Community Care: The First Year: Community care in Northern Ireland: a promising start

Integrated health and social services, generous funding, and a special sense of community have got Northern Ireland off to a promising start after the government's community care reforms. Public ignorance about the new arrangements remains a problem, but there is little evidence of serious hardship in any client group. The biggest threat is to nursing and residential homes, which face closure as increasing numbers of elderly and disabled people opt to stay at home. After only a year and without the benefit of formal evaluation, however, the real problems for disabled people and their carers may not yet have emerged.

Health professionals, planners, and policy makers in Northern Ireland have been busy. Since the introduction of general management in 1985, they have been faced with general practice fundholding, National Health Service trusts, changes to the allocation of funds between the four health boards, and finally the Community Care Act 1990.

The policy for community care in Northern Ireland is set out in the policy document People First.1 One of the key policy changes, ending unlimited central funding for elderly and disabled people who need placement in residential or nursing homes, came into force in April last year. The four health and social services boards and their units of management, many of them planning to be NHS trusts, were charged with organising and paying for care according to people's assessed needs. The new discretionary and cash limited system led to widespread fears that elderly and disabled people would be kept at home “on the cheap,” increasing the burden on carers; that formal assessments of elderly patients in hospital would delay discharge and block beds needed for acute admissions; that elderly and disabled people would have little choice about where they were cared for; that nursing and residential homes would be …