Community care

Community care services are intended to help people who need care and support to live with dignity and independence in the community and to avoid social isolation. The services are aimed at the elderly and those who have mental illness, learning disability and physical disability. The main aim in providing community care services is to enable people to remain living in their own homes and to retain as much independence as possible, avoiding social isolation. Local authority social services provide community care services or arrange for them to be provided. Care needs can be difficult to gauge and provision also involves matching client expectation, finances available and people willing to do the job.

The rules about which community care services must be paid for and how much can be charged, are complicated. It may be advisable to see an experienced adviser - eg, at the local Citizens Advice Bureau.

There is a wide range of services that may be available, including:

• Home care services: help with personal tasks - eg, bathing, washing, getting up and going to bed, shopping and managing finances.

• Home helps: can provide assistance with general domestic tasks, including cleaning and cooking, and may be particularly important in maintaining hygiene in the home.

• Adaptations to the home: major adaptations (eg, installation of a stair lift or downstairs lavatory, or lowering work tops in the kitchen); minor adaptations (eg, handrails in the bathroom).

• Meals: daily delivery of a meal, delivery of a weekly or monthly supply of frozen food or providing meals at a day centre or lunch club.

• Recreational, occupational, educational and cultural activities: day centres, lectures, games, outings and help with living skills and budgeting. This usually also involves providing transport to attend facilities.

The National Health Service and Community Care Act 1990

• Devolved the prime responsibility for means-tested funding from the central Department of Social Security to local Social Services departments.

• Local authorities were given the responsibility to assess people's needs and to plan and provide care. This includes the allocation of funds for places in nursing and residential homes as well as other services such as domiciliary care.

• Key objectives of the act included¹ :
  

  • Services for people at home. There are three types of service available - domiciliary, day and respite.

  • Domiciliary care includes home help or home care, occupational therapy and bathing services.

  • Day services include all the different types of daytime care outside a person's home, ie day centres, lunch clubs or day hospitals.

  • Respite care allows carers and people being cared for to have a break from each other. Respite services include a sitting service, day centre attendance, family placement schemes and respite in residential or nursing homes.

  • Services for carers. Carers need to be considered when an individual's needs assessment is being made.

• Any person, including any member of the primary healthcare team, can make a referral to Social Services on behalf of a patient.

• The local authority must carry out an assessment for anyone who appears to need a community care service.

• The local authority should then provide a written care plan, setting out:
  

  • The services which are to be provided, by whom and when and what will be achieved by providing them.

  • A contact point to deal with problems over services.

  • Information on how the person (or representative) can request a review of the services being provided if circumstances change.

• With the consent of the patient, GPs are expected to contribute relevant health information to help Social Services in the care assessment.

• The Community Care (Residential Accommodation) Act 1998 restricts the amount of a person's capital which may be taken into account by a local authority in determining whether the person should be provided with residential accommodation² .

The Health and Social Care Act 2012³

The Health and Social Care Act 2012 transferred commissioning responsibilities from Primary Care Trusts to Clinical Commissioning Groups (CCGs) in England and Wales. Whilst the provision of community services is principally the purview of social service departments, there is inevitable overlap with commissioners of health services. Joint commissioning is also appropriate for some services.

Health and Wellbeing Boards (HWBs)^{4 5}

Health and wellbeing boards are a formal committee of the local authority charged with promoting greater integration and partnership between bodies from the NHS, public health and local government.

HWBs have been set up in order to plan how best to meet the needs of local populations and to tackle local inequalities in health and community service provision. They comprise representatives from CCGs and local authorities. They are able to assist local authorities to meet their obligations under the 2012 Social Care Act to promote individual well-being and improve access to care and support.

In 2021, the UK Government have published plans that include abolishing Clinical Commissioning Groups and matching integrated care systems to local authority boundaries. Councils will have statutory representation on ICS boards, which will be required to work closely with existing health and wellbeing boards⁶ .

Domiciliary and residential care

Since the introduction of the internal market this has been increasingly provided by commercial organisations. The effect of the Care Act and increasing pressure on local government spending on this scenario is uncertain but may well further open up the market to private sector providers of these types of care⁷ . Indeed, this is already beginning to be reflected in the statistical returns from Councils with Adult Social Services Responsibilities (CASSRs) - large providers of social service provision who regularly submit statistical information to the Health and Social Care Information Centre.

Joint Strategic Needs Assessment⁸

The Health and Social Care Act 2012 required Community Health and Wellbeing Boards (CHWBs) to draw up Joint Strategic Needs Assessment (JSNA) plans. The JSNA is a process through which a council's social care services (Education, Social Care and Wellbeing) work together with public health and NHS services to assess the needs of their populations. The hope was that JSNAs would lead to increasing activity in the arenas of joint commissioning and pooled budgets although, due to growing financial pressures, progress has been slow.

Numbers using community care services

The Health and Social Care Information Centre regularly publishes statistics on the provision of community care services. Community care social services activity for the year 2014-2015 found that in England⁹ :

• There were 1,846,000 requests for support from new clients actioned in 2014-15. Of these, 72% were from clients aged 65 and over; the remaining 28% were aged 18-64.

• 79% of requests came from the community; 18% had been discharged from hospital.