CARE Act

Abstract: AIMS AND METHOD The Community Care Act came into effect in April 1993. In order to see what impact this would have on the discharge profile of dementia in-patients, prospective studies of in-patient discharges from a dementia assessment ward before the Act, and five and 41 months after the Act were conducted. RESULTS The proportion of patients discharged to their own homes and to residential/nursing home care remained unaffected by the Act. Duration of hospital stay increased after the Act in 1993 and 1996 ( P =0.02) largely due to delays in placement into care homes. Placement delay was increased both in 1993 and 1996, but by 1996 the difference was no longer statistically significant. Duration of hospital stay was unaffected by the Act for those patients discharged to their own homes. CLINICAL IMPLICATIONS The new care management process by social services was found to be associated with delayed discharges for people with dementia requiring residential/nursing home placements, thus causing pressures on beds and higher in-patient costs.

Abstract: Part 1 The service context: classification of people with learning disabilities causes of learning disabilities epidemiology of learning disabilities historical development of service provision residential and day services services to families education and assessment services leisure and recreation services empowerment and advocacy financial services. Part 2 Implementing the Community Care Act: professional and planning issues in assessment assessment methods and professional directions community care plans care management quality assurance and inspection the survival of collaboration and co-operation is a co-ordinated service attainable?

Abstract: The principle of user involvement in mental health services is now advocated by central government, encouraged by service commissioners and accepted as a feature of service development by provider managers. In the wake of the 1990 NHS and Community Care Act, most localities have witnessed one or more consultation exercises which have informed mental health strategy documents produced by NHS and social service commissioners. This paper reports a piece of action research about user involvement in one locality, which attempted to take users beyond the role of passive suppliers of opinion and encouraged their role as active negotiators of change. achievements and limits of success of this exercise, the socio-political context of user involvement in British mental health service development is considered. In order to understand both the