Audit Commission report: 'Making a reality of community care'

The Audit Commission published Making a reality of community care in 1986. The report highlighted a number of problems associated with moving care for disabled and older people into the community.

The commission found that the shift of responsibility for care services from health to local government had taken place without a corresponding financial shift. It also identified a fragmentation of responsibilities for implementing policies and suggested that organisations had been slow to shift resources and people between services.

The commission felt that joint planning and community care policies were in 'some disarray', which had caused inefficiencies and poor value for money.

The commission further pointed out that the failure of policy contributed to the failure of the development of community care, noting:

• the lack of incentives for local authorities to develop community care services
• the absence of a comprehensive framework for providers and organisations to frame collaborative planning and delivery
• the lack of a comprehensive system of financial and procedural planning to aid those leaving long-term care
• the absence of a logical or efficient approach to assessing different models of community care.

The report also highlighted that, during the late 1970s, a loophole in benefit payments for board and lodging meant it had become cheaper to place a person in residential care rather than provide home care help. 

The income support system allowed people to claim for board and lodging, provided that they met the supplementary benefit rules. This meant that eligible people choosing to live in a residential setting (regardless of whether their needs warranted it) could claim allowances to meet their fees (up to a threshold).

Anecdotally, some local authorities encouraged individuals to move into residential care and claim the allowance as a means of shifting costs to the centre. As a result, social security spend on residential care grew dramatically from £10m in 1974 to £1bn in 1989, and private sector provision of residential care expanded.