the potential benefits in involving specialist clinicians in the assessment process include identifying previously undiagnosed conditions and enhancing care managers' decision making. Such an assessment could be provided at a modest marginal cost. The approach is fully compatible with proposals for the role of the community geriatrician and commensurate with current good clinical practice in old age psychiatry.

Since 1989, government policy in the United Kingdom has advocated that social services providers develop care management systems in order to deliver coordinated and individually tailored packages of care to all user groups. This cross-sectional postal survey describes national variations in care management arrangements for people with mental health problems in England on 14 key indicators developed from previous research. One hundred and one social services providers (response rate: 77%) completed two questionnaires: The first related to care management arrangements for all user groups, and the second related specifically to arrangements for people with mental health problems. Significant national variation was found. Furthermore, there was little evidence of integration between health and social care, of care management being delivered through specialist multidisciplinary mental health teams, and of selective arrangements targeted at those most in need. The results are discussed in the context of apparently widespread disparity between existing care management arrangements and government policy guidance.

Current policy in England emphasises both the importance of caring for highly dependent older people for as long as possible in their own homes, and the development of specialist care services for people with dementia. However, the differences between specialist and generic home care services for people with dementia are poorly understood. This cross-sectional postal survey describes the standards of home care services for people with dementia in the North West of England, and investigates the differences in quality standards between specialist and generic home care services. Forty-six percent of identified services provided information on a range of quality indicators. Most services provided only a few of the indicators utilized by the study, and there was little evidence of services adopting national minimum standards. Few differences were found between the two service types, although generic services appeared to offer a greater degree of flexibility than specialist services. These results help to inform the understanding of home care service mix and provision, and the uptake of national minimum standards. They provide key material for shaping the future provision of home care for older people with dementia.

In this at-risk group, integrated assessment offers a means of potentially both delaying care-home admissions and taking account of a wider range of factors in placement decisions. Such an approach is viewed as an important policy goal both in the UK and internationally.

These findings indicate some potential gains from integration, and highlight the level of work still needed to achieve it. Further research is needed to build on the structural and process measures used in this research in order that the costs and outcomes consequent upon these practices can be measured.