Community Care: The First Year: Gwent: a good start and better prospectsBMJ 1994; 308 doi: https://doi.org/10.1136/bmj.308.6931.778 (Published 19 March 1994) Cite this as: BMJ 1994;308:778
- R Robinson
- British Medical Journal London WC1H 9JR.
Optimism was in better supply than disappointment among the people to whom I spoke about how community care was working in Gwent. I had returned a year after hearing about the plans,1 and just eight months after the new community care arrangements came into operation on 1 April.2
* This is the second of four articles looking at the progress of the community care reforms
One problem in assessing the effects of the new arrangements in Gwent is that they have not been part of a controlled trial. Too many changes have happened at the same time to draw safe conclusions about the effects of any one of them. For example, on the same day that the community care reforms came into force, the services for mental illness, learning disability, and community health became the responsibility of the new Gwent Community NHS Trust. This change was preceded in 1991 by the establishment of clinical directorates, the move which Dr Stephen Hunter, consultant in mental illness, believes had the most powerful and beneficial effect on the development of this service. All these changes occurred against a background of a long standing and successful local policy of transferring the care of mental illness into the community. Learning disability and mental illness had anyway been given special status by the All Wales strategies.3,4
Organisational change has not ended. Proposals currently before parliament would abolish the administrative country of Gwent in 1996 and replace it with new unitary authorities with different boundaries from the present five boroughs (see fig 1). Coterminosity of local authority and health authority boundaries will be lost. General practitioner fundholding, now operating in about a third of practices in Gwent, may have a greater impact next year, when such practices will be able to make their own …