Effect of NHS and Community Care Act Problem with interpretation

BMJ 1994; 309 doi: https://doi.org/10.1136/bmj.309.6954.605 (Published 03 September 1994) Cite this as: BMJ 1994;309:605
  1. C Cooper,
  2. P Crome

    EDITOR, - We believe that the simple approach and methodology of Peter A Lewis and colleagues' study fail to recognise the complexity of the changes brought about by the NHS and Community Care Act 1990.1 With the support of the Nuffield Provincial Hospitals Trust, we are undertaking a detailed comparison of the discharges from five elderly care units in South East Tha mes region for the first six months of 1992 and 1994. Our preliminary findings lead us to suggest that the paper does not take account of several issues.

    Period of data collection - In many districts it took a few months for the new systems to be fully operational. Therefore changes in the numbers of patients going to institutions or in their lengths of stay in hospital might not be apparent from information collected in the first few months after the introduction of the act.

    Changes in procedures brought about by the act - The paper fails to discuss the changes in hospital and social work procedures that occurred on 1 April 1993. The impact of the act was different in different districts, depending on, for example, the previous style of administration in social services, the type of community services provided before the introduction of the act, and the availability and range of places in institutions.

    Other NHS changes - Any other changes in the operational policies of the department are not discussed. In our region changes in catchment areas and admission and other NHS trust policies have occurred in some districts, which affected the process of discharge from hospital.

    Placements not arranged by the local authority - In one district in our study all …

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