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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.

To assess problems of care in a private nursing home an observational study was carried out over two months, during which a research nurse worked as a member of the staff in a home caring for 25 patients aged The problems that were identified were mainly due to poor communication between the home and general practitioners and hospitals and to the lack of guidance policy on common issues that arise in long term care. Such a policy could be produced by health authority staff, general practitioners, and representatives of nursing homes. IntroductionThe private sector has an established role in providing long term care ofthe elderly. Though controversial, the white paper Caring for People confirms that in the future the independent sector will remain an important provider of care.'Traditionally, care provided by the NHS and social services entails an initial assessment of the patient and then continuing review. These often formalised bureaucratic procedures are a form of quality assurance and a measure of the deployment of services. We previously documented some of the consequences of not having a regulatory bureaucracy for private nursing homes.2 In this study we observed

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