Bookmarkers beware: Bookmarks to pages other than the home page may not work after we change our server in April Editor's Choice | This Week in BMJ | Press releases BMJ No 7128 Volume 316 News Saturday 31 January 1998 Community care is failing elderly people Britain's system of care in the community, acknowledged by the government to be inadequate for psychiatric patients, is also failing many elderly people. A report last week by the statutory Clinical Standards Advisory Group found that community health and social services were fragmented, confused, and underfunded, with unacceptable variations according to where people live. The advisory group monitors the impact on clinical standards of the NHS reforms. Its findings of inequity and inadequacy in care for elderly people amount to a serious indictment of the first five years of community care. The report recommends government action to clear up widespread confusion over the services that elderly people can expect, which agency should pay for the services, and who is entitled to receive them. It criticises the practice of "cost shunting" between the NHS and local authorities, resulting in elderly people being disadvantaged by short term funding. There is confusion over the services elderly people can expect Photo: PETER ARKELL/IMPACT There is concern that national guidelines on discharge from hospital are not being implemented, at a time when the elderly person's need for health services in the community is at its most critical. Meanwhile, the increased workload on GPs and district nurses has not been matched by an increase in resources. On the perennial problem of defining the boundary between health and social care, the single message that the advisory group passes on to the government about how to improve services for elderly people is, "get rid of the divide between health care and social care." Care by the NHS is free to patients, but social care by the local authority is means tested. The group recommends that nursing care, wherever it is provided, should be paid for by the NHS. The government welcomes the report as endorsing its intention to demolish unhelpful barriers between health and social care - for example, by pooling budgets. It will now await the recommendations of the Royal Commission on long term care, due to report by the end of this year. Professor Dame June Clark, who headed the advisory group's study, is also a member of the Royal Commission. Community Health Care for Elderly People is available from the Stationery Office, £11.50; for a free summary, telephone the NHS Response Line (0541 555455). John Warden London Home | Current issue | Past issues | Classified ads | Career Focus | Feedback Collections | About this site | About the BMJ | BMA | Medline