National Health Service and Community Care

The National Health Service and Community Care Act 1990 made a number of changes in the way people were cared for resulting in a move away from institutional statutory care to care in the community.

The Act was in force throughout the UK until power was devolved to Scotland, since when the way care is delivered and inspected has been superseded by more recent legislation in Scotland.

Care management
The Act emphasises a care management approach which is underpinned by the assessment of individual need and the designing of individual packages of care. The impact of the NHS and Community Care Act 1990 has been the promotion of a mixed economy of care. A wide range of voluntary services along with a vastly expanded private sector now provide care services together with the public sector provision.

The main effects of the act

The key effect of the NHS & Community Care Act was to change the way services were planned and delivered to individuals who are in need of care. Local authorities, instead of just being responsible for statutory care services, are now required to purchase other services from voluntary and independent providers. Local authorities must consult the local health board, housing departments, voluntary organisations, housing agencies, carers groups and other relevant groups in relation to planning care and services to meet individual needs.

Care provision must be inspected to ensure the quality of care meets required standards. Local authorities are also now responsible for monitoring contracts for care from all providers, both statutory and independent.

Social Services Departments will be expected to set out the needs of the population they serve (National Health Service and Community Care Act 1990).


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Key points

The main features of the National Health Service and Community Care Act 1990

The main features are:


The NHS and Community Care Act 1990 has changed the way care is provided so as to ensure that the service user is at the centre of the process. Needs led assessment is followed by the identification of a range of providers to meet those needs. However, community care is not a ‘cheap’ option and there still remain many challenges about how care is funded.



Prior to the NHS & Community Care Act 1990, most care provided was statutory, either by the Local Authority or Health board. Older people, for example, expected to be cared for in the local authority care home when they could no longer manage independently and the NHS was expected to provide care ‘from the cradle to the grave’.

The Conservative government, in order to rationalise government spending, moved away from statutory care to community care. This was a recommendation from the Griffiths report (1987) and also resulted in the ‘Internal Market System’ where statutory bodies were required to work with the private and voluntary section to provide of health and social care.




Further information

Under the NHS & Community Care Act 1990, care became needs led rather than service led, where the needs of the individual were seen as more important than the service. Care in the Community grew and a range of services were made available to meet the individual’s assessed needs.

Initially, many problems arose as a result of the emptying of large institutions with insufficient community services in place. People with mental health problems were particularly vulnerable.

The role of a care manager, especially in social services, was instigated with responsibility for designing the care plan and coordinating the package of care to be delivered.



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