Education And Debate

Equity in the NHS: Equity in community care

BMJ 1994; 308 doi: (Published 04 June 1994) Cite this as: BMJ 1994;308:1496
  1. L Challis,
  2. M Henwood
  1. School of Social Sciences, University of Bath, Bath BA2 7AY 88 Vicarage Road, Pitstone, Leighton Buzzard LU7 9EY
  1. Correspondence to: Linda Challis.

    The implementation of the NHS and Community Care Act 1990 made local authority social services departments responsible for the organisation and funding of support and care in the community. This development took effect at the same time as a blurring of the boundaries between health and social care. One consequence is that the relevance of equity (a guiding principle of the 1946 National Health Service Act, but relatively lacking from the 1948 National Assistance Act, the foundation of many social services) has come to be more keenly appreciated within personal social services. Equity questions arise in community care over the distribution of public resources between different client groups, income groups, generations, and localities. Moreover, no mechanisms exist to monitor the trends that emerge from different ways that people get access to care. Yet there is a risk that substantial divisive consequences may occur, particularly between generations.

    The implementation of the 1990 National Health Service and Community Care Act on 1 April 1993 made local authority social services departments responsible for organising and funding support and care in the community to “enable people affected by ageing or disability to live as independently as possible.”1 Both the concept of community care and responsibility for its organisation have been notoriously difficult to pin down. For example, a study by the Department of Health and Social Security in 1981 noted the conflicting interpretations of community care by health and social services authorities.2 For the NHS, community care usually referred to care provided outside the health service, including local authority residential care. For social services departments it referred principally to non-residential care. The recognition in the 1990 legislation that in practice “people frequently need both social care and health care” is an important acknowledgment of the complexity of this policy area and of …

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