Chapter 78 Community care
For 20 years, community care has been a cornerstone in the development of health services, and many doctors who previously spent their lives in hospitals are increasingly based in community settings. Community care is a concept embraced by people of all professions and political persuasions.
At its broadest, community care involves service delivery, economic policy, political rhetoric and philosophical ideology. It can be seen as a way of delivering services, of enhancing quality of life or of reducing spending by an out-of-control welfare state. It has come from the New Right in both the UK and the USA, and from a Marxist background in Italy. The development of community care throughout developed countries has come about through a variety of clinical, social and political influences (Fig. 1).
The most numerous group within community care is the elderly, but it also covers people with mental health problems, and people with learning, physical or sensory disabilities. Some of the problems in discussing community care come from translating what is a generic policy to services appropriate for different patient and client groups. Guiding users through a variety of different agencies and organizations, all of which should cooperate and interrelate (Fig. 2), adds to the problem.
