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 home 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 available 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, e.g. 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, e.g. bathing, washing, getting up and going to bed, shopping, 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, e.g. installation of a stair lift or downstairs lavatory, or lowering work tops in the kitchen; minor adaptations, e.g. 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 included:¹
  • 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, i.e. 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 accommodation.²

Numbers using community care services

The Office for National Statistics regularly surveys the provision of home care services. The survey carried out in England during the survey week in September 2005 found the following results:³

• An estimated 3.6 million contact hours were provided to around 354,500 households (or 367,700 clients), which is an increase in the number of contact hours of 6% and a slight fall in the number of households receiving home care when compared with 2004.
• The average number of contact hours per household was 10.1 (an increase from 9.4 in 2004, suggesting that more intensive services are being provided for a smaller number of service users, continuing the trend seen over the last 10 years).
• Around 28% of households received intensive home care in 2005 (defined as more than 10 contact hours and 6 or more visits during the week). This is a 6% increase from 2004.
• Around 48% of households who received home care received more than 5 hours of care and 6 or more visits..
• 73% of the total contact hours of home care were provided by the independent sector (an increase from 70% in 2004).
• Around 15,400 households were receiving home care from both the Councils with Social Services Responsibilities (CSSRs) directly and the independent sector (a 5% increase from the 2004 figure of 14,700).

Document references

1. National Health Service and Community Care Act 1990 (c. 19)
2. Community Care (Residential Accommodation) Act 1998
3. Statistical work area: social care, Dept of Health

Internet and further reading

• Kmietowicz Z; Community care networks could help 200,000 more people die at home instead of hospital; BMJ. 2010 Nov 15;341:c6508. doi: 10.1136/bmj.c6508.

Acknowledgements