E-Book, Englisch, 342 Seiten
E-Book, Englisch, 342 Seiten
ISBN: 978-1-4831-4128-2
Verlag: Elsevier Science & Techn.
Format: EPUB
Kopierschutz: Adobe DRM (»Systemvoraussetzungen)
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Chapter 1 An introduction to community care
Mary Ashwin and Ann Compton Publisher Summary
This chapter focuses on the concept of community care. The two main groups of professionals involved in providing community care are health workers and social service workers. There is a difference between care “in” the community and care “by” the community. Care “in” the community includes care in locally based institutions and domiciliary care provided by a range of paid staff. Care “by” the community refers to the care provided by family, friends, and local voluntary bodies. The target of community care has changed over time. The Seebohm Report, 1968, saw community care as a re-integrative process for those who had become isolated or disaffected. It now tends to be defined as a policy that seeks to provide supportive services from a range of sources to provide the user with a situation as close to normal everyday life as possible. The care provided to achieve this goal consists of a mix of physical caring, and psychological and environmental support. 1 The origin
The concept of community care is as vague as its current usage. As early as 1961 Professor Richard Titmus was mystified as to its origin. Its first appearance in official documents was in the report of the Royal Commission on Mental Illness and Mental Deficiency 1957. It was used from then on increasingly, not always to describe the same thing, but usually directed towards the care of certain groups. The main recipients of this care were people suffering from mental illness, those experiencing learning difficulties or the frail elderly population. The two main groups of professionals involved in providing this care were Health and Social Service workers. 2 Definitions
Community care has been variously defined. In the earlier reports it was used to identify any care given outside large institutions, including that within smaller locally based residential establishments, such as Cheshire Homes and 46 bedded homes for the elderly. Gradually this has now changed so that it now • excludes most residential establishments of any size used on a permanent basis; • includes both statutory and voluntary services as well as personal social networks with special emphasis on family care. 3 Distinctions
Two useful distinctions were highlighted by Martin Bulmer (1987). He draws attention to the difference between care ‘IN’ the community and care ‘BY’ the community. • Care ‘IN’ the community includes care in locally based institutions and domiciliary care provided by a range of paid staff. • Care ‘BY’ the community is seen as referring to care by family, friends and local voluntary bodies. He sees the trend in official policy increasingly towards this form of care. The second distinction between FORMAL and INFORMAL carers is harder to define. It covers the whole range of services from formal statutory care through commercially provided care and voluntary care to informal care (Chapter 2). All these types of care are seen as interdependent though the precise nature of their enmeshing is complex. 4 Targeting
The target of community care has also changed over time. The Seebohm Report (1968) saw community care as a re-integrative process for those who had become isolated or disaffected. It now tends to be defined as a policy which seeks to provide supportive services from a range of sources in order to provide the user with a situation as close to ‘normal’ everyday life as possible. Clearly words such as ‘normal’ are open to a multitude of interpretations but in the 1989 White Paper it was linked to ‘care packages for individuals’, thus somewhat faintly echoing the Griffiths concern for ‘client choice’. The sort of care provided to achieve this current goal will consist of a mixture of physical caring and psychological and environmental support. The distribution of these tasks between the informal and formal carers is seen as negotiable. 5 Service delivery
The community practitioner faces a formidable challenge; she or he is required to undertake a task with an infinitely variable range of collaborations. The only common clear objective is the rather negative one of avoiding institutionalisation. Exercise Write a description of community care as it might appear to a: (a) civil servant; (b) colleague; (c) service user; (d) family carer. What are the main conflicts highlighted in the different descriptions? The development of community based practice – a case example
With the inception of the National Health Service (NHS) in 1948, health care was divided into three service areas: hospital, family practitioner and community. Community health services were mainly the province of the Health Department of a County, Borough or City Council. These included all environmental health services, maternal and child welfare, health visiting, home nursing services, vaccination and immunisation, and the care and after-care of mentally ill and mentally handicapped people. Some of these services had been provided by voluntary agencies, and these were either absorbed into the NHS or provided with financial help. School medical services were run in conjunction with the Council’s Education Department. Industrial health services were organised by the Ministry of Labour via the Factory Inspectorate, whilst the Armed services retained their own health services separate from the NHS. Physiotherapy was seen as a scarce resource. Its main provision under the NHS was restricted to hospitals, except in Scotland where the nature of the scattered population made it desirable to maintain orthopaedic aftercare. Variations in the rest of the UK included: • Some areas had charitably funded mobile physiotherapy services which did not attract NHS funding. Some were closed but others were maintained by voluntary contributions and fundraising. • Some physiotherapists with their own practices chose to become private practitioners rather than be absorbed into the NHS. • A few industries employed physiotherapists. • A relatively small number of physiotherapists were employed by education authorities, usually for ‘delicate’ children. At that time physiotherapy could only be prescribed by a medical practitioner. Within the NHS most general practitioners only had access to the hospital-based treatments through referral to a hospital-based practitioner. This meant that the majority of patients had to see a hospital consultant before they were able to receive physiotherapy. This often involved a long delay between problem identification and treatment. This situation remained virtually unchanged despite medical and professional developments until 1971 when professional concerns and Government events coincided. A number of practice issues emerged: • Physiotherapists were realising the value of pre-discharge home visits for patients with major disabilities. Rehabilitation programmes could then be tailored more realistically to lifestyle. • When carers were invited to attend departments they were taught essential techniques for caring safely, but because there were major discrepancies between the home and institutional environment only some of the problems were ameliorated. • Physiotherapists were also concerned that there was no provision for those patients who needed or were prescribed therapy but were too debilitated, or exhausted by travel, to attend outpatient appointments. • Other patients regularly returned for courses of treatment, stating they could not manage at home without some support. Often there was little that the therapist could offer clinically. • Frequently patients with acute conditions were having to wait, often several months, to be seen by consultants. These acute conditions could have been relieved instead of developing into chronic problems with subsequent damaging effects upon the patients’ social, economic and psychological welfare. In 1970 two Acts of Parliament came into effect: the Education (Handicapped Children) Act. the Chronically Sick and Disabled Persons’ Act. Both had clauses within them that enabled local authorities to make provisions for needs they identified. This created an opportunity for the appointment of physiotherapists by Education, Health or Social Services...
