is still no consolidated legal framework relating to services for older people equivalent to the 1989 Children Act. Instead, discussions about the health and social care divide and the so called ‘Berlin Wall’ still have to refer back to the 1948 National Assistance Act and the introduction of the concept of being ‘in need of care and attention’. Equally, the provision of social care services in the community relates to a variety of different Acts dating back to the late 1960s and early 1970s.

The second point is that the government rejected the main proposal of the Royal Commission on Long-Term Care (Sutherland Report, 1999) that all personal care should be free. Although this has been justified in terms of the need to invest in new services rather than subsidise old ones, not all commentators are convinced (see Chapter Two). It is true that substantial additional money is being invested in intermediate care, but it is doubtful if all the eight standards of the national framework can possibly be met within allocated resources.