Care in the Community

Care in the Community (also called "Community Care" or "Domiciliary Care") is a British policy of deinstitutionalisation, treating and caring for physically and mentally disabled people in their homes rather than in an institution. Institutional care was the target of widespread criticism during the 1960s and 1970s, but it was not until 1983 that the government of Margaret Thatcher adopted a new policy of care after the Audit Commission published a report called 'Making a Reality of Community Care' which outlined the advantages of domiciliary care.

Although this policy has been attributed to the Margaret Thatcher government in the 1980s, community care was not a new idea. As a policy it had been around since the early 1950s and the 1961 Water Tower speech of Enoch Powell. Its general aim was a more cost-effective way of helping people with mental health problems and physical disabilities, by removing them from impersonal, often Victorian, institutions, and caring for them in their own homes. Since the 1950s various governments had been attracted to the policy of community care. Despite support for the policy, the number of in-patients in large hospitals and residential establishments continued to increase. At the same time, public opinion was gradually turned against long-stay institutions by allegations from the media.

In the 1960s Barbara Robb put together a series of accounts in a book called Sans Everything and she used this to launch a campaign to improve or else close long stay facilities. Shortly after this, the brutality and poor care being meted out in Ely Hospital, a long stay hospital for the mentally handicapped in Cardiff, was exposed by a nurse writing to the News of the World. This exposure prompted an official enquiry. Its findings were highly critical of conditions, staff morale and management. Rather than bury this report it was in fact deliberately leaked to the papers by the then Secretary of State for Health Richard Crossman, who hoped to obtain increased resources for the health service.

Following the situation at Ely Hospital a series of scandals in mental hospitals hit the headlines. All told similar stories of abuse and inhumane treatment of patients who were out of sight and out of mind of the public, hidden away in institutions. At the same time Michael Ignatieff and Peter Townsend both published books which exposed the poor quality of care within certain institutions. The 1981 ITV documentary Silent Minority which spotlighted the conditions of mental patients at the Borocourt Hospital near Reading, Berkshire and the St Lawrence Hospital in Caterham, Surrey brought the issue into the public eye.

In the 1980s there was increasing criticism and concern about the quality of long term care for dependent people. There was also concern about the experiences of people leaving long term institutional care and being left to fend for themselves in the community. Yet the government was committed to the idea of 'care in the community'. In 1986 the Audit Commission published a report called 'Making a Reality of Community Care'. This report outlined the slow progress in resettling people from long stay hospitals. It was this report which prompted the subsequent Green and White papers on community care.

Sir Roy Griffiths had already been invited by Margaret Thatcher to produce a report on the problems of the NHS. This report was influenced by the ideology of managerialism - the idea that problems could be solved by 'management'. Griffiths firmly believed that many of the problems facing the Welfare State were caused by the lack of strong effective leadership and management. Because of his previous work, which was greatly admired by the Prime Minister, Griffiths was asked to examine the whole system of community care. In 1988 he produced a report or a Green Paper called 'Community Care: Agenda for Action', also known as The Griffiths Report.

The Griffiths Report Proposed a solution to the issue of 'no-man's land' - the grey area between health and social services which included the long term or continuing care of dependent groups such as older people, the disabled and the mentally ill. In 1988 Griffiths said that community care was everybody's distant cousin but nobody's baby - meaning that community care was not working because no one wanted to accept the responsibility for community care.^{[citation needed]}

Community Care: Agenda for Action made six key recommendations for action: