Implementation of community care policy in the United Kingdom: will it be achieved?

In the United Kingdom, the provision of health and social care within the community is the subject of major reform. This reform is aimed at reducing the dominance of the state as provider of welfare services whilst encouraging the independent sector to provide the bulk of services through competition and market forces. The purpose of this paper is to discuss the implementation of government policy with respect to health and social care in the community. The policy recommended in the 1989 White Paper Caring for People, which is sanctioned in the National Health Service (NHS) and Community Care Act (1990), is the focus for discussion. Implementation theory is used as a framework to explore the modification and reshaping which inevitably accompanies the translation of government policy into reality. The nature of any actual or potential deficit between stated policy and community care reform in practice is examined against this theoretical background. An historical stance is taken in order to place current policy into the wider context and consider what determinants may have led to the radical proposals for community care, and indeed other sectors of public service. A consideration of predominating philosophies is prudent to an analysis of government policy-making and therefore the values and beliefs of 'new public management' are employed as a conceptual framework underpinning current reform. The feasibility of a quasi-market in the delivery of health and social care is considered and some of the main issues which may result in implementation deficit with respect to the implementation of Caring for People are examined.