Facing Up to Underfunding: Equity and Retrenchment in Community Care

Abstract

Local social services departments in the UK are expected to distribute their cash-limited budgets for community care in ways that achieve an equitable allocation of resources in situations where, with present levels of funding, they cannot meet all the needs with which they are presented. This paper discusses a case study of the introduction of a "needs-based" formula to allocate a local authority's budget for home care services and a follow-up survey to investigate whether services reached the people intended to benefit. The article argues that the "gatekeeping" role of community care assessments is important to safeguard equity without the inflexibility of highly standardized tests of eligibility. However, with the new Labour government seeking to reduce dependency on public expenditure, and a growing lobby for national standards of social care, it will be increasingly important that local authorities justify their different practices with evidence about how they relate to local needs.

Rationed Care: Assessing the Support Needs of Informal Carers in English Social Services Authorities

“…It is a likely prospect that social care will continue to be rationed, and available selectively according to assessed need and ability to pay (Blackman, 1998). Common sense suggests that it is in the interests of organisations to help practitioners better manage supply and demand imbalances.…”

Defining responsibility for care: approaches to the care of older people in six European countries

“…The selective and discretionary nature of social care provision is evident to different extents across all six counties. Subjective discretion should in theory be moderated in Denmark, Norway and England by the use of written assessment and eligibility criteria, which are publicly available and guide decisions on the basis of consistency and proportionality in the treatment of different cases depending on their needs (Blackman, 1998). However, even if selectivity is undertaken systematically according to objective criteria, there is still ample room for professional discretion.…”