The impact of the Community Care Act: views from the independent sector

The 1990 NHS and Community Care Act introduced changes that had significant implications for independent service providers. The legislation was intended to decrease unnecessary institutionalization, increase the demand for non-statutory community care services, and improve collaboration between the private and public service sectors. Preliminary evidence on the impact of the Act suggests that the principal changes related to private service provision have not been translated into practice, but the data are confined to studies from the local authorities' perspective or that of carers. In this paper, the views of independent service providers in an urban area of Scotland were examined through interviews with 24 administrators of nursing homes or residential care facilities. The study investigated their perceptions of the impact of the law on institutionalization, diversification into community care, and partnerships between the public and private spheres. The findings show that facilities have experienced a range of problems since the law came into effect, including higher vacancy rates, more disabled residents, delays in admissions, cash Bow problems and reductions in private pay patients. Those owned by public limited companies were more able to buffer themselves from the adverse effects. A large proportion of the facilities had diversified into community based long-term care, but these were perceived as a minor sideline. Finally, the legislation did not result in links forged between independent service providers and the social service departments of local authorities who are charged with. assessing, coordinating and purchasing long-term care.