The introduction in April 1993 of new arrangements for assessment and care management following the NHS and Community Care Act 1990 (Department of Health 1990a) heralded a period of major transition for front-line workers in the health and social services. Policy expectations for the development of the purchaser/provider split and the 'new managerialism' have posed unprecedented ideological, organizational and professional challenges. Two years after the full implementation of the reforms a postal survey of the experiences of care managers about policy and practice changes was undertaken in Wales. This paper focuses on the stresses and satisfactions of care management practice among three distinct groups of front-line workers: social workers, community nurses and community psychiatric nurses. The results of multiple regression analyses, corroborated by qualitative data, implicate an increased workload in general and administrative work in particular, combined with reduced opportunities for client contact, as the main sources of stress. Being able to control or shape those factors impinging on the experience of stress and job satisfaction appears to lie at the heart of the dilemma. Practice and policy implications are considered.

Based on a postal survey in 1995 of all front‐line staff in Wales with an assessment and/or care management role, findings are reported about how tasks and roles were operationalised following the full introduction of the new community care in April 1993. Further information was obtained by interviews with managers in health and social services. Only a fifth of social services posts were designated or titled as care management posts. The majority of these workers were located in services for elderly and physically disabled people. Although few had a specific budget, the majority considered that they had greater control over financial resources than before April 1993. The analysis of tasks undertaken by front‐line staff shows that there remains a broad overlap between the roles of care managers and social workers. The results highlight the nature of increasing demands on staff and raise issues about the impact of increased workloads and administration on service quality. They also highlight tensions between care management and traditional professional roles. Some pointers for continuing debate are provided.

Although much has been written about the concept of assessment, there is still no clear consensus on the characteristics of good practice. Moreover, recent studies have highlighted the fact that frameworks for assessment are often heavily influenced by particular professional perspectives, and consequently the holistic assessment of need envisaged in the National Health Service (NHS) and Community Care Act 1990 has yet to emerge. This paper identifies some of the contradictions inherent in the practice guidance relating to assessment and discusses the results of early evaluations of the implementation of the new assessment process. A possible model to structure this process is outlined and suggestions made as to the benchmarks of good assessment practice.

For more than two decades, community care has been proclaimed the answer to the 'social problem' of the ageing of the population. Since the publication of the Community Care Whit(. Paper (Department of Health 1989), a plethora of discussion and guidance documents have followrd. In this paper, critical examination is made of some of the assumptions that appear to underpin policy and debate about community care. It is argued that recent policy and community care reforms may be affected adversely by inherent conceptual contradictions and conflicting understandings and expectations about community care. It is suggested that the reassuring connotations of the phrase 'community care' may not be reflected in its reality and that the debate needs to be extended to acknowledge and address some of the underlying dynamics, contradictions and interactions that may have a bearing on the success of the reforms.